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Relationship between neurocognitive functioning and episode recurrences in bipolar disorder
Diego J Martino1, Sergio A Strejilevich, Eliana Marengo
1Bipolar Disorders Program, Neuroscience Institute, Favaloro University, Congreso 2477, Buenos Aires, Argentina. diejmartino@gmail.com
Journal of Affective Disorders
|December 13, 2012
Summary
Cognitive impairment in bipolar disorder (BD) patients significantly increases the risk of illness recurrence. This suggests cognitive deficits may precede or cause a poorer clinical course, rather than result from it.
Area of Science:
- Neuroscience
- Psychiatry
- Cognitive Psychology
Background:
- The link between cognitive impairment and the clinical progression of bipolar disorder (BD) remains unclear.
- Existing research has not definitively established whether cognitive decline is a cause or consequence of recurrent episodes in BD.
Purpose of the Study:
- To investigate the relationship between clinically significant cognitive impairment and the time to recurrence in patients with bipolar disorder.
- To compare the clinical course, specifically episode recurrence, between euthymic BD patients with and without cognitive deficits.
Main Methods:
- Seventy euthymic bipolar disorder patients were assessed for baseline neurocognitive performance.
- Participants were categorized into two groups: those with (n=49) and without (n=21) clinically significant cognitive impairment.
- Prospective follow-up using a modified life chart method was conducted over a mean of 16.3 months.
Main Results:
- Patients with cognitive impairment faced a significantly higher risk of any recurrence (HR: 3.13), hypo/manic episodes (HR: 2.42), and depressive episodes (HR: 3.84).
- These findings remained statistically significant after adjusting for confounding factors like prior episode count, time since last episode, BD subtype, antipsychotic use, and subclinical symptoms.
Conclusions:
- Cognitive impairment is associated with an increased risk of recurrence in bipolar disorder patients.
- The study suggests that cognitive impairment may be a causal factor in the poorer clinical course of BD, rather than a result of illness progression.
- A distinct subgroup of BD patients with cognitive impairment and a progressive illness trajectory may explain the observed associations.
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