Cognitive reserve and functional outcome in euthymic Bipolar I Disorder

Functional impairment often persists in bipolar disorder despite symptomatic remission. Cognitive reserve (CR) has been proposed as a protective factor that may influence recovery. This cross-sectional study examined the association between CR and functional outcome among euthymic individuals with Bipolar I Disorder (BD-I). Eighty-four outpatients with DSM-5 BD-I attending a tertiary-care teaching hospital in Puducherry, India, were assessed using the Lifetime of Experiences Questionnaire (LEQ) and the Functioning Assessment Short Test (FAST). Higher CR was significantly associated with better psychosocial functioning (rho = -0.27, p = 0.011), and the association remained modestly significant after controlling for age, education, duration of illness, and age at onset (partial rho = -0.26, p = 0.022). Women and participants from middle socioeconomic groups demonstrated higher CR scores. Although CR showed a significant association with functional outcome in multivariable analysis, the modest explanatory power of the model suggests that functional outcome is influenced by multiple factors. These findings support a potential role for cognitive reserve in functional outcome among individuals with bipolar disorder.