Neurocognitive and symptomatic predictors of functional outcome in bipolar disorders: A prospective 1 year follow-up study

Bipolor Disorder Program, Neurosciences Institute, Favaloro Foundation, Buenos Aires, Argentina.
Journal of Affective Disorders (Impact Factor: 3.38). 12/2008; 116(1-2):37-42. DOI: 10.1016/j.jad.2008.10.023
Source: PubMed


The aim of this study was to estimate the predictive value of cognitive impairments and time spent ill in long-term functional outcome of patients with bipolar disorder (BD).
Thirty five patients with euthymic BD completed a neurocognitive battery to assess verbal memory, attention, and executive functions at study entry. The course of illness was documented prospectively for a period longer than 12 months using a modified life charting technique based on the NIMH life-charting method. Psychosocial functioning was assessed with the General Assessment of Functioning (GAF) and the Functioning Assessment Short Test (FAST) at the end of follow-up period when patients were euthymic.
Impairments in verbal memory and in attention, as well as subsyndromal depressive symptomatology were independent predictors of GAF score at the end of the study explaining 43% of variance. Similarly, impairments in attention and executive functioning were independent predictors of FAST score explaining 28% of variance.
We did not control factors that could affect functional outcome such as psychosocial interventions, familiar support and housing and financial resources.
Both cognitive impairments and time spent with subsyndromal depressive symptomatology may be illness features associated with poorer long-term functional outcome. Developing strategies to treat these illness features might contribute to enhance long-term functional outcome among patients with BD.

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    • "Regarding the present results, it is worth mentioning that the changes in delayed free recall were not correlated with changes in functional outcome. This was an unexpected result, since it has been consistently found that verbal memory impairment is related to worse functional outcome (Martínez-Arán et al. 2007; Martino et al. 2009; Bonnin et al. 2010). Even though these are preliminary results, we have different hypotheses that may explain this lack of relationship between the two variables: first, it might be attributed to the loss of statistical power due to small sample size in the functional remediation group. "
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    ABSTRACT: Background: Functional remediation is a novel intervention with demonstrated efficacy at improving functional outcome in euthymic bipolar patients. However, in a previous trial no significant changes in neurocognitive measures were detected. The objective of the present analysis was to test the efficacy of this therapy in the enhancement of neuropsychological functions in a subgroup of neurocognitively impaired bipolar patients. Method: A total of 188 out of 239 DSM-IV euthymic bipolar patients performing below two standard deviations from the mean of normative data in any neurocognitive test were included in this subanalysis. Repeated-measures analyses of variance were conducted to assess the impact of the treatment arms [functional remediation, psychoeducation, or treatment as usual (TAU)] on participants' neurocognitive and functional outcomes in the subgroup of neurocognitively impaired patients. Results: Patients receiving functional remediation (n = 56) showed an improvement on delayed free recall when compared with the TAU (n = 63) and psychoeducation (n = 69) groups as shown by the group × time interaction at 6-month follow-up [F 2,158 = 3.37, degrees of freedom (df) = 2, p = 0.037]. However, Tukey post-hoc analyses revealed that functional remediation was only superior when compared with TAU (p = 0.04), but not with psychoeducation (p = 0.10). Finally, the patients in the functional remediation group also benefited from the treatment in terms of functional outcome (F 2,158 = 4.26, df = 2, p = 0.016). Conclusions: Functional remediation is effective at improving verbal memory and psychosocial functioning in a sample of neurocognitively impaired bipolar patients at 6-month follow-up. Neurocognitive enhancement may be one of the active ingredients of this novel intervention, and, specifically, verbal memory appears to be the most sensitive function that improves with functional remediation.
    Psychological Medicine 09/2015; DOI:10.1017/S0033291715001713 · 5.94 Impact Factor
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    • "Depressive symptoms even at the subsyndromal level have been found to produce cognitive effects, predominantly on verbal memory (Bonnín et al., 2012; Torrent et al., 2012). Poor cognition, particularly verbal memory deficits, has been linked to poor psychosocial functioning in many studies (Bonnín et al., 2010; Martino et al., 2009). There is a complex interaction among neurocognition, psychosocial outcome and residual depressive symptoms. "
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    ABSTRACT: Cognitive impairments and subsyndromal depressive symptoms are present during euthymic periods of bipolar disorder (BD). Most studies have determined that cognitive impairments and residual depressive symptoms have major impacts on psychosocial functioning. The aim of the present study was to identify the major factor responsible for low psychosocial functioning in a subgroup of patients with BD despite clinical recovery. Sixty patients with bipolar I disorder and 41 healthy subjects were enrolled in this study. Cognitive performance, neurological soft signs (NSSs), psychosocial functioning, residual mood symptoms and illness characteristics were assessed. Using the median value of the Functioning Assessment Short Test (FAST) as the cut-off point, the patients were divided into two groups, high- (n=29) or low-functioning (n=31), and they were compared based on total NSS, residual depressive symptoms, cognitive performance and clinical variables. Performances on the verbal memory tests and social functioning were significantly worse in the euthymic patients with BD. Increased rates of NSS were identified in the patients compared with the normal controls. The low-functioning patients performed significantly worse on verbal memory, and their NSS and residual depressive symptoms were significantly higher compared to high-functioning patients. In the regression analysis, subsyndromal depressive symptoms and verbal learning measures were identified as the best predictors of psychosocial functioning. The patients were artificially separated into two groups based on a FAST score cut-off. In this study, residual depressive symptoms and verbal memory impairments were the most prominent factors associated with the level of functioning. Copyright © 2014 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 12/2014; 174C:336-341. DOI:10.1016/j.jad.2014.12.026 · 3.38 Impact Factor
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    • "Cognitive deficits in BD could be extended to different subtypes of the disease (Martino et al., 2011a; Bora et al., 2011) and beyond traditional neurocognitive domains (Martino et al., 2011b; Samamé et al. 2012). Likewise, the association between cognitive deficits and functional outcome reached by the patients with BD has been consistently reported both in cross-sectional (Zubieta et al., 2001; Dickerson et al., 2004; Martinez-Arán et al., 2004) and longitudinal (Jaeger et al., 2007; Tabarés-Seisdedos et al., 2008; Martino et al., 2009) studies. Therefore, in few years, cognitive impairments changed from being an ignored issue to have an essential role in the pathophysiology and clinical conceptualization of BD. "
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    ABSTRACT: Background: Cross-sectional and meta-analytic studies showed that patients with bipolar disorder (BD) had neurocognitive impairments even during periods of euthymia. The aim of this study was to estimate the prevalence of BD patients with and without clinically significant cognitive impairments, as well as to analyze clinical and functional variables in these subgroups. Methods: Hundred patients with BD and 40 healthy controls were assessed with an extensive neurocognitive assessment. Soft (some cognitive domain with a performance below 1.5 SD of the mean) and hard (at least two domains with values below 2 SD of the mean) criteria were utilized to define clinically significant cognitive impairments. Results: Using both soft and hard criteria, the prevalence of clinically significant cognitive impairments was higher in people with BD than in healthy controls. 70% of patients only showed failures of small effect (d=0.21-0.35) in 2 measures of executive functions. Moreover, 30% of patients were indistinguishable from healthy subjects in terms of both neurocognitive and psychosocial functioning. On the contrary, 30% of the sample showed more severe cognitive deficits than those usually reported in literature and had the worst psychosocial functioning. Conclusions: The fact that cognitive impairments are very heterogeneous among euthymic patients with BD could contribute to understanding differences in functional outcome. Theoretical and practical implications of these findings are discussed.
    Journal of Affective Disorders 06/2014; 167C:118-124. DOI:10.1016/j.jad.2014.05.059 · 3.38 Impact Factor
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