A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. J Affect Disord 93(1-3):105-115

School of Neurology, Neurobiology and Psychiatry (Psychiatry), University of Newcastle upon Tyne, Leazes Wing, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
Journal of Affective Disorders (Impact Factor: 3.38). 07/2006; 93(1-3):105-15. DOI: 10.1016/j.jad.2006.02.016
Source: PubMed


A number of studies have reported evidence of cognitive deficits in euthymic bipolar patients. Qualitative reviews of the literature have indicated impairments in executive functions and declarative memory are most consistently reported. However, not all primary studies conducted to date have had sufficient power to detect statistically significant differences and there have been few attempts to quantify the magnitude of impairments. This review aims to combine data from available studies to identify the profile of neuropsychological deficits in euthymic bipolar patients and quantify their magnitude.
Systematic literature review and meta-analysis.
Large effect sizes (d>or=0.8) were noted for aspects of executive function (category fluency, mental manipulation) and verbal learning. Medium effect sizes (0.5<or=d<0.8) were found for aspects of immediate and delayed verbal memory, abstraction and set-shifting, sustained attention, response inhibition, and psychomotor speed. Small effect sizes (0.2<or=d<0.5) were reported for verbal fluency by letter, immediate memory, and sustained attention.
Sufficient data were not available to investigate all domains. For example analyses did not include measures of visuospatial function.
Euthymic bipolar patients demonstrate relatively marked impairment in aspects of executive function and verbal memory. It is not yet clear whether these are two discrete areas of impairment or are related to one another. Future investigations should clarify the functional significance of deficits and indicate whether patients will benefit from ameliorative interventions.

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Available from: Peter Gallagher, May 06, 2014
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    • "rical volumes differ. fMRI studies of areas activated by the presentation of happy or sad faces differentiates bipolar from unipolar depression, with unipolar showing greater amygdala activation for sad faces and vice versa for bipolar (Maletic and Raison 2014). 6. Bipolar patients exhibit specific deficits in executive function and verbal memory (Robinson et. al 2006)."

    • "Comparatively understudied are the contributions of cognitive functioning and sleep to sustained work disability, as both are often found to be impaired despite remission of mood symptoms and may in fact be inter-related (see Boland and Alloy, 2013 for a review of the theoretical relationship between sleep and neurocognition in BD). Numerous reports point to widespread cognitive deficits in the euthymic phase of BD, including deficits in verbal memory, verbal learning, attention, and executive functioning (Robinson et al., 2006; Torres et al., 2007; Arts et al., 2008, Bora et al., 2009; Kurtz et al., 2009; Mann-Wrobel et al., 2011; Peters et al., 2014). Studies including indices of work performance in their analyses have consistently reported associations between work disability and verbal learning and memory (Dickerson et al., 2004; Martinez-Àran et al., 2004). "
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    ABSTRACT: Bipolar Disorder (BD) is associated with impairment in a number of areas including poor work functioning, often despite the remission of mood symptoms. The present study aimed to examine the role of sleep disturbance and cognitive functioning in occupational impairment in BD. Twenty-four euthymic BD participants and 24 healthy control participants completed a week of prospective assessment of sleep disruption via self-report and actigraphy, a battery of neuropsychological tests of executive functioning, working memory, and verbal learning, and assessments of work functioning. BD participants experienced significantly poorer cognitive functioning as well as greater months of unemployment and greater incidence of being fired than controls. Moderation analyses revealed that both poor sleep and cognitive functioning were associated with poor work performance in BD participants, but not control participants. Sleep and cognitive functioning may be impaired in euthymic BD and are associated with poor work functioning in this population. More research should be conducted to better understand how sleep and cognitive functioning may interact in BD.
    10/2015; DOI:10.1016/j.psychres.2015.09.051
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    • "This cognitive impairment includes decreases in short-term verbal memory, sustained attention , working memory, executive functions, and attention span (Bora et al., 2011; Dias et al., 2012); and persists beyond acute episodes, despite the long-term remission (Thompson et al., 2005). Specifically, there is evidence of the presence of cognitive dysfunction , even in asymptomatic patients, particularly in the domains of executive function and declarative memory (Arts et al., 2008; Robinson et al., 2006). Despite a growing body of research, it is still difficult to determine whether cognitive complaints reflect intrinsic aspects of the disease, lasting subclinical symptoms, comorbid conditions (e.g., ADHD, substance abuse, or cerebrovascular disease), or adverse side effects of the prescribed drug therapy (Baldessarini et al., 2008). "
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    ABSTRACT: Background: The aim of choosing a mood-stabilizing drug (lithium or anticonvulsants) or a combination of them with minimal neurocognitive effects is to stimulate the development of criteria for a therapeutic adequacy, particularly in Bipolar Disorder (BD) patients who are clinically stabilized. Method: Three groups of BD patients were established according to their treatment: i) lithium monotherapy (n = 29); ii) lithium together with one or more anticonvulsants (n = 28); and iii) one or more anticonvulsants (n = 16). A group of healthy controls served as the control (n = 25). The following tests were applied: Wechsler Adult Intelligence Scale, Trail Making Test, Wechsler Memory Scale, Rey Complex Figure Test, Stroop color-word test, Wisconsin Card Sorting Test, Tower of Hanoi, Frontal Assessment Battery, and Reading the Mind in the Eyes Test. Results. Relative to healthy controls, BD patients showed the following: i) those on lithium monotherapy, but not other BD groups, had preserved short-term auditory memory, long-term memory, and attention; ii) those who took only anticonvulsants showed worse findings in short-term visual memory, working memory, and several executive functions; and iii) all BD patients showed worse performance in processing speed, resistance to interference, and emotion recognition. Limitations: Medication alone cannot explain why all BD patients showed common cognitive deficits despite different pharmacological treatment. Conclusion: The impairment on some executive functions and emotion recognition is an inherent trait in BD patients, regardless of their pharmacological treatment. However, while memory, attention, and most of the executive functions are preserved in long-term stable BD patients, these cognitive functions are impaired in those who take anticonvulsants.
    Journal of Affective Disorders 10/2015; DOI:10.1016/j.jad.2015.10.008 · 3.38 Impact Factor
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