Assessing cognitive deficits in bipolar disorder: are self reports valid? Psychiatry Res 136: 43- 50

Department of Psychiatry Research, Zucker Hillside Hospital, North Shore Long Island Jewish Health System, 75-59 263rd Street, Glen Oaks, NY 11004, USA.
Psychiatry Research (Impact Factor: 2.47). 08/2005; 136(1):43-50. DOI: 10.1016/j.psychres.2004.12.009
Source: PubMed


Patients with affective disorders frequently report problems with attention, concentration and memory, although little research has investigated subjective cognitive complaints relative to objective neuropsychological deficits. We compared subjective (self-rated) cognition and objective (clinician-rated) neuropsychological functioning in 37 DSM-IV bipolar outpatients. Subjects completed three standardized self-report inventories: the Cognitive Difficulties Scale (CDS), Cognitive Failures Questionnaire (CFQ), and Patient's Assessment of Own Functioning (PAOF). These were followed by a systematic neuropsychological test battery. More than 75% of our sample of bipolar patients displayed some cognitive deficits, most notably in the domains of verbal learning and memory. In general, patients' self-reports of impairment failed to reliably predict objective neuropsychological deficits. Mood ratings for mania and depression were not significantly correlated with any of the self-report inventories or the objective neuropsychological variables. The findings suggest that most bipolar patients demonstrate objective signs of cognitive impairment, but they are unable to report them accurately, at least using available self-report inventories. Such discrepancies could relate to impaired insight, efforts to conceal deficits, or to subthreshold affective symptoms.

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    • "ion of objective cognitive deficits in bipolar patients with cognitive complaints . Our demonstration of a poor correlation between measures of global objective cognitive function and subjective measures of cognition is consistent with other studies by our group ( Demant et al . , 2015 ; Svendsen et al . , 2012 ) and others ( Arts et al . , 2011 ; Burdick et al . , 2005 ) . However , we found significant weak to moderate correlation between objectively measured working memory and executive skills and cognitive complaints , similar to findings of Rosa et al . ( 2013 ) . However , in contrast with Rosa et al . ( 2013 ) , we found no correlation between measures of verbal learning and memory and cognitive"
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    ABSTRACT: Cognitive impairment is common in bipolar disorder and contributes to socio-occupational difficulties. The objective was to validate and evaluate instruments to screen for and monitor cognitive impairments, and improve the understanding of the association between cognitive measures and socio-occupational capacity. Patients with bipolar disorder in partial or full remission (n=84) and healthy controls (n=68) were assessed with the Screen for Cognitive Impairment in Psychiatry (SCIP), Cognitive Complaints in Bipolar Disorder Rating Scale (COBRA), and established neuropsychological tests and subjective rating scales. Socio-occupational function and affective symptoms were evaluated with the Functional Assessment Short Test, and the Hamilton Depression Rating Scale 17-items and Young Mania Rating Scale, respectively. Concurrent validity of the SCIP and COBRA were assessed by correlation with established objective and subjective cognitive measures, and decision validity was determined with Receiver-Operating-Characteristic analyses. Correlations and linear regression analyses were conducted to determine the associations between objective and subjective cognitive impairment, and socio-occupational difficulties. The SCIP and COBRA correlated strongly with established objective and subjective cognitive measures, respectively. The SCIP yielded higher sensitivity and specificity for detection of cognitive dysfunction than the COBRA or a combined SCIP-COBRA measure. Correlations between objective and subjective cognitive impairment were weak but both were associated with socio-occupational difficulties. Influence of ageing was not investigated. The SCIP and COBRA are valid for detection of objective and subjective cognitive impairment in bipolar disorder. Screening for cognitive dysfunction should be conducted with an objective measure like the SCIP. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 08/2015; 187:10-19. DOI:10.1016/j.jad.2015.07.039 · 3.38 Impact Factor
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    • "Indeed, it is unlikely that our finding of poor or no correlations between subjective and objective measures represents a type II error since our sample size was relatively large (n¼77) in comparison with other studies in the field in which sample sizes of bipolar patients ranged from n¼15–60 (Burdick et al., 2005; Martinez-Aran et al., 2005; Svendsen et al., 2012). In keeping with our findings, several other studies using self-assessment tools also found no significant correlation with objective cognitive measures (Burdick et al., 2005; van der Werf-Eldering et al., 2011; Svendsen et al., 2012), suggesting that patients may be unable to correctly evaluate their own cognitive function. On the other hand, the highly structured nature and limited naturalistic validity of objective cognitive tests may also limit the ability of these tests to capture patients' cognitive difficulties in reallife scenarios. "
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    ABSTRACT: Cognitive dysfunction is prevalent in bipolar disorder (BD). However, the evidence regarding the association between subjective cognitive complaints, objective cognitive performance and psychosocial function is sparse and inconsistent. Seventy seven patients with bipolar disorder who presented cognitive complaints underwent assessment of objective and subjective cognitive function and psychosocial functioning as part of their participation in two clinical trials. We investigated the association between global and domain-specific objective and subjective cognitive function and between global cognitive function and psychosocial function. We also identified clinical variables that predicted objective and subjective cognitive function and psychosocial functioning. There was a significant, however weak, correlation between objective and subjective measures of global cognitive function but not within the individual cognitive domains, and a moderate correlation between subjective cognitive function and psychosocial function. Increased depression severity predicted greater subjective cognitive dysfunction globally (memory, attention and executive function) and in attention as well as lower psychosocial functioning. In conclusion, subjective cognitive difficulties seem to reflect general objective deficits in bipolar disorder but not individual cognitive domains. Cognitive complaints are associated with impaired psychosocial function and both are predicted by greater depression severity. Subjective cognitive complaints seem clinically useful as a threshold marker aiming for further objective cognitive assessment. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    06/2015; 229(1-2). DOI:10.1016/j.psychres.2015.05.022
    • "Although intercorrelations of cognition and functional capacity with symptom severity are modest, performance on NP and FC indices and symptom severity (particularly depressive symptoms) independently predict real-world disability measured through informant reports and milestone functional achievements (residential independence and educational/academic achievement; Bowie et al., 2008, 2010; Mausbach et al., 2010). Moreover, selfreports of cognitive ability or disability in schizophrenia (Bowie et al., 2007; McKibbin et al., 2004; Sabbag et al., 2011, 2012), bipolar disorder (Burdick et al., 2005), Multiple Sclerosis (Carone et al., 2005), and Traumatic Brain Injury (TBI; Spikman and van der Naalt, 2010) converge poorly with objective performance. However, the studies that have examined self-reported mood symptoms found that these reports correlated with informant reports of impaired everyday functioning. "
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    ABSTRACT: Individuals with posttraumatic stress disorder (PTSD) experience cognitive impairments and disability in everyday activities. In other neuropsychiatric disorders, impairments in cognition and functional capacity (i.e., the ability to perform everyday tasks) are associated with impairments in real-world functioning, independent of symptom severity. To date, no studies of functional capacity have been conducted in PTSD. Seventy-three women with moderate to severe PTSD underwent assessment with measures of cognition (MATRICS Consensus Cognitive Battery: MCCB), functional capacity (UCSD Performance-Based Skills Assessment-Brief: UPSA-B), PTSD (Clinician-Administered PTSD Scale and PTSD Symptom Scale–Self-report (PSS-SR)), and depression (Montgomery Asberg Depression Rating Scale). Patients also reported their subjective level of disability (Sheehan Disability Scale). Over-reporting of symptom severity was assessed using six validity items embedded within the PSS-SR. Results indicated that on average PTSD patients manifested mild impairments on the functional capacity measure, performing about 1/3 standard deviation below healthy norms, and similar performance on the MCCB. Both clinician-rated and self-rated PTSD symptom severity correlated with self-reported disability but not with functional capacity. Self-reported disability did not correlate with functional capacity or cognition. Greater self-reported disability, depression, and PTSD symptoms all correlated with higher scores on the PSS-SR validity scale. The divergence between objective and subjective measures of disability suggests that individuals’ distress, as indexed by symptom validity measures, may be impacting self-reports of disability. Future studies of disability should incorporate objective measures in order to obtain a broad perspective on functioning.
    Journal of Psychiatric Research 10/2014; 57(1). DOI:10.1016/j.jpsychires.2014.06.002 · 3.96 Impact Factor
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