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ABSTRACT: Cognitive impairment may be part of the endophenotype of bipolar disorder (BP), but little is known about patterns and severity of impairment in BP subgroups and their relation to depression. The same applies to deficits in emotion processing known to be present in BP.
To explore the relationship between depression and impairment in cognition and emotion processing and the differences between BP subgroups, we assessed 36 (25 BP I and 11 BP II) patients using a cognitive battery and a facial emotion recognition task.
BP patients were impaired compared to published norms on memory, naming and executive measures (Binomial Single Proportion tests, p<0.05). Cognitive performance was largely unrelated to depression ratings. Surprise recognition was the only emotion processing impairment in BP patients compared to controls (patients' recognition score 75% v. controls' 89%, p=0.024). Patients with higher depression ratings were more impaired in recognizing expressions of anger (t23=2.21, p=0.037). BP II patients were more impaired than BP I patients in IQ, memory and executive measures (Mann-Whitney tests, p<0.05). Depression severity or exposure to medication or electroconvulsive therapy (ECT) did not explain these differences.
We confirm cognitive impairment and an isolated facial emotion processing deficit in BP patients and suggest that these deficits are largely unrelated to depressive symptoms. Our study also provides evidence that cognitive deficits are more severe and pervasive in BP II patients, suggesting that recurrent depressive episodes, rather than mania, may have a more detrimental and lasting effect on cognition.
Psychological Medicine 01/2007; 36(12):1799-809. · 6.16 Impact Factor
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ABSTRACT: Background. Cognitive impairment may be part of the endophenotype of bipolar disorder (BP), but little is known about patterns and severity of impairment in BP subgroups and their relation to depression. The same applies to deficits in emotion processing known to be present in BP.
Psychological Medicine 11/2006; 36(12):1799 - 1809. · 6.16 Impact Factor
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ABSTRACT: Repeated neuropsychological assessments are often used to monitor change in cognitive functioning over time. Thus, knowledge about the reliability and stability of neuropsychological tests and the effects of age and IQ is of paramount importance. In this study we document, for six cognitive tests: test-retest reliabilities, practice effects, reliable change (RC) indices corrected for practice, and the impact of premorbid IQ and age.
A sample of 188 normal adults (aged 40-70 years) were administered, on two occasions, one or more of the following tests: the Graded Naming Test (GNT), the Silhouettes Test, two tests of verbal fluency, the Modified Wisconsin Card Sorting Test, and a new test of speed and attention (the Symbol Digit Test). There was a 1-month interval between assessments. At first assessment, all participants were administered the revised National Adult Reading Test (NART).
The test-retest reliability of the tests ranged from very good (the GNT and Silhouettes Test) to moderate (verbal fluency tests and Symbol Digit Test) and to poor (Modified Card Sorting Test). Significant, although modest, practice effects were found on all tests. RC indices were generally large except for the Graded Naming Test and the Silhouettes Test. Premorbid IQ scores significantly correlated with performance on all the tests, the exception being semantic fluency. Age only correlated with the Silhouettes Test and the new Symbol Digit Test. Neither NART IQ nor age correlated with practice effects.
The psychometric properties of the GNT and Silhouettes Test indicated that they are useful tools for monitoring even small cognitive changes. In contrast, the verbal fluency tests and the new Symbol Digit Test are only suitable for monitoring large changes in performance. The Modified Card Sorting Test is an unreliable tool for monitoring 'executive' functions.
British Journal of Clinical Psychology 07/2004; 43(Pt 2):197-210. · 1.90 Impact Factor
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ABSTRACT: The Recognition Memory Test (RMT) is widely used; however, important characteristics such as reliability and stability over time were largely unknown. In this study, we document for the first time test-retest reliabilities, practice effects, and Reliable Change (RC) indices for this test.
A sample of 206 normal adults (aged 40-70) were administered twice either the same version or two different versions of the RMT, with a 1-month interval between assessments. The normal sample was split into two groups; a young (aged 40-54) and an old (55-70) group.
Test-retest reliabilities were modest when using either the same versions or different versions. Practice effects were abolished when different versions of the RMT were used. In contrast, practice effects were clearly present on the same version of the non-verbal subtest for both control groups. However, practice effects were present on the same versions of the verbal subtest only in the old group. RC indices were rather large when using the same or different versions.
Although modest, the test-retest reliability of the RMT is no worse than those reliabilities reported for other commonly used recall memory tests. Thus, the inherent clinical advantages of using a recognition paradigm make its use desirable. Usage of different versions of the RMT enables us to avoid practice effects. However, the RC indices indicate that large changes in scores are needed to detect a significant improvement or decline in an individual's performance.
British Journal of Clinical Psychology 12/2003; 42(Pt 4):407-25. · 1.90 Impact Factor
