Neuropsychological performance in depressed and euthymic bipolar patients.
Bipolar Disorders Program, Clinical Institute of Psychiatry and Psychology, Hospital Clinic, Barcelona Stanley Medical Institute Research Center, University of Barcelona, Barcelona, Spain. Neuropsychobiology
(Impact Factor: 2.26).
01/2002; 46 Suppl 1:16-21.
Recent studies have suggested that the presence of persistent cognitive dysfunctions in bipolar patients is not restricted to acute episodes, but they persist even during remission states. Nevertheless, there are several methodological pitfalls in most studies, such as unclear remission criteria, diagnostic heterogeneity or small sample sizes.
Several domains of cognitive function were examined in 30 depressed bipolar patients [DSM-IV criteria for major depression, Hamilton Depression Scale (HDRS) > or =17] and 30 euthymic bipolar patients (at least 6 months of remission, HDRS < or =8 and Young Mania Rating Scale, YMRS < or =6). Psychosocial functioning was assessed through General Assessment of Functioning.
The two groups showed a similar pattern of neuropsychological performance. However, the depressed group was significantly impaired on the Controlled Oral Word Association Test, FAS (COWAT), a measure of verbal fluency, compared with the euthymic group. On the other hand, functional outcome in euthymic patients was related to verbal fluency, even after controlling for residual depressive symptoms.
Neuropsychological performance was similar in both groups, except for verbal fluency, which was lower in the depressed group. Poor verbal fluency was related to a poor social outcome in euthymic patients. Further research including longitudinal designs aimed at evaluating changes in cognition in these patients is warranted.
Available from: Carlos Matute
- "Our results that patients with higher BDNF levels have better cognitive performance suggest that plasma BDNF levels could be used as a biological marker of cognition in patients with a first psychotic episode. Cognitive performance is an important clinical variable associated with prognosis in severe mental illness
. The nature of the relationship is unclear but, based on previous studies
, we can hypothesize that lower BDNF functioning in the brain (e.g. during an acute episode of psychosis) can lead to cognitive impairment and could contribute towards the differences in cognition observed between different patients and between patients and healthy subjects. "
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Cognitive impairments are seen in first psychotic episode (FEP) patients. The neurobiological underpinnings that might underlie these changes remain unknown. The aim of this study is to investigate whether Brain Derived Neurotrophic Factor (BDNF) levels are associated with cognitive impairment in FEP patients compared with healthy controls.
45 FEP patients and 45 healthy controls matched by age, gender and educational level were selected from the Basque Country area of Spain. Plasma BDNF levels were assessed in healthy controls and in patients. A battery of cognitive tests was applied to both groups, with the patients being assessed at 6 months after the acute episode and only in those with a clinical response to treatment.
Plasma BDNF levels were altered in patients compared with the control group. In FEP patients, we observed a positive association between BDNF levels at six months and five cognitive domains (learning ability, immediate and delayed memory, abstract thinking and processing speed) which persisted after controlling for medications prescribed, drug use, intelligence quotient (IQ) and negative symptoms. In the healthy control group, BDNF levels were not associated with cognitive test scores.
Our results suggest that BDNF is associated with the cognitive impairment seen after a FEP. Further investigations of the role of this neurotrophin in the symptoms associated with psychosis onset are warranted.
Available from: Ernst H W Koster
- "Lemke Leyman 2 , Rudi De Raedt, and Ernst H.W. Koster (Ghent University, Belgium)An increasing amount of empirical evidence has demonstrated the presence of general information processing deficits underlying the onset and endurance of bipolar disorder (Green, Cahill, and Mahli, 2007;Quraishi and Frangou, 2002). Patients with bipolar I and bipolar II disorder show significant deficits on a variety of conventional neuropsychological tests with disturbances on measures of working memory (e.g.Glahn et al., 2006), selective and sustained attention (e.g.Clark, Iversen, and Goodwin, 2002;Nehra, Chakrabarti, Pradhan, and Khehra, 2006), mental flexibility (e.g.Frangou, Donaldson, Hadjulis, Landau, and Goldstein, 2005;Krabbendam, Arts, Van Os, and Aleman, 2005), and verbal fluency (e.g.Martinez-Aran et al., 2002;). These information-processing deficits are not restricted to symptomatic bipolar patients in the depressed or manic state of the illness, but also seem to persist during remission as stable vulnerability factors. "
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ABSTRACT: Compared to the extensive research focussing on cognitive vulnerability factors underlying the onset and maintenance of major depressive disorder, studies investigating dysfunctional processing of emotional information in bipolar depression remain scarce. Therefore, this experimental study examined the nature and time course of attentional biases for emotional information in depressive patients with bipolar disorder. Fourteen currently depressed patients with Bipolar I Disorder (BD) and 14 nondepressed control participants (NC), matched for age, gender and education level, performed an emotional modification of the spatial cueing task. Cues consisted of angry, positive and neutral facial expressions presented for 200 and 1,000 ms. BD patients showed an enhanced cue validity effect for angry faces and had more difficulties in disengaging attention away from angry as well as happy facial expressions compared to NC participants, who conversely demonstrated a «protective bias» away from negative information. This pattern of differential attentional processing was only found within the early stage of information processing at a presentation duration of 200 ms. These results provide evidence for deficits at the early stages of attentive processing of emotional information in depressed bipolar patients compared to healthy controls.
Available from: Jose Sánchez-Moreno
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ABSTRACT: Cognitive impairment in bipolar disorder may be a stable characteristic of the illness, although discrepancies have emerged with regard to what dysfunctions remain during remission periods. The aim of this study was to ascertain whether euthymic bipolar patients would show impairment in verbal learning and memory and in executive functions compared with healthy controls. Secondly, to establish if there was a relationship between clinical data and neuropsychological performance.
Forty euthymic bipolar patients were compared with 30 healthy controls through a battery of neuropsychological tests assessing estimated premorbid IQ, attention, verbal learning and memory, and frontal executive functioning. The effect of subsyndromal symptomatology was controlled.
Remitted bipolar patients performed worse than controls in several measures of memory and executive function, after controlling for the effect of subclinical symptomatology, age and premorbid IQ. Verbal memory impairment was related to global assessment of function scores, as well as to a longer duration of illness, a higher number of manic episodes, and prior psychotic symptoms.
Results provide evidence of neuropsychological impairment in euthymic bipolar patients, after controlling for the effect of subsyndromal depressive symptoms, suggesting verbal memory and executive dysfunctions. Cognitive impairment seems to be related to a worse clinical course and poor functional outcome.
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