Cognitive impairment in late life schizophrenia and bipolar I disorder

Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. .
International Journal of Geriatric Psychiatry (Impact Factor: 2.87). 01/2013; 28(1). DOI: 10.1002/gps.3793
Source: PubMed


Evidence in younger populations suggests quantitative but not categorical differences in cognitive impairments between schizophrenia and bipolar disorder. It is uncertain whether a similar distinction applies to patients in later life.
We compared the cognitive abilities of older, community-living schizophrenia patients, controlling for their state of symptomatic remission, with those of older euthymic patients with bipolar I disorder. The study included 67 patients with schizophrenia (20 in symptomatic remission, 47 not in symptomatic remission; mean age 68 years) and 74 euthymic bipolar I patients (mean age 70 years), who were compared using analysis of covariance on clinical and neuropsychological variables (e.g., attention/working memory, verbal memory, executive function and verbal fluency) and contrasted with 69 healthy controls.
Remitted (SR) and non-remitted (SN) schizophrenia patients and bipolar I (BP) patients were impaired relative to healthy controls, with mostly large effect sizes for verbal memory (Cohen's d: SR 1.34, SN 1.48, BP 1.09), executive function (Cohen's d: SR 0.87, SN 1.29, BP 0.71) and verbal fluency (Cohen's d: SR 1.09, SN 1.25, BP 0.88), but smaller effect sizes for the domain of attention/working memory (Cohen's d: SR 0.26, SN 0.18, BP 0.52). Differences in cognitive performance between the remitted schizophrenia patients and the bipolar I patients were not significant.
In both older patients with schizophrenia and with bipolar disorder, serious and pervasive cognitive deficits can be demonstrated. Trait-related cognitive deficits in schizophrenia and bipolar disorder may share major phenotypic similarity in later life. Copyright

Download full-text


Available from: Paul D Meesters
  • Source
    • "Although non-remitted FEP patients also showed poorer visual memory compared to remitted patients at initial assessment, this deficit does not appear to be stable over the follow-up period. Differences in verbal memory have not been previously reported in studies using the RSGW remission definition , whether it was in chronic schizophrenia (Helldin et al., 2006; Ciudad et al., 2009; Eberhard et al., 2009; Li et al., 2010; Brissos et al., 2011; Hofer et al., 2011; Meesters et al., 2011; Yun da et al., 2011; Meesters et al., 2013) or in a first-episode sample (Bodnar et al., 2008; Bodnar et al., 2011). Some studies have found associations between visual memory and symptoms severity (Hoff et al., 1999; Verdoux et al., 2002; Dominguez Mde et al., 2009; August et al., 2012); however, this may not entirely explain our results since the symptom levels at baseline in our two groups were not statistically different. "
    [Show abstract] [Hide abstract]
    ABSTRACT: With the introduction of a clear definition of symptomatic remission from the Remission in Schizophrenia Working Group (RSWG), studies have sought to characterize cognitive functioning in remitted and non-remitted schizophrenia patients. However, most investigations of cognition and remission are cross-sectional or have studied samples of chronically ill patients. Therefore, the aim of this study was to compare cognitive performance between remitted and non-remitted first-episode psychosis (FEP) patients longitudinally. Seventy patients were categorized as remitted (n = 17) or non-remitted (n = 53) using the full RSWG criteria after being treated for approximately 15 months, during which cognition was evaluated twice. Since our previous investigations in FEP have isolated verbal memory as a potential cognitive marker of symptomatic remission, analyses were limited to verbal, visual and working memory. We have found that non-remitted patients had a significantly worse verbal memory performance than remitted patients after 3 months (F(1,68) = 6.47, p = 0.006) and 15 months of treatment (F(1,68) = 19.49, p < 0.001). Visual memory was also significantly lower in non-remitted patients compared to those in remission but only at initial assessment (F(1,68) = 8.21, p = 0.003) while working memory performance was similar at both time points. Our findings suggest that verbal memory may be a specific and stable marker of clinical remission in FEP patients. This cognitive domain can easily be evaluated at treatment intake in the hope of identifying early on patients who are less likely to remit.
    Full-text · Article · Mar 2014 · Schizophrenia Research
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose of review: This work aims to review the most recent publications on cognitive impairment and dementia associated with bipolar disorder (BPD), especially in the elderly. Recent findings: In the last years, a growing number of studies aiming at better understanding of cognitive impairment in BPD were found. Impairments found in BPD were compared with other psychiatric disorders and primary cognitive diseases. The impact of cognitive impairment on functionality was also recently highlighted. With respect to neurobiology, studies that explored inflammatory, neurotrophic and pathological cascades possibly associated with BPD and cognition were published. Finally, the first study covering treatment of cognitive impairment was carried out with pramipexole, and it raised important methodological issues for future research in BPD. Summary: Cognitive impairment and dementia in BPD should be better explored with cognitive and functionality protocols along with biological and neuroimaging markers.
    Full-text · Article · Nov 2012 · Current opinion in psychiatry
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: A sizeable body of work has consistently documented that a number of euthymic mixed-age bipolar disorder subjects exhibit prominent impairments in a variety of cognitive domains. By contrast, knowledge about neuropsychological functioning in elderly patients is scant, despite being necessary for the adequate treatment of this population and the understanding of illness evolution. The aim of this study was to combine findings from the available literature in order to examine the pattern and extent of cognitive deficits in euthymic late-life bipolar disorder subjects. Methods: A literature search was conducted through the online databases PubMed, ScienceDirect, EBSCO, and Wiley-Blackwell, covering the period between January 1990 and April 2012. Effect sizes reflecting patient-control differences for 10 cognitive variables were extracted from selected investigations and combined by means of meta-analytical procedures. Results: No significant patient-control differences were found for global cognitive status as assessed with the Mini-Mental State Examination and the Clock Drawing Test. Significant overall effect sizes (Hedges' g) of between 0.61 and 0.88 were noted for sustained attention, digit span (forwards and backwards), delayed recall, serial learning, cognitive flexibility, and verbal fluency (phonemic and categorical). Conclusions: The extent of cognitive dysfunction in euthymic late-life bipolar disorder subjects may be, on average, similar to that reported for remitted young adult patients. Larger effect sizes of impairment may be associated with late illness onset. Implications and future directions for research are proposed.
    Full-text · Article · May 2013 · Bipolar Disorders
Show more