Meta-analysis of the association between cognitive abilities and everyday functioning in bipolar disorder

Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093-0603, USA.
Bipolar Disorders (Impact Factor: 4.97). 05/2012; 14(3):217-26. DOI: 10.1111/j.1399-5618.2012.01011.x
Source: PubMed


Neurocognitive deficits are common in bipolar disorder and contribute to functional disability. However, the degree to which general and specific cognitive deficits affect everyday functioning in bipolar disorder is unknown. The goal of this meta-analysis was to examine the magnitude of the effect of specific neurocognitive abilities on everyday functioning in bipolar disorder.
We conducted a comprehensive meta-analysis of studies that reported associations between performance on objective neuropsychological tasks and everyday functioning among individuals with bipolar disorder. From an initial pool of 486 papers, 22 studies met inclusion criteria, comprising a total of 1344 participants. Correlation coefficients were calculated for 11 cognitive domains and four measurement modalities for functioning. We also examined effect moderators, such as sample age, clinical state, and study design.
The mean Pearson correlation between neurocognitive ability and functioning was 0.27, and was significant for all cognitive domains and varied little by cognitive domain. Correlations varied by methods of everyday functioning assessment, being lower for clinician and self-report than performance-based tasks and real-world milestones such as employment. None of the moderator analyses were significant.
Overall, the strength of association between cognitive ability and everyday functioning in bipolar disorder is strikingly similar to that seen in schizophrenia, with little evidence for differences across cognitive domains. The strength of association differed to a greater extent according to functional measurement approach.

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Available from: Alexandrea L Harmell, Feb 01, 2014
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    • "The relationship between poorer course of bipolar disorder and greater neurocognitive impairment has been previously reported (Martinez-Aran et al. 2007; Lopez-Jaramillo et al. 2010), as well as the impact of neurocognitive deficits on psychosocial functioning (Tabares-Seisdedos et al. 2008; Bonnin et al. 2010; Depp et al. 2012; Torrent et al. 2012). As a consequence of these findings, the interest in the development of therapeutic strategies that contribute to restoring or mitigating the impact of sustained neurocognitive and functional impairment has grown in the last few years (Fuentes-Dura et al. 2012; Vieta, 2014). "
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    ABSTRACT: Background: Functional remediation is a novel intervention with demonstrated efficacy at improving functional outcome in euthymic bipolar patients. However, in a previous trial no significant changes in neurocognitive measures were detected. The objective of the present analysis was to test the efficacy of this therapy in the enhancement of neuropsychological functions in a subgroup of neurocognitively impaired bipolar patients. Method: A total of 188 out of 239 DSM-IV euthymic bipolar patients performing below two standard deviations from the mean of normative data in any neurocognitive test were included in this subanalysis. Repeated-measures analyses of variance were conducted to assess the impact of the treatment arms [functional remediation, psychoeducation, or treatment as usual (TAU)] on participants' neurocognitive and functional outcomes in the subgroup of neurocognitively impaired patients. Results: Patients receiving functional remediation (n = 56) showed an improvement on delayed free recall when compared with the TAU (n = 63) and psychoeducation (n = 69) groups as shown by the group × time interaction at 6-month follow-up [F 2,158 = 3.37, degrees of freedom (df) = 2, p = 0.037]. However, Tukey post-hoc analyses revealed that functional remediation was only superior when compared with TAU (p = 0.04), but not with psychoeducation (p = 0.10). Finally, the patients in the functional remediation group also benefited from the treatment in terms of functional outcome (F 2,158 = 4.26, df = 2, p = 0.016). Conclusions: Functional remediation is effective at improving verbal memory and psychosocial functioning in a sample of neurocognitively impaired bipolar patients at 6-month follow-up. Neurocognitive enhancement may be one of the active ingredients of this novel intervention, and, specifically, verbal memory appears to be the most sensitive function that improves with functional remediation.
    Full-text · Article · Sep 2015 · Psychological Medicine
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    • "naïve patients [4]. Furthermore, cognitive dysfunction is closely related to impaired psychosocial functioning in MDD [6] [8], BD [9] and SZ [10]. "
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    ABSTRACT: An increasing body of evidences from preclinical as well as epidemiological and clinical studies suggest a potential beneficial role of dietary intake of omega-3 fatty acids for cognitive functioning. In this narrative review, we will summarize and discuss recent findings from epidemiological, interventional and experimental studies linking dietary consumption of omega-3 fatty acids to cognitive function in healthy adults. Furthermore, affective disorders and schizophrenia (SZ) are characterized by cognitive dysfunction encompassing several domains. Cognitive dysfunction is closely related to impaired functioning and quality of life across these conditions. Therefore, the current review focues on the potential influence of omega-3 fatty acids on cognition in SZ and affective disorders. In sum, current data predominantly from mechanistic models and animal studies suggest that adjunctive omega-3 fatty acid supplementation could lead to improved cognitive functioning in SZ and affective disorders. However, besides its translational promise, evidence for clinical benefits in humans has been mixed. Notwithstanding evidences indicate that adjunctive omega-3 fatty acids may have benefit for affective symptoms in both unipolar and bipolar depression, to date no randomized controlled trial had evaluated omega-3 as cognitive enhancer for mood disorders, while a single published controlled trial suggested no therapeutic benefit for cognitive improvement in SZ. Considering the pleiotropic mechanisms of action of omega-3 fatty acids, the design of well-designed controlled trials of omega-3 supplementation as a novel, domain-specific, target for cognitive impairment in SZ and affective disorders is warranted.
    Full-text · Article · Jun 2015 · Current Neuropharmacology
    • "Individuals with BD have significant problems with general functioning, including occupational functioning and social adjustment (Macqueen et al., 2001). Cognitive performance is a significant predictor of psychosocial functioning and disability in BD (Depp et al., 2012; Sanchez-Moreno et al., 2009); the relation between functioning and cognition extends to a number of areas including employment (Bearden et al., 2011; O'shea et al., 2010; Ryan et al., 2013) social functioning (Laes and Sponheim, 2006), and observational , objectively scored ratings of performance of instrumental activities of daily living (e.g., writing a check, meal preparation) (Gildengers et al., 2013). Cognitive differences between BD and HC are found in the areas of learning and memory, sustained attention , and executive skills such as planning, task initiation and switching, and inhibition (Boland and Alloy, 2013). "
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    ABSTRACT: Objectives Openness to experience (O) is a well-established personality factor and is associated with cognitive performance. Little is known about the personality-cognitive relationship in bipolar disorder, an illness with significant variability in mood. Cognitive evaluation is essential in psychopathology assessment as it may reflect underlying disease processes and psychosocial functional capacity. Screening using a proxy personality variable may identify those in need of comprehensive cognitive testing. We hypothesized that O and measures of cognition would associate in both the Bipolar Disorder (BD) and healthy control (HC) samples, whereas neuroticism and extraversion would correlate with cognition only in the BD sample. Methods Data from a longitudinal study of BD were used to study the association between personality factors and cognitive measures of attention, executive functioning, memory and fine motor skills. Regression analyses were used to determine the variables that account for the association between personality and cognition. Results Aspects of O explained significant cognitive variance (~5%) in both groups; this persisted when demographic variables (including BD versus HC status) were considered. Neuroticism and extraversion did not consistently correlate with cognitive performance in either group. Limitations There were more females in the HC group who were slightly younger compared to the BD group. We lack direct measures of positive affect, and there is a reliance on a single measure of personality. Conclusions BD Individuals scoring low on self-reported Openness are potential candidates for more comprehensive cognitive assessments (which represent a limited resource).
    No preview · Article · Oct 2014 · Journal of Affective Disorders
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