Article

A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. J Affect Disord 93(1-3):105-115

School of Neurology, Neurobiology and Psychiatry (Psychiatry), University of Newcastle upon Tyne, Leazes Wing, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
Journal of Affective Disorders (Impact Factor: 3.38). 07/2006; 93(1-3):105-15. DOI: 10.1016/j.jad.2006.02.016
Source: PubMed

ABSTRACT

A number of studies have reported evidence of cognitive deficits in euthymic bipolar patients. Qualitative reviews of the literature have indicated impairments in executive functions and declarative memory are most consistently reported. However, not all primary studies conducted to date have had sufficient power to detect statistically significant differences and there have been few attempts to quantify the magnitude of impairments. This review aims to combine data from available studies to identify the profile of neuropsychological deficits in euthymic bipolar patients and quantify their magnitude.
Systematic literature review and meta-analysis.
Large effect sizes (d>or=0.8) were noted for aspects of executive function (category fluency, mental manipulation) and verbal learning. Medium effect sizes (0.5<or=d<0.8) were found for aspects of immediate and delayed verbal memory, abstraction and set-shifting, sustained attention, response inhibition, and psychomotor speed. Small effect sizes (0.2<or=d<0.5) were reported for verbal fluency by letter, immediate memory, and sustained attention.
Sufficient data were not available to investigate all domains. For example analyses did not include measures of visuospatial function.
Euthymic bipolar patients demonstrate relatively marked impairment in aspects of executive function and verbal memory. It is not yet clear whether these are two discrete areas of impairment or are related to one another. Future investigations should clarify the functional significance of deficits and indicate whether patients will benefit from ameliorative interventions.

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Available from: Peter Gallagher, May 06, 2014
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    • "rical volumes differ. fMRI studies of areas activated by the presentation of happy or sad faces differentiates bipolar from unipolar depression, with unipolar showing greater amygdala activation for sad faces and vice versa for bipolar (Maletic and Raison 2014). 6. Bipolar patients exhibit specific deficits in executive function and verbal memory (Robinson et. al 2006)."

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    • "Attentional and cognitive alterations are significant in different BD states and they also persist into euthymic phases (Maekawa et al., 2013). Cognitive deficits in response inhibition, verbal memory and attention persist across mood phases but are enhanced during the manic and depressive states (Robinson et al., 2006). These patients present deficits in a broad range of cognitive functions, such as verbal memory, sustained attention, executive function aspects and emotional processing (Andersson et al., 2008; Maekawa et al., 2013). "
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    ABSTRACT: Bipolar disorder (BD) is characterized by an alternated occurrence between acute mania episodes and depression or remission moments. The objective of this study is to analyze the information processing changes in BP (Bipolar Patients) (euthymia, depression and mania) during the oddball paradigm, focusing on the P300 component, an electric potential of the cerebral cortex generated in response to external sensorial stimuli, which involves more complex neurophysiological processes related to stimulus interpretation. Twenty-eight bipolar disorder patients (BP) (17 women and 11 men with average age of 32.5, SD: 9.5) and eleven healthy controls (HC) (7 women and 4 men with average age of 29.78, SD: 6.89) were enrolled in this study. The bipolar patients were divided into 3 major groups (i.e., euthymic, depressive and maniac) according to the score on the Clinical Global Impression - Bipolar Version (CGI-BP). The subjects performed the oddball paradigm simultaneously to the EEG record. EEG data were also recorded before and after the execution of the task. A one-way ANOVA was applied to compare the P300 component among the groups. After observing P300 and the subcomponents P3a and P3b, a similarity of amplitude and latency between euthymic and depressive patients was observed, as well as small amplitude in the pre-frontal cortex and reduced P3a response. This can be evidence of impaired information processing, cognitive flexibility, working memory, executive functions and ability to shift the attention and processing to the target and away from distracting stimuli in BD. Such neuropsychological impairments are related to different BD symptoms, which should be known and considered, in order to develop effective clinical treatment strategies.
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