Assessing cognitive deficits in bipolar disorder: are self reports valid? Psychiatry Res 136: 43- 50
Northwestern University, Evanston, Illinois, United States Psychiatry Research
(Impact Factor: 2.47).
08/2005; 136(1):43-50. DOI: 10.1016/j.psychres.2004.12.009
Patients with affective disorders frequently report problems with attention, concentration and memory, although little research has investigated subjective cognitive complaints relative to objective neuropsychological deficits. We compared subjective (self-rated) cognition and objective (clinician-rated) neuropsychological functioning in 37 DSM-IV bipolar outpatients. Subjects completed three standardized self-report inventories: the Cognitive Difficulties Scale (CDS), Cognitive Failures Questionnaire (CFQ), and Patient's Assessment of Own Functioning (PAOF). These were followed by a systematic neuropsychological test battery. More than 75% of our sample of bipolar patients displayed some cognitive deficits, most notably in the domains of verbal learning and memory. In general, patients' self-reports of impairment failed to reliably predict objective neuropsychological deficits. Mood ratings for mania and depression were not significantly correlated with any of the self-report inventories or the objective neuropsychological variables. The findings suggest that most bipolar patients demonstrate objective signs of cognitive impairment, but they are unable to report them accurately, at least using available self-report inventories. Such discrepancies could relate to impaired insight, efforts to conceal deficits, or to subthreshold affective symptoms.
Available from: Scot E Purdon
- "and concentration difficulties mediate as much as 25% of the impact of depression on patients' psychosocial impairment (Buist- Bouwman et al., 2008). However, the association between subjectively reported and objectively measured cognitive difficulties in affective disorders remains controversial with some studies finding no association (Burdick et al., 2005; Svendsen et al., 2012) and others showing significant but weak correlations (Demant et al., 2015a; Jensen et al., 2015; Rosa et al., 2013). Correct identification of objective cognitive dysfunction is important in the clinic for monitoring treatment effects and in randomised controlled trials investigating new candidate treatments for cognitive dysfunction in UD (Martinez-Aran and Vieta, 2015; Solé et al., 2015). "
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Persistent cognitive dysfunction in unipolar depression (UD) contributes to socio-occupational impairment, but there are no feasible methods to screen for and monitor cognitive dysfunction in this patient group. The present study investigated the validity of two new instruments to screen for cognitive dysfunction in UD, and their associations with socio-occupational capacity.
Participants (n=53) with UD in partial or full remission and healthy control persons (n=103) were assessed with two new screening instruments, the Danish translations of the Screen for Cognitive Impairment in Psychiatry (SCIP-D) and Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) and with established neuropsychological and self-assessment measures. Depression symptoms and socio-occupational function were rated with the Hamilton Depression Rating Scale and Functional Assessment Short Test respectively.
The SCIP-D and COBRA were valid for detection of objective and subjective cognitive impairment, respectively. The three parallel SCIP-D forms were equivalent. A combined SCIP-D-COBRA measure showed high sensitivity and good specificity for objective cognitive impairment (91% and 70%, respectively). There was no correlation between subjective and objective measures of cognition. Subjective cognitive difficulties correlated more with socio-occupational impairment (r=0.7, p<0.01) than did objective cognitive difficulties, for which there was a weak correlation with the executive skills domain only (r =-0.3, p=0.05).
A modest sample size.
The SCIP-D and COBRA are valid measures of objective and subjective cognitive impairment, respectively, and should ideally be implemented together in the screening for cognitive dysfunction in UD.
Available from: Kamilla Miskowiak
- "ion of objective cognitive deficits in bipolar patients with cognitive complaints . Our demonstration of a poor correlation between measures of global objective cognitive function and subjective measures of cognition is consistent with other studies by our group ( Demant et al . , 2015 ; Svendsen et al . , 2012 ) and others ( Arts et al . , 2011 ; Burdick et al . , 2005 ) . However , we found significant weak to moderate correlation between objectively measured working memory and executive skills and cognitive complaints , similar to findings of Rosa et al . ( 2013 ) . However , in contrast with Rosa et al . ( 2013 ) , we found no correlation between measures of verbal learning and memory and cognitive"
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ABSTRACT: Cognitive impairment is common in bipolar disorder and contributes to socio-occupational difficulties. The objective was to validate and evaluate instruments to screen for and monitor cognitive impairments, and improve the understanding of the association between cognitive measures and socio-occupational capacity.
Patients with bipolar disorder in partial or full remission (n=84) and healthy controls (n=68) were assessed with the Screen for Cognitive Impairment in Psychiatry (SCIP), Cognitive Complaints in Bipolar Disorder Rating Scale (COBRA), and established neuropsychological tests and subjective rating scales. Socio-occupational function and affective symptoms were evaluated with the Functional Assessment Short Test, and the Hamilton Depression Rating Scale 17-items and Young Mania Rating Scale, respectively. Concurrent validity of the SCIP and COBRA were assessed by correlation with established objective and subjective cognitive measures, and decision validity was determined with Receiver-Operating-Characteristic analyses. Correlations and linear regression analyses were conducted to determine the associations between objective and subjective cognitive impairment, and socio-occupational difficulties.
The SCIP and COBRA correlated strongly with established objective and subjective cognitive measures, respectively. The SCIP yielded higher sensitivity and specificity for detection of cognitive dysfunction than the COBRA or a combined SCIP-COBRA measure. Correlations between objective and subjective cognitive impairment were weak but both were associated with socio-occupational difficulties.
Influence of ageing was not investigated.
The SCIP and COBRA are valid for detection of objective and subjective cognitive impairment in bipolar disorder. Screening for cognitive dysfunction should be conducted with an objective measure like the SCIP.
Copyright © 2015 Elsevier B.V. All rights reserved.
Available from: Kamilla Miskowiak
- "Indeed, it is unlikely that our finding of poor or no correlations between subjective and objective measures represents a type II error since our sample size was relatively large (n¼77) in comparison with other studies in the field in which sample sizes of bipolar patients ranged from n¼15–60 (Burdick et al., 2005; Martinez-Aran et al., 2005; Svendsen et al., 2012). In keeping with our findings, several other studies using self-assessment tools also found no significant correlation with objective cognitive measures (Burdick et al., 2005; van der Werf-Eldering et al., 2011; Svendsen et al., 2012), suggesting that patients may be unable to correctly evaluate their own cognitive function. On the other hand, the highly structured nature and limited naturalistic validity of objective cognitive tests may also limit the ability of these tests to capture patients' cognitive difficulties in reallife scenarios. "
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ABSTRACT: Cognitive dysfunction is prevalent in bipolar disorder (BD). However, the evidence regarding the association between subjective cognitive complaints, objective cognitive performance and psychosocial function is sparse and inconsistent. Seventy seven patients with bipolar disorder who presented cognitive complaints underwent assessment of objective and subjective cognitive function and psychosocial functioning as part of their participation in two clinical trials. We investigated the association between global and domain-specific objective and subjective cognitive function and between global cognitive function and psychosocial function. We also identified clinical variables that predicted objective and subjective cognitive function and psychosocial functioning. There was a significant, however weak, correlation between objective and subjective measures of global cognitive function but not within the individual cognitive domains, and a moderate correlation between subjective cognitive function and psychosocial function. Increased depression severity predicted greater subjective cognitive dysfunction globally (memory, attention and executive function) and in attention as well as lower psychosocial functioning. In conclusion, subjective cognitive difficulties seem to reflect general objective deficits in bipolar disorder but not individual cognitive domains. Cognitive complaints are associated with impaired psychosocial function and both are predicted by greater depression severity. Subjective cognitive complaints seem clinically useful as a threshold marker aiming for further objective cognitive assessment.
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