Hostname: page-component-7f64f4797f-rcs6z Total loading time: 0 Render date: 2025-11-04T08:55:15.324Z Has data issue: false hasContentIssue false
  • English
  • Français

Affective symptoms and intra-individual variability in the short-term course of cognitive functioning in bipolar disorder

Published online by Cambridge University Press:  09 December 2011

C. A. Depp ,
G. N. Savla ,
L. A. Vergel de Dios ,
B. T. Mausbach  and
B. W. Palmer
C. A. Depp*
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
G. N. Savla
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
L. A. Vergel de Dios
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
B. T. Mausbach
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
B. W. Palmer
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA Veterans Medical Research Foundation, VA San Diego, La Jolla, CA, USA
*
*Address for correspondence: C. A. Depp, Ph.D., University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive (0664), La Jolla, CA 92093-0664, USA. (Email: cdepp@ucsd.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Few studies have examined the short-term course of cognitive impairments in bipolar disorder (BD). Key questions are whether trajectories in symptoms covary with cognitive function and whether BD is associated with increased intra-individual variability in cognitive abilities.

Method

Forty-two out-patients with BD and 49 normal comparison (NC) subjects were administered a battery of neuropsychological tests at baseline, 6, 12 and 26 weeks, along with concurrent ratings of depressive and manic symptom severity. Mixed-effects regressions were used to model relationships between time, diagnosis and symptom severity on composite cognitive performance. Within-person variance in cognitive functioning across time was calculated for each subject.

Results

BD patients had significantly worse performance in cognitive ability across time points, but both groups showed significant improvement in cognitive performance over repeated assessments (consistent with expected practice effects). BD was associated with significantly greater intra-individual variability in cognitive ability than NCs; within-person variation was negatively related to baseline cognitive ability in BD but not NC subjects. Changes in affective symptoms over time did not predict changes in cognitive ability.

Conclusions

Moderate changes in affective symptoms did not covary with cognitive ability in BD. The finding of elevated intra-individual variability in BD may reduce capacity to estimate trajectories of cognitive ability in observational and treatment studies.

Keywords

Bipolar disordercognitive functioningdepressionintra-individual variabilitylongitudinal statistical analysisneuropsychology

Information

Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 7 , July 2012 , pp. 1409 - 1416
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Arts, B, Jabben, N, Krabbendam, L, van Os, J (2008). Meta-analyses of cognitive functioning in euthymic bipolar patients and their first-degree relatives. Psychological Medicine 38, 771–785.CrossRefGoogle ScholarPubMed
Arts, B, Jabben, N, Krabbendam, L, van Os, J (2011). A 2-year naturalistic study on cognitive functioning in bipolar disorder. Acta Psychiatrica Scandinavica 123, 190–205.CrossRefGoogle Scholar
Bearden, CE, Hoffman, KM, Cannon, TD (2001). The neuropsychology and neuroanatomy of bipolar affective disorder: a critical review. Bipolar Disorders 3, 106–150; discussion 151–153.CrossRefGoogle ScholarPubMed
Bowie, CR, Depp, C, McGrath, JA, Wolyniec, P, Mausbach, BT, Thornquist, MH, Luke, J, Patterson, TL, Harvey, PD, Pulver, AE (2010). Prediction of real-world functional disability in chronic mental disorders: a comparison of schizophrenia and bipolar disorder. American Journal of Psychiatry 167, 1116–1124.CrossRefGoogle ScholarPubMed
Buchanan, RW, Davis, M, Goff, D, Green, MF, Keefe, RS, Leon, AC, Nuechterlein, KH, Laughren, T, Levin, R, Stover, E, Fenton, W, Marder, SR (2005). A summary of the FDA-NIMH-MATRICS workshop on clinical trial design for neurocognitive drugs for schizophrenia. Schizophrenia Bulletin 31, 5–19.CrossRefGoogle ScholarPubMed
Burdick, KE, Braga, RJ, Goldberg, JF, Malhotra, AK (2007). Cognitive dysfunction in bipolar disorder: future place of pharmacotherapy. CNS Drugs 21, 971–981.CrossRefGoogle ScholarPubMed
Burdick, KE, Goldberg, JF, Harrow, M (2006). Neurocognition as a stable endophenotype in bipolar disorder and schizophrenia. Journal of Nervous and Mental Disease 194, 255–260.CrossRefGoogle Scholar
Burdick, KE, Goldberg, JF, Harrow, M, Faull, RN, Malhotra, AK (2010). Neurocognitive dysfunction and psychosocial outcome in patients with bipolar I disorder at 15-year follow-up. Acta Psychiatrica Scandinavica 122, 499–506.CrossRefGoogle ScholarPubMed
Burdick, KE, Goldberg, TE, Cornblatt, BA, Keefe, RS, Gopin, CB, Derosse, P, Braga, RJ, Malhotra, AK (2011). The MATRICS consensus cognitive battery in patients with bipolar I disorder. Neuropsychopharmacology 36, 1587–1592.CrossRefGoogle ScholarPubMed
Chaves, OC, Lombardo, LE, Bearden, CE, Woolsey, MD, Martinez, DM, Barrett, JA, Miller, AL, Velligan, DI, Glahn, DC (2011). Association of clinical symptoms and neurocognitive performance in bipolar disorder: a longitudinal study. Bipolar Disorders 13, 118–123.CrossRefGoogle ScholarPubMed
Cysique, LA, Franklin, D Jr., Abramson, I, Ellis, RJ, Letendre, S, Collier, A, Clifford, D, Gelman, B, McArthur, J, Morgello, S, Simpson, D, McCutchan, JA, Grant, I, Heaton, RK (2011). Normative data and validation of a regression based summary score for assessing meaningful neuropsychological change. Journal of Clinical and Experimental Neuropsychology 33, 505–522.CrossRefGoogle ScholarPubMed
Delis, D, Kaplan, E, Kramer, J (2001). Delis-Kaplan Executive Function System (D-KEFS). The Psychological Corporation: San Antonio, TX.Google Scholar
Depp, CA, Savla, GN, Moore, DJ, Palmer, BW, Stricker, JL, Lebowitz, BD, Jeste, DV (2008). Short-term course of neuropsychological abilities in middle-aged and older adults with bipolar disorder. Bipolar Disorders 10, 684–690.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P). Biometrics Research, New York State Psychiatric Institute: New York.Google Scholar
Goodwin, GM, Martinez-Aran, A, Glahn, DC, Vieta, E (2008). Cognitive impairment in bipolar disorder: neurodevelopment or neurodegeneration? An ECNP expert meeting report. European Neuropsychopharmacology 18, 787–793.CrossRefGoogle ScholarPubMed
Harvey, PD, Palmer, BW, Heaton, RK, Mohamed, S, Kennedy, J, Brickman, A (2005). Stability of cognitive performance in older patients with schizophrenia: an 8-week test-retest study. American Journal of Psychiatry 162, 110–117.CrossRefGoogle ScholarPubMed
Harvey, PD, Wingo, AP, Burdick, KE, Baldessarini, RJ (2010). Cognition and disability in bipolar disorder: lessons from schizophrenia research. Bipolar Disorders 12, 364–375.CrossRefGoogle ScholarPubMed
Heaton, RK, Temkin, N, Dikmen, S, Avitable, N, Taylor, MJ, Marcotte, TD, Grant, I (2001). Detecting change: a comparison of three neuropsychological methods, using normal and clinical samples. Archives of Clinical Neuropsychology 16, 75–91.CrossRefGoogle Scholar
Jaeger, J, Berns, S, Loftus, S, Gonzalez, C, Czobor, P (2007). Neurocognitive test performance predicts functional recovery from acute exacerbation leading to hospitalization in bipolar disorder. Bipolar Disorders 9, 93–102.CrossRefGoogle ScholarPubMed
Krabbendam, L, Honig, A, Wiersma, J, Vuurman, EF, Hofman, PA, Derix, MM, Nolen, WA, Jolles, J (2000). Cognitive dysfunctions and white matter lesions in patients with bipolar disorder in remission. Acta Psychiatrica Scandinavica 101, 274–280.CrossRefGoogle ScholarPubMed
MacDonald, SW, Nyberg, L, Backman, L (2006). Intra-individual variability in behavior: links to brain structure, neurotransmission and neuronal activity. Trends in Neurosciences 29, 474–480.CrossRefGoogle ScholarPubMed
Malhi, GS, Ivanovski, B, Hadzi-Pavlovic, D, Mitchell, PB, Vieta, E, Sachdev, P (2007). Neuropsychological deficits and functional impairment in bipolar depression, hypomania and euthymia. Bipolar Disorders 9, 114–125.CrossRefGoogle ScholarPubMed
Martinez-Aran, A, Vieta, E, Reinares, M, Colom, F, Torrent, C, Sanchez-Moreno, J, Benabarre, A, Goikolea, J, Comes, M, Salamero, M (2004). Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder. American Journal of Psychiatry 161, 262–270.CrossRefGoogle ScholarPubMed
Montgomery, SA, Asberg, M (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 381–389.CrossRefGoogle ScholarPubMed
Mur, M, Portella, MJ, Martinez-Aran, A, Pifarre, J, Vieta, E (2008). Long-term stability of cognitive impairment in bipolar disorder: a 2-year follow-up study of lithium-treated euthymic bipolar patients. Journal of Clinical Psychiatry 69, 712–719.CrossRefGoogle ScholarPubMed
Ram, N, Gerstorf, D (2009). Time-structured and net intraindividual variability: tools for examining the development of dynamic characteristics and processes. Psychology and Aging 24, 778–791.CrossRefGoogle ScholarPubMed
Rapport, L, Brines, D, Axelrod, B, Thiesen, M (1997). Full scale IQ as mediator of practice effects: the rich get richer. The Clinical Neuropsychologist 11, 375–380.CrossRefGoogle Scholar
Shapiro, AM, Benedict, RH, Schretlen, D, Brandt, J (1999). Construct and concurrent validity of the Hopkins Verbal Learning Test – revised. The Clinical Neuropsychologist 13, 348–358.CrossRefGoogle ScholarPubMed
Torres, IJ, Boudreau, VG, Yatham, LN (2007). Neuropsychological functioning in euthymic bipolar disorder: a meta-analysis. Acta Psychiatrica Scandinavica (Suppl.) 434, 17–26.CrossRefGoogle Scholar
Wilkinson, GS, Robertson, GJ (2006). Wide Range Achievement Test 4, Professional Manual. Psychological Assessment Resources: Lutz, FL.Google Scholar
Yatham, LN, Torres, IJ, Mahli, GS, Frangou, S, Glahn, DC, Bearden, CE, Burdick, KE, Martinez-Aran, A, Dittman, S, Goldberg, JF, Ozerdem, A, Aydemir, O, Chengappa, KN (2010). The International Society for Bipolar Disorders – Battery for Assessment of Neurocognition (ISBD-BANC). Bipolar Disorders 12, 351–363.CrossRefGoogle ScholarPubMed
Young, RC, Biggs, J, Ziegler, V, Meyer, D (1978). A rating scale for mania: reliability, validity, and sensitivity. British Journal of Psychiatry 133, 429–435.CrossRefGoogle ScholarPubMed
Supplementary material: File

Depp Supplementary Figure

Fig. S1. Plots of individual trajectories in cognitive ability in (a) NC and (b) BD subjects.

Download Depp Supplementary Figure(File)
File 138.2 KB