Euthymic bipolar disorder: Are there cognitive dysfunctions?

2011 ◽  
Vol 26 (S2) ◽  
pp. 198-198
Author(s):  
G. Da Ponte ◽  
T. Neves ◽  
M. Lobo
Keyword(s):  
Bipolar Disorder ◽  
Executive Functions ◽  
Cognitive Dysfunction ◽  
Cognitive Deficits ◽  
Verbal Memory ◽  
Clinical Case ◽  
Relevant Literature ◽  
Psychological Tests ◽  
Drug Treatments ◽  
Depressive Episodes

IntroductionThe presence of cognitive dysfunction in bipolar disorder is well established, but in the euthymic phase appear a few studies that point to the absence of cognitive deficits.ObjectivesAlert to cases of euthymic bipolar disorder with no cognitive dysfunction.MethodsReview of relevant literature and description of a clinical case with psychological tests that assess memory and executive functions.ResultsDescription of a clinical case: FP is a middle age woman, early retired, with a bipolar disorder type 2, which begins at age 30.Her disease has several depressive episodes, and in the last 10 years, she spent most of the days lying in bed and repeatedly resorted to the emergency department for excessive voluntary drug intoxication or simply because she “wanted” to be hospitalized; her husband could not stand this situation. In September of 2009, in addition to the medical and psychological consultations, she starts attending group therapy; over the next 6 months her medication was changed and finally her disease goes into remission.The psychological tests, made at euthymic phase, show’s no significant deficits in verbal memory and executive functions.ConclusionsThis patient has a disease with prolonged course and multiple hospitalizations and drug treatments, but don’t present relevant cognitive deficits, which may point to the fact that cognitive impairment is determined by biological factors.

scholarly journals Cognitive impact in bipolar disorder

2019 ◽  
pp. 052-058
Author(s):  
Bourin Michel
Keyword(s):  
Bipolar Disorder ◽  
Verbal Memory ◽  
Visual Memory ◽  
Age Of Onset ◽  
Cognitive Difficulties ◽  
Speed Of Information Processing ◽  
History Of ◽  
Bipolar Patients ◽  
Disability Severity ◽  
Depressive Episodes

It appears that bipolar patients suffer from cognitive difficulties whereas they are in period of thymic stability. These intercritical cognitive difficulties are fairly stable and their severity is correlated with the functional outcome of patients. Nevertheless, the profile of cognitive impairment varies significantly from study to study quantitatively and qualitatively. According to the studies, the authors find difficulties in terms of learning, verbal memory, visual memory, working memory, sustained attention, speed of information processing, functions executive. On the other hand, deficits of general intelligence, motor functions, selective attention, and language are not usually found. One of the reasons for the heterogeneity of results is the difficulty of exploring cognition in bipolar disorder. Many factors must be taken into account, such as the presence of residual mood symptoms, the longitudinal history of the disorder (age of onset, number of episodes due, among others, the neurotoxic impact of depressive episodes and deleterious cognitive effects). (length of hospitalization), level of disability severity, comorbidities (particularly addictive).

Cognitive Dysfunction as a Symptom Dimension Across Major Psychiatric Disorders

2019 ◽  
pp. 35-44
Author(s):  
Zihang Pan ◽  
Roger S. McIntyre
Keyword(s):  
Bipolar Disorder ◽  
Major Depressive Disorder ◽  
Psychiatric Disorders ◽  
Cognitive Dysfunction ◽  
Cognitive Deficits ◽  
Functional Disability ◽  
Cognitive Symptoms ◽  
Compelling Evidence ◽  
Psychiatric Illnesses ◽  
Neurobiological Substrates

Cognitive dysfunction is a symptom domain across multiple psychiatric disorders. Cognitive deficits in individuals with major depressive disorder (MDD) and bipolar disorder (BD) are significant contributors to global occupational and functional disability. The subdomains of learning and memory, executive function, processing speed, and attention and concentration are significantly impaired in individuals with MDD and BD. Treatment outcomes of cognitive symptoms with first-line agents have been suboptimal. Neuroinflammatory pathways are hypothesized to play key roles in the pathoaetiology of cognitive symptoms in MDD and BD. There is compelling evidence to suggest that elevation of systemic proinflammatory cytokines is involved in neurotoxicity, apoptosis, and aberrant neurocircuit function. These substrates offer opportunities to identify relevant biomarkers, refine treatment targets, and manage cognitive deficits across major psychiatric illnesses. This chapter provides an overview of cognitive symptoms across MDD and BD and discusses potential neurobiological substrates contributing to cognitive dysfunction.

Patterns of Impairment in Executive Functions within Unipolar and Bipolar Depression

2017 ◽  
Vol 41 (S1) ◽  
pp. S212-S212
Author(s):  
B. Suciu ◽  
R. Paunescu ◽  
I. Miclutia
Keyword(s):  
Bipolar Disorder ◽  
Executive Functions ◽  
Cognitive Deficits ◽  
Cognitive Abilities ◽  
Bipolar Depression ◽  
Cognitive Effort ◽  
Unipolar Disorder ◽  
Depressed Patients ◽  
Competing Interest ◽  
Executive Impairment

IntroductionThe majority of studies revealed that cognitive deficits are an important aspect in many psychiatric illnesses, such as bipolar disorder and major depressive disorder. In the past, cognitive impairment was considered part of depression and it was expected to diminish as other mood symptoms improved with treatment.MethodThis study is based on the review of recent literature, performed in order to understand the dimension of executive impairment in unipolar and bipolar depression.ResultsBoth unipolar and bipolar depressed patients display cognitive deficits in several cognitive domains within executive functions. Different subcomponents of executive functions are altered in both types of patients, but impairments in sustained attention appear specific in bipolar depression while dysfunctional divided attention is reported in unipolar disorder. Studies describe deficits in planning strategies and monitoring processes that are characteristically impaired in unipolar depressed patients. Also these subjects tend to make more perseverative responses suggesting set shifting deficits and moreover they require longer time and more cognitive effort in order to accomplish tasks involving inhibitory control or cognitive flexibility. Other findings suggest that bipolar I depressed patients perform worse than bipolar II depressed patients and unipolar depressed patients across all executive functions especially in the decision making process that is considered to be a trait marker for bipolar disorder with no differences between the two types of bipolar subjects.ConclusionsExecutive functions represent a term that includes a higher order of cognitive abilities with deficits that are present in both disorders but display slightly different patterns of impairment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Managing Cognitive Dysfunction in Bipolar Disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. S15-S16
Author(s):  
K. Miskowiak
Keyword(s):  
Bipolar Disorder ◽  
Cognitive Impairment ◽  
Cognitive Dysfunction ◽  
Functional Recovery ◽  
Cognitive Deficits ◽  
Clinical Treatment ◽  
Screening Tools ◽  
Treatment Target ◽  
Concentration Difficulty

Cognitive dysfunction, including memory and concentration difficulty, is an emerging treatment target in bipolar disorder. However, a key challenge in the management of these cognitive deficits is the lack of treatments with robust effects on cognition. Further, it is unclear how cognitive dysfunction should be assessed and addressed in the clinical treatment of the disorder. This talk will review the evidence for cognitive impairment in bipolar disorder, including its severity, persistence and impact on patients’ functional recovery. It will then discuss when and how to assess cognition and present some new feasible screening tools for cognitive dysfunction. Finally, it will highlight some novel candidate cognition treatments.Disclosure of interestI have acted as a consultant and received honoraria from Lundbeck and Allergan.

scholarly journals Residual Negative Symptoms Differentiate Cognitive Performance in Clinically Stable Patients with Schizophrenia and Bipolar Disorder

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Rajeev Krishnadas ◽  
Seethalakshmi Ramanathan ◽  
Eugene Wong ◽  
Ajita Nayak ◽  
Brian Moore
Keyword(s):  
Bipolar Disorder ◽  
Cognitive Function ◽  
Cognitive Deficits ◽  
Verbal Memory ◽  
Negative Symptoms ◽  
Psychotic Symptoms ◽  
Cognitive Tests ◽  
Healthy Controls ◽  
Patient Groups ◽  
The Difference

Cognitive deficits in various domains have been shown in patients with bipolar disorder and schizophrenia. The purpose of the present study was to examine if residual psychopathology explained the difference in cognitive function between clinically stable patients with schizophrenia and bipolar disorder. We compared the performance on tests of attention, visual and verbal memory, and executive function of 25 patients with schizophrenia in remission and 25 euthymic bipolar disorder patients with that of 25 healthy controls. Mediation analysis was used to see if residual psychopathology could explain the difference in cognitive function between the patient groups. Both patient groups performed significantly worse than healthy controls on most cognitive tests. Patients with bipolar disorder displayed cognitive deficits that were milder but qualitatively similar to those of patients with schizophrenia. Residual negative symptoms mediated the difference in performance on cognitive tests between the two groups. Neither residual general psychotic symptoms nor greater antipsychotic doses explained this relationship. The shared variance explained by the residual negative and cognitive deficits that the difference between patient groups may be explained by greater frontal cortical neurophysiological deficits in patients with schizophrenia, compared to bipolar disorder. Further longitudinal work may provide insight into pathophysiological mechanisms that underlie these deficits.

Neurocognitive impairments in euthymic patients with bipolar disorder type II

2016 ◽  
Vol 33 (S1) ◽  
pp. S122-S122
Author(s):  
R.S. Ilhan ◽  
V. Senturk-Cankorur
Keyword(s):  
Bipolar Disorder ◽  
Working Memory ◽  
Executive Functions ◽  
Verbal Memory ◽  
Rating Scale ◽  
Neurocognitive Functioning ◽  
Type I ◽  
Neurocognitive Impairments ◽  
Perseverative Errors ◽  
Disorder Type

IntroductionMost of the studies have indicated that there have been neurocognitive impairments especially in the domains of executive functions, attention, verbal and working memory among euthymic patients with bipolar disorder type I (BD-I). However, there has been limited research investigating neurocognitive functioning in euthymic patients with BD- II.Objectives/aimsAim of this study was to investigate neurocognitive functions in euthymic BD-II patients. Our hypothesis was that euthymic BD-II patients would have neurocognitive impairments in the domains of executive functions, attention, verbal and working memory.MethodsEuthymic BD-II patients (n = 37) and healthy controls (HC) (n = 35) were compared in terms of their neurocognitive functioning in the domains of executive functions assesed by the number of perseverative errors, non-perseverative errors and category completed on the Wisconsin Cart Sorting Test (WCST); working memory assessed by Auditory Consonant Trigrams (ACT); immediate verbal memory assessed by the Logical Memory subscale of the Wechsler Memory Scale I (WMS I) and attention assesed by Stroop Colour-Word Interference Test (SCWIT). Euthymic state was confirmed by the low scores both on Hamilton Depression Rating Scale, Young Mania Rating Scale.ResultsSignificant differences were found between two groups in terms of WCST non-perseverative errors (Z = 3.8, P < 0.01) and category completed subtests (Z = 3.8, P < 0.01), ACT (t = 2.97, P < 0.01) WMSI (Z = 2.4, P = 0.01), SCWIT (t = 3.52, P < 0.01) performances.ConclusionsOur study indicated that euthymic BD-II patients had poorer performance on the domains of executive functions, attention, working memory and verbal memory than the HC group. But future studies with large samples are needed to support our results.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Effect of Gender on Neurocognitive Functioning in Bipolar Disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. S213-S213 ◽  
Author(s):  
K. Tournikioti ◽  
P. Ferentinos ◽  
I. Michopoulos ◽  
D. Dikeos ◽  
C. Soldatos ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Executive Functions ◽  
Associative Learning ◽  
Verbal Memory ◽  
Visual Memory ◽  
Fixed Effects ◽  
Gender Effects ◽  
Analysis Of Covariance ◽  
Healthy Controls ◽  
Bipolar Patients

IntroductionBipolar disorder (BD) is frequently associated with cognitive deficits in attention, verbal memory and executive functions that have been related to various clinical characteristics of the disorder.ObjectivesHowever, few studies have examined the effect of gender on cognition despite its clinical relevance.AimsThe aim of our study was to investigate potential diagnosis-specific gender effects on visual memory/learning and executive functions in BD.MethodsCognitive performance of 60 bipolar-I patients and 30 healthy controls was evaluated by using CANTAB battery tasks targeting spatial memory (SRM), paired associative learning (PAL), executive functions (ID/ED, SOC). A multivariate analysis of covariance (MANCOVA) of neuropsychological parameters was performed with gender and diagnosis as fixed effects and age and education as covariates. Following univariate analyses of covariance (ANCOVA) were undertaken to examine the effect of gender on each neuropsychological task.ResultsBipolar patients showed significantly poorer performance in paired associative learning (PAL), set shifting (ID/ED) and planning (SOC). Moreover, a diagnosis specific gender effect was observed for cognitive functioning in BD (gender × diagnosis interaction P = 0.029). Specifically, male healthy controls outperformed healthy females in tasks of visual memory/learning but this pattern was not sustained (SRM) or was even reversed (PAL) in BD patients.ConclusionsThe present study is one of the few studies that have examined the effect of gender on neurocognitive function in BD. Our findings indicate that the gender-related variation observed in healthy subjects is disrupted in BD. Moreover, they suggest that gender may modulate the degree of frontotemporal dysregulation observed in BD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Cognitive Impairment in Relapsing-Remitting Multiple Sclerosis Patients with Very Mild Clinical Disability

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
S. Migliore ◽  
A. Ghazaryan ◽  
I. Simonelli ◽  
P. Pasqualetti ◽  
F. Squitieri ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Executive Functions ◽  
Cognitive Dysfunction ◽  
Cognitive Functions ◽  
Verbal Memory ◽  
Visual Memory ◽  
Clinical Stage ◽  
Relapsing Remitting ◽  
Multiple Sclerosis Patients

Cognitive dysfunction affects 40–65% of multiple sclerosis (MS) patients and can occur in the early stages of the disease. This study aimed to explore cognitive functions by means of the Italian version of the minimal assessment of cognitive function in MS (MACFIMS) in relapsing-remitting MS (RRMS) patients with very mild clinical disability to identify the primarily involved cognitive functions. Ninety-two consecutive RRMS patients with Expanded Disability Status Scale (EDSS) scores ≤ 2.5 and forty-two healthy controls (HC) were investigated. Our results show that 51.1% of MS patients have cognitive dysfunction compared to HC. An impairment of verbal and visual memory, working memory, and executive functions was found in the RRMS group. After subgrouping RRMS by EDSS, group 1 (EDSS ≤ 1.5) showed involvement of verbal memory and executive functions; moreover, group 2 (2 ≤ EDSS ≤ 2.5) patients were also impaired in information processing speed and visual memory. Our results show that utilizing a comprehensive neuropsychological assessment, approximately half of MS patients with very mild physical disability exhibit cognitive impairment with a primary involvement of prefrontal cognitive functions. Detecting impairment of executive functions at an early clinical stage of disease could be useful to promptly enroll MS patients in targeted rehabilitation.

Cognitive characteristics of unipolar (major depressive disorder) and bipolar depression

2016 ◽  
Vol 33 (S1) ◽  
pp. S374-S374 ◽  
Author(s):  
B. Suciu ◽  
R. Paunescu ◽  
I. Miclutia
Keyword(s):  
Bipolar Disorder ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Cognitive Deficits ◽  
Bipolar Depression ◽  
Cognitive Domain ◽  
Global Functioning ◽  
Major Depressive ◽  
Cognitive Domains ◽  
Depressive Episodes

IntroductionImpairment in cognitive performance is an important characteristic in many psychiatric illnesses, such as Bipolar Disorder and Major Depressive Disorder. Initially, cognitive dysfunctions were considered to be present only in acute depressive episodes and to improve after symptoms recovered. Reports have described persistent cognitive deficits even after significant improvement of depressive symptoms.Aims/ObjectivesWe wanted to understand the dimension of cognitive impairment in unipolar and bipolar depression and also to underline the differences between cognitive profiles of patients diagnosed within the two mentioned disorders.MethodThis review examined recent literature about unipolar and bipolar depression.ResultsBoth depressed patients presented cognitive deficits in several cognitive domains. Different aspects of attention were altered in both patients but impairment in shifting attention appeared specific to unipolar disorder while impaired sustained attention was particular for bipolar disorder. Both types of patients showed memory deficits that were associated with poor global functioning. Two recent studies described that bipolar depressed subjects were more impaired across all cognitive domains than unipolar depressed subjects on tests assessing verbal memory, verbal fluency, attention and executive functions. The most consistently deficits were displayed on measures of executive functioning – such as tasks requiring problem solving, planning, decision making – suggesting that this cognitive domain is a trait-marker for depression.ConclusionsCognitive deficits are present in both disorders during a depressive episode but they display slightly different patterns of impairment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

P01-223-Recovery of cognitive functioning in patients with co-occurring bipolar disorder and alcohol dependence during early remission from an acute mood episode

2011 ◽  
Vol 26 (S2) ◽  
pp. 224-224
Author(s):  
B. Levy ◽  
E. Manove ◽  
R. Weiss
Keyword(s):  
Bipolar Disorder ◽  
Alcohol Dependence ◽  
Cognitive Functioning ◽  
Cognitive Dysfunction ◽  
Verbal Memory ◽  
Visual Memory ◽  
Longitudinal Design ◽  
Dually Diagnosed ◽  
Mood Episode

IntroductionPreliminary data suggest that patients who suffer from both bipolar disorder (BD) and alcohol dependence (AD) may be more vulnerable to cognitive dysfunction than patients with a single diagnosis, especially during periods that are clinically unstable.ObjectiveThe purpose of this study was to examine the cognitive recovery of dually-diagnosed patients during remission from an acute mood disturbance.AimThe study aimed to replicate our previous comparison of cognitive functioning between BD patients with and without AD, while on the inpatient unit, and to extend this investigation in a longitudinal design post-discharge.MethodFifty-five adult inpatients with bipolar I disorder completed a neuropsychological battery, mood measures and substance abuse measures upon discharge from the hospital and at a 3 month follow up. Analyses provided group comparisons on these measures between patients who presented with co-occurrence of AD (n = 21) in the year prior to hospital admission and patients without a Substance Use Disorder (SUD; n = 34).ResultsCompared to patients without SUD, dually-diagnosed patients scored significantly more poorly on measures of visual memory, verbal memory and executive functioning both at hospital discharge and follow-up. They also exhibited more limited recovery of these functions over the course of this period. Mood symptoms decreased in both groups from discharge to follow up.ConclusionsPatients with co-occurring BD and AD may suffer from more severe cognitive dysfunction and less favorable recovery of cognitive deficits than BD patients without SUD over the course of remission from a mood episode.

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