Meta-analysis of neuropsychological functioning in euthymic bipolar disorder: an update and investigation of moderator variables

Mann-Wrobel, Monica C.; Carreno-Ponce, Jaime T.; Dickinson, Dwight

doi:10.1111/j.1399-5618.2011.00935.x

Cited by 282 publications

(247 citation statements)

References 24 publications

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“…In spite of this, there was individual variability where some patients displayed a greater neuropsychological decline, which was associated with a poorer psychosocial adaptation at the end of the follow-up. This finding endorses the fact that longitudinal studies are needed to shed more light on the relative progression of cognitive impairment in subjects with bipolar disorder (Mann-Wrobel et al 2011). The results of the follow-up studies provide clues about the disease process involved as they may contribute to the development of psychosocial and neuropsychological programmes for improving the currently low functional recovery rates in treated bipolar disorder patients (Gildengers et al 2009 ;Martínez-Arán et al 2011).…”

Section: Discussionmentioning

confidence: 87%

“…Despite current evidence, the neuropsychological profile during euthymia has not yet been well established and substantial heterogeneity has been reported (Mann-Wrobel et al 2011). Emerging data suggest that patients with bipolar disorder exhibit cognitive impairment in attention, verbal memory and executive functioning during remission (Martínez-Arán et al 2004b ;Mur et al 2007 ;Torres et al 2007 ;Mann-Wrobel et al 2011). Several studies reveal that it is important to examine cognitive performance in euthymic bipolar disorder patients since there is a strong association between neuropsychological impairment and poor psychosocial functioning outcome (Wingo et al 2009).…”

Section: Introductionmentioning

confidence: 99%

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Persistence of cognitive impairment and its negative impact on psychosocial functioning in lithium-treated, euthymic bipolar patients: a 6-year follow-up study

et al. 2012

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BackgroundPrevious cross-sectional studies report that cognitive impairment is associated with poor psychosocial functioning in euthymic bipolar patients. There is a lack of long-term studies to determine the course of cognitive impairment and its impact on functional outcome.MethodA total of 54 subjects were assessed at baseline and 6 years later; 28 had DSM-IV TR bipolar I or II disorder (recruited, at baseline, from a Lithium Clinic Program) and 26 were healthy matched controls. They were all assessed with a cognitive battery tapping into the main cognitive domains (executive function, attention, processing speed, verbal memory and visual memory) twice over a 6-year follow-up period. All patients were euthymic (Hamilton Rating Scale for Depression score lower than 8 and Young mania rating scale score lower than 6) for at least 3 months before both evaluations. At the end of follow-up, psychosocial functioning was also evaluated by means of the Functioning Assessment Short Test.ResultsRepeated-measures multivariate analysis of covariance showed that there were main effects of group in the executive domain, in the inhibition domain, in the processing speed domain, and in the verbal memory domain (p<0.04). Among the clinical factors, only longer illness duration was significantly related to slow processing (p=0.01), whereas strong relationships were observed between impoverished cognition along time and poorer psychosocial functioning (p<0.05).ConclusionsExecutive functioning, inhibition, processing speed and verbal memory were impaired in euthymic bipolar out-patients. Although cognitive deficits remained stable on average throughout the follow-up, they had enduring negative effects on psychosocial adaptation of patients.

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Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Persistence of cognitive impairment and its negative impact on psychosocial functioning in lithium-treated, euthymic bipolar patients: a 6-year follow-up study

et al. 2012

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“…The size of the WSE treatment effect for digit span backward (0.51, medium effect) is comparable to that reported by Burdick and colleagues 13 in a subset of their euthymic bipolar subjects treated with a dopamine agonist, pramipexole. A recent meta-analysis 9 of cognitive impairments in euthymic bipolar disorder individuals indicated that working memory deficits were in the large (0.8) effect size range. Furthermore, in recently manic patients who were previously employed, Bearden and colleagues 12 showed that gains in working memory, episodic memory, and executive functioning robustly predicted (odds ratio > 10) occupational recovery by 3 months.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] Medium to large effect size impairments have been reported in executive functioning, working memory, processing speed, episodic memory, fluency, and problem-solving and perceptual cognitive domains; in other words, a broad cognitive deficit although less severe than those reported in persons with schizophrenia. 9 In schizophrenia, cognitive impairments are consistently associated with poor functional outcomes. 10 Likewise, in 6 of 8 studies, cognitive impairments were linked to worse functioning in persons with bipolar disorder even after controlling for demographic, illness, and mood variables.…”

mentioning

confidence: 99%

Randomized Placebo-Controlled Adjunctive Study of an Extract ofWithania somniferafor Cognitive Dysfunction in Bipolar Disorder

Chengappa

Bowie²,

Schlicht³

et al. 2013

J. Clin. Psychiatry

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Objective:Cognitive impairments contribute significantly to inadequate functional recovery following illness episodes in bipolar disorder, yet data on treatment interventions are sparse. We assessed the cognitive effects of a standardized extract of the medicinal herb Withania somnifera (WSE) in bipolar disorder.Method: Sixty euthymic subjects with DSM-IV bipolar disorder were enrolled in an 8-week, double-blind, placebo-controlled, randomized study of WSE (500 mg/d) as a procognitive agent added adjunctively to the medications being used as maintenance treatment for bipolar disorder. Study enrollment and data analyses were completed between December 2008 and September 2012. Cognitive testing at baseline and 8 weeks assessed primary efficacy outcomes. Psychopathology and adverse events were monitored at scheduled visits.Results: Fifty-three patients completed the study (WSE, n = 24; placebo, n = 29), and the 2 groups were matched in terms of demographic, illness, and treatment characteristics. Compared to placebo, WSE provided significant benefits for 3 cognitive tasks: digit span backward (P = .035), Flanker neutral response time (P = .033), and the social cognition response rating of the Penn Emotional Acuity Test (P = .045). The size of the WSE treatment effect for digit span backward was in the medium range (Cohen d = 0.51; 95% CI, 0.25-0.77). None of the other cognitive tasks showed significant betweengroup differences. Mood and anxiety scale scores remained stable, and adverse events were minor. Conclusions:Although results are preliminary, WSE appears to improve auditory-verbal working memory (digit span backward), a measure of reaction time, and a measure of social cognition in bipolar disorder. Given the paucity of data for improving cognitive capacity in bipolar disorder, WSE offers promise, appears to have a benign side-effects profile, and merits further study.Trial Registration: ClinicalTrials.gov identifier: NCT00761761

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“…Cognitive impairment is a well-established finding in both schizophrenia (eg ) and bipolar disorder (eg Mann-Wrobel et al, 2011. The pattern of impairment appears to be broadly similar in both disorders: poor performance is seen in most or all domains of neuropsychological function, but deficits are disproportionately marked in executive function, long-term memory and sustained attention.…”

Section: Schizoaffective Disorder: Neuropsychological Findings In Relmentioning

confidence: 99%

Neuropsychological and Brain Functional Changes Across the Different Phases of Schizoaffective Disorder

Merce

Raduà

Amann

2015

European Psychiatry

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Schizoaffective disorder was first described by J. Kasanin in 1933, since then its nosology remains a matter of controversy. We aim to add further neurobiological findings to this debate.Memory and executive function were tested in 22 acutely ill schizoaffective patients; they also underwent fMRI scanning during performance of the n-back working memory test. The same measures were obtained after they had been in remission for ≥2 months. 22 matched healthy individuals were also examined.Compared to controls, acute schizoaffective patients showed reduced activation in the DLPFC and also a failure of deactivation in the medial frontal cortex (1).In clinical remission, schizomanic patients showed an improvement of memory but not of executive function, while schizodepressive patients did not change in either domain. All schizoaffective patients in clinical remission showed memory and executive impairment compared to the controls. On fMRI, acutely ill schizomanic patients had reversible frontal hypo-activation when compared to clinical remission, while activation patterns in ill and remitted schizodepressive patients were similar. The whole group of schizoaffective patients in clinical remission showed a failure of de-activation in the medial frontal gyrus compared to the healthy controls. There was evidence for memory improvement and state dependent changes in activation in schizomanic patients across relapse and remission (2).The results demonstrate that schizoaffective disorder is characterized by medial frontal failure of deactivation and hence default mode network dysfunction (3), which is present during both active illness and remission suggesting that it is a trait factor for the disorder.

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Meta-analysis of neuropsychological functioning in euthymic bipolar disorder: an update and investigation of moderator variables

Cited by 282 publications

References 24 publications

Persistence of cognitive impairment and its negative impact on psychosocial functioning in lithium-treated, euthymic bipolar patients: a 6-year follow-up study

Persistence of cognitive impairment and its negative impact on psychosocial functioning in lithium-treated, euthymic bipolar patients: a 6-year follow-up study

Randomized Placebo-Controlled Adjunctive Study of an Extract ofWithania somniferafor Cognitive Dysfunction in Bipolar Disorder

Neuropsychological and Brain Functional Changes Across the Different Phases of Schizoaffective Disorder

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