Predictors of the discrepancy between objective and subjective cognition in bipolar disorder: a novel methodology

Abstract

Objective neuropsychological assessment seems especially warranted in patients with (residual) mood symptoms, BD type II, chronic illness, and/or high IQ for correct identification of cognitive deficits before commencement of treatments targeting cognition.

Assessing and addressing cognitive impairment in bipolar disorder: the International Society for Bipolar Disorders Targeting Cognition Task Force recommendations for clinicians

“…At the same time, subjective assessments would also miss a considerable group of patients with unreported objective cognitive impairments due to poor insight or limited metacognitive capacity . Specifically, patients with BD may underreport difficulties within processing speed, attention and executive function domains . This is in keeping with emerging evidence that deficits in processing speed and attention domains are often mistaken for memory problems because failure to pay attention to and process information hampers subsequent recall of this information .…”

“…This implies that it is not always the patients with the most subjective complaints who show greatest objective impairments and vice versa. Indeed, patients’ insight into their own cognitive abilities relies on several factors, including metacognitive capacity and severity of mood symptoms . Since 30‐50% of remitted patients are objectively cognitively intact in comparison with norms despite subjective cognitive complaints, relying purely on subjectively reported difficulties could lead to a high false positive rate.…”

“…Brief cognitive screening is valuable for three key reasons: (i) to detect cognitive impairment, (ii) to identify those who are relatively cognitively intact in comparison with norms, and (iii) to track cognition over time. First, screening for objective cognitive impairment is clinically important for patients with symptoms of depression or mania close to the clinical threshold, since these patients tend to display greater subjective problems than objective impairment . Objective neurocognitive screening assessment can clarify whether their subjective cognitive difficulties and/or socio‐occupational problems are a consequence of objective cognitive impairment or secondary to other factors, such as residual mood symptoms or difficulties applying cognitive skills in complex daily life.…”

Methodological recommendations for cognition trials in bipolar disorder by the International Society for Bipolar Disorders Targeting Cognition Task Force

“…Indeed, the correlation between subjective and objective measures of cognition is poor, indicating that it is not always the patients with most subjective complaints who show greatest objective deficits and vice versa. This discrepancy seems to be influenced by patients’ clinical characteristics, with disproportionately more subjective than objective cognitive impairment in patients with greater subsyndromal depression or mania symptom severity, bipolar disorder type II (vs type I), and greater illness chronicity …”

Preparando el escenario para dejar de fumar en el paciente con Trastorno Bipolar: intervención breve en la práctica clínica

“…Se puede extrapolar alguna evidencia indirecta, sin embargo, a partir de estudios de fumadores con esquizofrenia o sin trastornos psiquiátricos. En un conjunto de ensayos clínicos con placebo controlado, la disfunción basal, medida a través de la atención sostenida, la memoria de trabajo espacial y la cognición ejecutiva, se ha asociado al fracaso del tratamiento para el tabaquismo en fumadores con esquizofrenia que buscaban tratamiento (Moss et al, 2009). Subrayamos que la esquizofrenia y el TB comparten un núcleo de disfunción neurocognitiva, con altos índices de dependencia comórbida de la nicotina y bajos índices de abstinencia tabáquica.…”