The longitudinal course of cognition in older adults with bipolar disorder

Abstract

Objectives-Epidemiological studies suggest that elders with bipolar disorder (BD) may be at increased risk for dementia compared to the general population. We sought to investigate whether older adults with BD would present with more cognitive dysfunction than expected for their age and education, and whether they would experience a more rapid cognitive decline over three-year prospective follow-up.Methods-Thirty-three subjects age ≥ 50, mean (SD) age 69.7 (7.9) years, with BD I (n = 28) and II (n = 5) had neuropsychological examination at baseline and longitudinally over three years. All subjects were administered the Dementia Rating Scale (DRS) when euthymic. Thirty-six mentally healthy comparators ('controls'), equated on age and education, were selected from ongoing studies in our research center examining the longitudinal relationship between late-life mood disorders and cognitive function.Results-Compared to mentally healthy comparators, subjects with BD performed significantly worse on the DRS at baseline [mean (SD) 135.2 (4.7); n = 33 versus 139.5 (3.3); n = 36], and over follow-up [131.9 (7.7); n = 14 versus 139.1 (3.4); n = 22]. There was a group-by-time interaction between the subjects with BD and the controls [group × time: F(1,64) = 5.07, p = 0.028].Conclusions-In our study, older adults with BD had more cognitive dysfunction and more rapid cognitive decline than expected given their age and education. Cognitive dysfunction and accelerated cognitive decline may lead to decreased independence, with increased reliance on family and community supports, and potential placement in assisted-living facilities. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptMore than 30 cross-sectional studies have revealed cognitive impairments in mixed-aged adults with bipolar disorder (BD) that are present even with symptomatic recovery (1-4). Deficits have been identified in multiple cognitive domains, including information processing speed (5,6), executive function (5-10), memory (7,(11)(12)(13)(14), attention/concentration (15,16), and visual-spatial abilities (17,18). In turn, cognitive impairment has been associated with impairment in functional abilities (5,6,13). Epidemiologic studies have suggested that BD is associated with increased risk of developing dementia (19)(20)(21).Despite the large number of cross-sectional studies, to our knowledge, there have been just six published studies on the longitudinal course of cognitive function in BD patients of any age (22-27), with only one study focused on older adults (23). This study by Dhingra and Rabins (23) used the Mini-Mental State Exam (MMSE) (28) to follow older patients for 5-7 years after they were hospitalized for mania. The investigators found that 8 (32%) of the 25 BD subjects followed-up experienced a decline in their MMSE to a score below 24 (indicating significant cognitive impairment), including 5 subjects (20%) who became so cognitively impaired that they required nursing home placement. Although no control group wa...

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013

“…Older adults with BD have been shown to have greater levels of cognitive dysfunction than age-matched mentally healthy control subjects (272)(273)(274)(275). Among older patients with BD, a greater burden from vascular risk factors has been associated with poorer outcomes on some cognitive measures (276,277).…”

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

“…There is an actual lack of longitudinal studies in the current literature foreclosing the possibility to determine the evolution of cognition (Balanzá-Martínez et al 2005 ;Burdick et al 2006 ;Mur et al 2008 ;Tabarés-Seisdedos et al 2008) and psychosocial functioning (Martino et al 2009 ;Bonnín et al 2010 ;Burdick et al 2010) in euthymic bipolar patients. Furthermore, the cognitive follow-up of these patients becomes crucial for providing tools to administer the most suitable pharmacological and psychosocial treatment strategies (Gildengers et al 2009). …”

The use of the Clock Drawing Test in bipolar disorder with or without dementia of Alzheimer’s type

“…Previous studies evaluating verbal fluency in adults with BD produced inconsistent results. Four of these studies reported some degree of impairment in euthymic BD subjects 6,8,24,25 , whereas four other studies did not report any clinically significant difference between BD subjects and healthy controls 26,27,28,29,30 . On the other hand, studies exploring the performance of the CDT among BD subjects are sparse.…”

“…In spite of a presumed stability of the cognitive impairment among the majority of patients through their life span, these deficits seems clinically important interfering negatively in functional capacity and exerting a negative effect on the global prognosis of these patients 15 . Additionally, the characterization and follow-up of these cognitive deficits are relevant since the risk to develop dementia among BD patients is almost three times higher especially among older patients, when compared to non-BD age-matched population 11,12,30 . In this matter, the identification of cognitive impairments cannot only rely on neuropsychological evaluation because of cost and time consuming, and the utilization of brief and common tests such as the CDT are of utmost interest.…”