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Cognitive deficits in bipolar disorder: from acute episode to remission

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Abstract

Considerable evidence demonstrates that neuropsychological deficits are prevalent in bipolar disorder during both acute episodes and euthymia. However, it is less clear whether these cognitive disturbances are state- or trait-related. We here present the first longitudinal study employing a within-subject pre- and post-testing examining acutely admitted bipolar patients (BP) in depression or mania and during euthymia, aiming to identify cognitive performance from acute illness to remission. Cognitive performance was measured during acute episodes and repeated after at least 3 months of remission. To do so, 55 BP (35 depressed, 20 hypo-/manic) and 55 healthy controls (HC) were tested with a neuropsychological test battery (attention, working memory, verbal memory, executive functioning). The results showed global impairments in acutely ill BP compared to HC: depressed patients showed a characteristic psychomotor slowing, while manic patients had severe deficits in executive functioning. Twenty-nine remitted BP could be measured in the follow-up (dropout rate 48 %), whose cognitive functions partially recovered, whereas working memory and verbal memory were still impaired. However, we found that subthreshold depressive symptoms and persisting sleep disturbances in euthymic BP were associated with reduced speed, deficits in attention and verbal memory, while working memory was correlated with psychotic symptoms (lifetime). This result indicates working memory as trait related for a subgroup of BP with psychotic symptoms. In contrast, attention and verbal memory are negatively influenced by state factors like residual symptoms, which should be more considered as possible confounders in the search of cognitive endophenotypes in remitted BP.

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Acknowledgments

We acknowledge all participants who took part in the present study. JV was supported by a grant of the German Excellence Initiative to the Graduate School of Life Sciences, University of Wuerzburg. JK and AR received support by the DFG and Laender funds RTG 1253/2 “Gk emotions”, AR and KZ received support by the DFG-funded study “earlyCBT” (BA 1504/7-1), AR and MAS received support by the DFG-funded study SFB TRR 58 Z02, and AR was supported by the Comprehensive Heart Failure Center Wuerzburg funded by the BMBF (project 01EO1004).

Author contributions

JV and AR designed the study and wrote the protocol. JV assisted the literature searches and analyses, undertook the statistical analysis, and wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.

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Authors and Affiliations

  1. Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University, Heinrich-Hoffmann-Straße 10, 60528, Frankfurt am Main, Germany

    J. Volkert, J. Kopf, S. Kittel-Schneider & A. Reif

  2. Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, 97080, Würzburg, Germany

    M. A. Schiele, Julia Kazmaier, Friederike Glaser & K. C. Zierhut

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  1. J. Volkert
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Volkert, J., Schiele, M.A., Kazmaier, J. et al. Cognitive deficits in bipolar disorder: from acute episode to remission. Eur Arch Psychiatry Clin Neurosci 266, 225–237 (2016). https://doi.org/10.1007/s00406-015-0657-2

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