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The effect of overweight/obesity on cognitive function in euthymic individuals with bipolar disorder

Published online by Cambridge University Press:  15 April 2020

C.Y. Yim ,
J.K. Soczynska ,
S.H. Kennedy ,
H.O. Woldeyohannes ,
E. Brietzke  and
R.S. McIntyre
C.Y. Yim
Affiliation:
Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada Psychiatry and Pharmacology, Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8 Canada
J.K. Soczynska
Affiliation:
Psychiatry and Pharmacology, Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8 Canada Institute of Medical Science, University of Toronto, Toronto, ON, Canada
S.H. Kennedy
Affiliation:
Psychiatry and Pharmacology, Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8 Canada Institute of Medical Science, University of Toronto, Toronto, ON, Canada Department of Psychiatry, University of Toronto, Toronto, ON, Canada
H.O. Woldeyohannes
Affiliation:
Psychiatry and Pharmacology, Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8 Canada
E. Brietzke
Affiliation:
Bipolar Disorder Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
R.S. McIntyre*
Affiliation:
Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada Psychiatry and Pharmacology, Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8 Canada Institute of Medical Science, University of Toronto, Toronto, ON, Canada Department of Psychiatry, University of Toronto, Toronto, ON, Canada
*
*Corresponding author. Tel.: +416 603 5279; fax: +416 603 5368. roger.mcintyre@uhn.on.ca (R.S. McIntyre).
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Abstract

Background

Persistent impairment in cognitive function has been described in euthymic individuals with bipolar disorder. Collective work indicates that obesity is associated with reduced cognitive function in otherwise healthy individuals. This sub-group post-hoc analysis preliminarily explores and examines the association between overweight/obesity and cognitive function in euthymic individuals with bipolar disorder.

Methods

Euthymic adults with DSM-IV-TR-defined bipolar I or II disorder were enrolled. Subjects included in this post-hoc analysis (n = 67) were divided into two groups (normal weight, body mass index [BMI] of 18.5–24.9kg/m2; overweight/obese, BMI≥25.0kg/m2). Demographic and clinical information were obtained at screening. At baseline, study participants completed a comprehensive cognitive battery to assess premorbid IQ, verbal learning and memory, attention and psychomotor processing speed, executive function, general intellectual abilities, recollection and habit memory, as well as self-perceptions of cognitive failures.

Results

BMI was negatively correlated with attention and psychomotor processing speed as measured by the Digit Symbol Substitution Test (P<0.01). Overweight and obese bipolar individuals had a significantly lower score on the Verbal Fluency Test when compared to normal weight subjects (P<0.05). For all other measures of cognitive function, non-significant trends suggesting a negative association with BMI were observed, with the exception of measures of executive function (i.e. Trail Making Test B) and recollection memory (i.e. process-dissociation task).

Conclusion

Notwithstanding the post-hoc methodology and relatively small sample size, the results of this study suggest a possible negative effect of overweight/obesity on cognitive function in euthymic individuals with bipolar disorder. Taken together, these data provide the impetus for more rigorous evaluation of the mediational role of overweight/obesity (and other medical co-morbidity) on cognitive function in psychiatric populations.

Keywords

OverweightObesityCognitive functionEuthymicBipolar

Information

Type
Original articles
Information
European Psychiatry , Volume 27 , Issue 3 , April 2012 , pp. 223 - 228
Copyright
Copyright © Elsevier Masson SAS 2012

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References

American Psychiatric Association, American Psychiatric Association, Task Force on DSM-IV. Diagnostic and statistical manual of mental disorders. DSM-IV-TR. 4th ed., text revision ed. Washington, DC: American Psychiatric Association; 2000.Google Scholar
Bearden, C.E., Hoffman, K.M., Cannon, T.D.The neuropsychology and neuroanatomy of bipolar affective disorder: a critical review. Bipolar Disord. 3 3: 2001 106–150.CrossRefGoogle ScholarPubMed
Benton, A.L., Hamsher, K.Multilingual aphasia examination. Iowa City: University of Iowa; 1976.Google Scholar
Bora, E., Yucel, M., Pantelis, C.Cognitive endophenotypes of bipolar disorder: a meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. J Affect Disord. 113 1–2: 2009 1–20.CrossRefGoogle ScholarPubMed
Broadbent, D.E., Cooper, P.F., FitzGerald, P., Parkes, K.R.The Cognitive Failures Questionnaire (CFQ) and its correlates. Br J Clin Psychol. 21 Pt 1 1982 1–16.CrossRefGoogle ScholarPubMed
Brook, J.S., Zhang, C., Saar, N.S., Brook, D.W.Psychosocial predictors, higher body mass index, and aspects of neurocognitive dysfunction. Percept Mot Skills. 108 1: 2009 181–195.CrossRefGoogle ScholarPubMed
Bruce-Keller, A.J., Keller, J.N., Morrison, C.D.Obesity and vulnerability of the CNS. Biochim Biophys Acta. 1792 5: 2009 395–400.CrossRefGoogle ScholarPubMed
Calkin, C., van, D.V., Ruzickova, M., Slaney, C., Garnham, J., Hajek, T.et al.Can body mass index help predict outcome in patients with bipolar disorder?. Bipolar Disord. 11 6: 2009 650–656.CrossRefGoogle ScholarPubMed
Capuron, L., Miller, A.H.Cytokines and psychopathology: lessons from interferon-alpha. Biol Psychiatry. 56 11: 2004 819–824.CrossRefGoogle ScholarPubMed
Cohen, R.A.Obesity-associated cognitive decline: excess weight affects more than the waistline. Neuroepidemiology. 34 4: 2010 230–231.CrossRefGoogle Scholar
Cournot, M., Marquie, J.C., Ansiau, D., Martinaud, C., Fonds, H., Ferrieres, J.et al.Relation between body mass index and cognitive function in healthy middle-aged men and women. Neurology. 67 7: 2006 1208–1214.CrossRefGoogle ScholarPubMed
Delis, D.C., Kramer, J.H., Kaplan, E., Ober, B.A.California Verbal Learning Test: CVLT-II. New York, NY: Psychological Corporation; 2000.Google Scholar
Drevets, W.C., Price, J.L., Furey, M.L.Brain structural and functional abnormalities in mood disorders: implications for neurocircuitry models of depression. Brain Struct Funct. 213 1–2: 2008 93–118.CrossRefGoogle ScholarPubMed
Elias, M.F., Elias, P.K., Sullivan, L.M., Wolf, P.A., D’Agostino, R.B.Obesity, diabetes and cognitive deficit: The Framingham Heart Study. Neurobiol Aging. 26 suppl. 1: 2005 11–16.CrossRefGoogle ScholarPubMed
Fagiolini, A., Frank, E., Houck, P.R., Mallinger, A.G., Swartz, H.A., Buysse, D.J.et al.Prevalence of obesity and weight change during treatment in patients with bipolar I disorder. J Clin Psychiatry. 63 6: 2002 528–533.CrossRefGoogle ScholarPubMed
Fergenbaum, J.H., Bruce, S., Lou, W., Hanley, A.J., Greenwood, C., Young, T.K.Obesity and lowered cognitive performance in a Canadian First Nations population. Obesity (Silver Spring). 17 10: 2009 1957–1963.CrossRefGoogle Scholar
Friedman, E.S.Cognitive deficits in bipolar individuals: implications for clinical practice. CNS Neurosci Ther. 15 4: 2009 305–306.CrossRefGoogle ScholarPubMed
Goodwin, F.K., Jamison, K.R., Ghaemi, S.N.Manic-depressive illness. Bipolar disorders and recurrent depression. 2nd ed 2007 Oxford University Press New York.Google Scholar
Gunstad, J., Paul, R.H., Cohen, R.A., Tate, D.F., Spitznagel, M.B., Gordon, E.Elevated body mass index is associated with executive dysfunction in otherwise healthy adults. Compr Psychiatry. 48 1: 2007 57–61.CrossRefGoogle ScholarPubMed
Gunstad, J., Spitznagel, M.B., Paul, R.H., Cohen, R.A., Kohn, M., Luyster, F.S.et al.Body mass index and neuropsychological function in healthy children and adolescents. Appetite. 50 2–3: 2008 246–251.CrossRefGoogle ScholarPubMed
Jacoby, L.L.Invariance in automatic influences of memory: toward a user's guide for the process-dissociation procedure. J Exp Psychol Learn Mem Cogn. 24 1: 1998 3–26.CrossRefGoogle Scholar
Jamrozinski K. Do euthymic bipolar patients have normal cognitive functioning? Curr Opin Psychiatry 2010;23(3):255–60.CrossRefGoogle Scholar
Jeong, S.K., Nam, H.S., Son, M.H., Son, E.J., Cho, K.H.Interactive effect of obesity indexes on cognition. Dement Geriatr Cogn Disord. 19 2–3: 2005 91–96.CrossRefGoogle ScholarPubMed
Lezak, M., Howieson, D., Loring, D.Neuropsychological assessment. 4th ed 2004 Oxford University Press New York.Google Scholar
Malhi, G.S., Ivanovski, B., Hadzi-Pavlovic, D., Mitchell, P.B., Vieta, E., Sachdev, P.Neuropsychological deficits and functional impairment in bipolar depression, hypomania and euthymia. Bipolar Disord. 9 1–2: 2007 114–125.CrossRefGoogle ScholarPubMed
Martinez-Aran, A., Vieta, E., Colom, F., Reinares, M., Benabarre, A., Gasto, C.et al.Cognitive dysfunctions in bipolar disorder: evidence of neuropsychological disturbances. Psychother Psychosom. 69 1: 2000 2–18.CrossRefGoogle ScholarPubMed
Martinez-Aran, A., Vieta, E., Reinares, M., Colom, F., Torrent, C., Sanchez-Moreno, J.et al.Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder. Am J Psychiatry. 161 2: 2004 262–270.CrossRefGoogle ScholarPubMed
Martinez-Aran, A., Vieta, E., Colom, F., Torrent, C., Sanchez-Moreno, J., Reinares, M.et al.Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disord. 6 3: 2004 224–232.CrossRefGoogle ScholarPubMed
Martinez-Aran, A., Vieta, E., Torrent, C., Sanchez-Moreno, J., Goikolea, J.M., Salamero, M.et al.Functional outcome in bipolar disorder: the role of clinical and cognitive factors. Bipolar Disord. 9 1–2: 2007 103–113.CrossRefGoogle ScholarPubMed
McElroy SL, Frye MA, Hellemann G, Altshuler L, Leverich GS, Suppes T, et al. Prevalence and correlates of eating disorders in 875 patients with bipolar disorder. J Affect Disord 2010;128(3):191–8.CrossRefGoogle Scholar
McElroy, S.L., Frye, M.A., Suppes, T., Dhavale, D., Keck, P.E. Jr.Leverich, G.S.et al.Correlates of overweight and obesity in 644 patients with bipolar disorder. J Clin Psychiatry. 63 3: 2002 207–213.CrossRefGoogle ScholarPubMed
McIntyre, R.S., Konarski, J.Z.Bipolar disorder: a national health concern. CNS Spectr. 9 11 Suppl. 12 2004 6–15.CrossRefGoogle ScholarPubMed
McIntyre, R.S., Konarski, J.Z., Mancini, D.A., Fulton, K.A., Parikh, S.V., Grigoriadis, S.et al.Measuring the severity of depression and remission in primary care: validation of the HAMD-7 scale. CMAJ. 173 11: 2005 1327–1334.CrossRefGoogle ScholarPubMed
McIntyre, R.S., Konarski, J.Z., Wilkins, K., Soczynska, J.K., Kennedy, S.H.Obesity in bipolar disorder and major depressive disorder: results from a national community health survey on mental health and well-being. Can J Psychiatry. 51 5: 2006 274–280.CrossRefGoogle ScholarPubMed
McIntyre, R.S., Nguyen, H.T., Soczynska, J.K., Lourenco, M.T., Woldeyohannes, H.O., Konarski, J.Z.Medical and substance-related co-morbidity in bipolar disorder: translational research and treatment opportunities. Dialogues Clin Neurosci. 10 2: 2008 203–213.Google ScholarPubMed
McIntyre, R.S., Kenna, H.A., Nguyen, H.T., Law, C.W., Sultan, F., Woldeyohannes, H.O.et al.Brain volume abnormalities and neurocognitive deficits in diabetes mellitus: points of pathophysiological commonality with mood disorders?. Adv Ther. 27 2: 2010 63–80.CrossRefGoogle ScholarPubMed
National Heart LaBI, National Institute of Diabetes and Digestive and Kidney Diseases (Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults). The evidence report. Bethesda, Md.: National Heart, Lung, and Blood Institute in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases; 1998.Google Scholar
Nelson HE, Willison JR. The revised National Adult Reading Test-Test Manual. Windsor: NFER-Nelson; 1991.Google Scholar
Nilsson, L.G., Nilsson, E.Overweight and cognition. Scand J Psychol. 50 6: 2009 660–667.CrossRefGoogle ScholarPubMed
Reitan, R.Validity of the Trail Making Test as an indicator of organic brain damage. Percept Mot Skills. 1958; 8: 271–276.CrossRefGoogle Scholar
Robinson, L.J., Thompson, J.M., Gallagher, P., Goswami, U., Young, A.H., Ferrier, I.N.et al.A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. J Affect Disord. 93 1–3: 2006 105–115.CrossRefGoogle ScholarPubMed
Sheehan, D.V., Lecrubier, Y., Sheehan, K.H., Amorim, P., Janavs, J., Weiller, E.et al.The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 59 suppl. 20: 1998 22–33.Google ScholarPubMed
Thompson, J.M., Gallagher, P., Hughes, J.H., Watson, S., Gray, J.M., Ferrier, I.N.et al.Neurocognitive impairment in euthymic patients with bipolar affective disorder. Br J Psychiatry. 2005; 186: 32–40.CrossRefGoogle ScholarPubMed
Volkow, N.D., Wang, G.J., Telang, F., Fowler, J.S., Goldstein, R.Z., Alia-Klein, N.et al.Inverse association between BMI and prefrontal metabolic activity in healthy adults. Obesity (Silver Spring). 17 1: 2009 60–65.CrossRefGoogle ScholarPubMed
Walther, K., Birdsill, A.C., Glisky, E.L., Ryan, L.Structural brain differences and cognitive functioning related to body mass index in older females. Hum Brain Mapp. 31 7: 2010 1052–1064.CrossRefGoogle ScholarPubMed
Wechsler, D.Wechsler Adult Intelligence Scale: WAIS-III. Manual. San Antonio, TX: The Psychological Corporation; 1997.Google Scholar
Wingo, A.P., Harvey, P.D., Baldessarini, R.J.Neurocognitive impairment in bipolar disorder patients: functional implications. Bipolar Disord. 11 2: 2009 113–125.CrossRefGoogle ScholarPubMed
Yatham, L.N., Kennedy, S.H., O’Donovan, C., Parikh, S., MacQueen, G., McIntyre, R.et al.Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: consensus and controversies. Bipolar Disord. 7 suppl. 3: 2005 5–69.CrossRefGoogle ScholarPubMed
Young, R.C., Biggs, J.T., Ziegler, V.E., Meyer, D.A.A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978; 133: 429–435.CrossRefGoogle ScholarPubMed
Zachary, R.A.Shipley Institute of Living Scale: revised manual. Los Angeles: Western Psychological Services; 2000.Google Scholar
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