Skip to main content Accessibility help
×
Home

Do premorbid and post-onset cognitive functioning differ between schizophrenia and bipolar disorder? A systematic review and meta-analysis

  • A. Trotta (a1), R. M. Murray (a1) and J. H. MacCabe (a1)

Abstract

Background

Schizophrenia (SZ) is characterized by a broad global cognitive impairment that precedes the onset of the disease. By contrast, some studies suggest that premorbid deficits are absent, or even reversed, in bipolar disorder (BD). However, studies have shown impairments in cognitive functioning after the illness onset in both disorders. The aim of this study was to systematically review and meta-analyze those studies that compared premorbid and/or post-onset global cognitive function between SZ and BD.

Method

We searched Medline (PubMed), EMBASE and PsycINFO for studies where information on cognitive functioning was collected in both SZ and BD within the same study or using the same methods.

Results

Compared to healthy comparison groups, SZ patients showed a significant premorbid cognitive impairment [standardized mean difference (SMD) −0.597, 95% confidence interval (CI) −0.707 to −0.487, p < 0.0001] and a large post-onset impairment (SMD −1.369, 95% CI −1.578 to −1.160, p < 0.0001). We found small significant deficits in premorbid intellectual function in the BD group when this was assessed retrospectively (−0.147, 95% CI −0.238 to −0.056, p = 0.001) but not prospectively (−0.029, 95% CI −0.199 to + 0.142, p = 0.744), and moderate cognitive impairment after onset (SMD −0.623, 95% CI −0.717 to −0.529, p < 0.0001).

Conclusions

SZ is characterized by significant deficits in premorbid intellectual function but the evidence regarding premorbid function in BD is equivocal. After illness onset, patients with both disorders seem to suffer a further decline in cognitive function but the magnitude of the impairment remains greater in SZ than in BD.

Copyright

Corresponding author

* Address for correspondence: Dr A. Trotta, PO52 Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. (Email: antonella.a.trotta@kcl.ac.uk)

References

Hide All
APA (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. DSM-5. American Psychiatric Association: Washington, DC.
Aylward, E, Walker, E, Bettes, B (1984). Intelligence in schizophrenia: meta-analysis of the research. Schizophrenia Bulletin 10, 430459.
Bergen, SE, O'Dushlaine, CT, Ripke, S, Lee, PH, Ruderfer, DM, Akterin, S, Moran, JL, Chambert, KD, Handsaker, RE, Backlund, L, Ösby, U, McCarroll, S, Landen, M, Scolnick, EM, Magnusson, PK, Lichtenstein, P, Hultman, CM, Purcell, SM, Sklar, P, Sullivan, PF (2012). Genome-wide association study in a Swedish population yields support for greater CNV and MHC involvement in schizophrenia compared with bipolar disorder. Molecular Psychiatry 17, 880886.
Booker, BH, Cyr, JJ (1986). Tables for clinicians to use to convert WAIS-R short forms. Journal of Clinical Psychology 42, 982986.
Canavan, AGM, Dunn, G, McMillan, TM (1986). Principal components of the WAIS-R. British Journal of Clinical Psychology 25, 8185.
Cohen, J (1969). Statistical Power Analysis for the Behavioral Sciences. Academic Press: New York, NY.
Craddock, N, Owen, MJ (2005). The beginning of the end for the Kraepelinian dichotomy. British Journal of Psychiatry 186, 364366.
Crow, TJ (2008). Craddock & Owen vs Kraepelin: 85 years late, mesmerised by ‘polygenes’. Schizophrenia Research 103, 156160.
Cyr, JJ, Booker, BH (1984). Use of appropriate formulas for selecting WAIS-R short forms. Journal of Consulting and Clinical Psychology 52, 903905.
Deary, IJ, Strand, P, Smith, P, Fernandes, C (2007). Intelligence and educational achievement. Intelligence 35, 1321.
Demjaha, A, MacCabe, JH, Murray, RM (2012). How genes and environmental factors determine the different neurodevelopmental trajectories of schizophrenia and bipolar disorder. Schizophrenia Bulletin 38, 209214.
DerSimonian, R, Laird, N (1986). Meta-analysis in clinical trials. Controlled Clinical Trials 7, 177188.
Egger, M, Davey Smith, G, Schneider, M, Minder, C (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal 315, 629634.
Fromer, M, Pocklington, AJ, Kavanagh, DH, Williams, HJ, Dwyer, S, Gormley, P, Georgieva, L, Rees, E, Palta, P, Ruderfer, DM, Carrera, N, Humphreys, I, Johnson, JS, Roussos, P, Barker, DD, Banks, E, Milanova, V, Grant, SG, Hannon, E, Rose, SA, Chambert, K, Mahajan, M, Scolnick, EM, Moran, JL, Kirov, G, Palotie, A, McCarroll, SA, Holmans, P, Sklar, P, Owen, MJ, Purcell, SM, O'Donovan, MC (2014). De novo mutations in schizophrenia implicate synaptic networks. Nature 506, 179184.
Harvey, PD, Wingo, AP, Burdick, KE, Baldessarini, RJ (2010). Cognition and disability in bipolar disorder: lessons from schizophrenia research. Bipolar Disorders 12, 364375.
Higgins, JPT, Thompson, SG, Deeks, JJ, Altman, DG (2003). Measuring inconsistency in meta-analyses. British Medical Journal 327, 557560.
Jastak, S, Wilkinson, G (1984). Wide Range Achievement Test: Manual of Instructions. Jastak Associates: Wilmington, DE.
Koenen, KC, Moffitt, TE, Roberts, AL, Martin, LT, Kubzansky, L, Harrington, H, Poulton, R, Caspi, A (2009). Childhood IQ and adult mental disorders: a test of the cognitive reserve hypothesis. American Journal of Psychiatry 166, 5057.
Lett, TA, Zai, CC, Tiwari, AK, Shaikh, SA, Likhodi, O, Kennedy, JL, Müller, DJ (2011). ANK3, CACNA1C and ZNF804A gene variants in bipolar disorders and psychosis subphenotype. World Journal of Biological Psychiatry 12, 392397.
Lichtenstein, P, Yip, BH, Björk, C, Pawitan, Y, Cannon, TD, Sullivan, PF, Hultman, CM (2009). Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study. Lancet 373, 234239.
Lodge, DJ, Grace, AA (2011). Developmental pathology, dopamine, stress and schizophrenia. International Journal of Developmental Neuroscience 29, 207213.
MacCabe, JH (2008). Population-based cohort studies on premorbid cognitive function in schizophrenia. Epidemiologic Reviews 30, 7783.
MacCabe, JH, Lambe, MP, Cnattingius, S, Sham, PC, David, AS, Reichenberg, A, Murray, RM, Hultman, CM (2010). Excellent school performance at age 16 and risk of adult bipolar disorder: national cohort study. British Journal of Psychiatry 196, 109115.
MacCabe, JH, Lambe, MP, Cnattingius, S, Torrång, A, Björk, C, Sham, PC, David, AS, Murray, RM, Hultman, CM (2008). Scholastic achievement at age 16 and risk of schizophrenia and other psychoses: a national cohort study. Psychological Medicine 38, 11331140.
Martino, DJ, Strejilevich, SA, Scapola, M, Igoa, A, Marengo, E, Ais, ED, Perinot, L (2008). Heterogeneity in cognitive functioning among patients with bipolar disorder. Journal of Affective Disorders 109, 149156.
Murray, RM, Sham, P, van Os, J, Zanelli, J, Cannon, M, McDonald, C (2004). A developmental model for similarities and dissimilarities between schizophrenia and bipolar disorder. Schizophrenia Research 71, 405416.
Nelson, HE (1982). National Adult Reading Test (NART): Test Manual. NFER-Nelson: Windsor.
Nelson, HE, McKenna, P (1975). The use of current reading ability in the assessment of dementia. British Journal of Social and Clinical Psychology 14, 259267.
Rees, E, Walters, JT, Georgieva, L, Isles, AR, Chambert, KD, Richards, AL, Mahoney-Davies, G, Legge, SE, Moran, JL, McCarroll, SA, O'Donovan, MC, Owen, MJ, Kirov, G (2014). Analysis of copy number variations at 15 schizophrenia-associated loci. British Journal of Psychiatry 204, 108114.
Schretlen, DJ, Cascella, NG, Meyer, SM, Kingery, LR, Testa, SM, Munro, CA, Pulver, AE, Rivkin, P, Rao, VA, Diaz-Asper, CM, Dickerson, FB, Yolken, RH, Pearlson, GD (2007). Neuropsychological functioning in bipolar disorder and schizophrenia. Biological Psychiatry 62, 179186.
Schumacher, J, Jamra, RA, Freudenberg, J, Becker, T, Ohlraun, S, Otte, AC, Tullius, M, Kovalenko, S, Bogaert, AV, Maier, W, Rietschel, M, Propping, P, Nöthen, MM, Cichon, S (2004). Examination of G72 and D-amino-acid oxidase as genetic risk factors for schizophrenia and bipolar affective disorder. Molecular Psychiatry 9, 203207.
Shifman, S, Bronstein, M, Sternfeld, M, Pisanté, A, Weizman, A, Reznik, I, Spivak, B, Grisaru, N, Karp, L, Schiffer, R, Kotler, M, Strous, RD, Swartz-Vanetik, M, Knobler, HY, Shinar, E, Yakir, B, Zak, NB, Darvasi, A (2004). COMT: a common susceptibility gene in bipolar disorder and schizophrenia. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics 128, 6164.
Stefanopoulou, E, Manoharan, A, Landau, S, Geddes, JR, Goodwin, G, Frangou, S (2009). Cognitive functioning in patients with affective disorders and schizophrenia: a meta-analysis. International Review of Psychiatry 21, 336356.
Stroup, DF, Berlin, JA, Morton, SC, Olkin, I, Williamson, GD, Rennie, D, Moher, D, Becker, BJ, Sipe, TA, Thacker, SB (2000). Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. Journal of the American Medical Association 283, 20082012.
Wechsler, D (2007). Wechsler Memory Scale – Third Edition (WMS-III). Norwegian Manual. Pearson Assessment: Stockholm.
WHO (1992). The ICD-10 Classification of Mental and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.
Woodberry, KA, Giuliano, AJ, Seidman, LJ (2008). Premorbid IQ in schizophrenia: a meta-analytic review. American Journal of Psychiatry 165, 579587.
Zipursky, RB, Reilly, TJ, Murray, RM (2012). The myth of schizophrenia as a progressive brain disease. Schizophrenia Bulletin 39, 13631372.

Keywords

Type Description Title
WORD
Supplementary materials

Trotta Supplementary Material
Appendix

 Word (39 KB)
39 KB

Do premorbid and post-onset cognitive functioning differ between schizophrenia and bipolar disorder? A systematic review and meta-analysis

  • A. Trotta (a1), R. M. Murray (a1) and J. H. MacCabe (a1)

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed