Hostname: page-component-7c8c6479df-995ml Total loading time: 0 Render date: 2024-03-26T13:02:59.643Z Has data issue: false hasContentIssue false

Empirical evidence for discrete neurocognitive subgroups in bipolar disorder: clinical implications

Published online by Cambridge University Press:  11 March 2014

K. E. Burdick*
Affiliation:
Departments of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
M. Russo
Affiliation:
Departments of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
S. Frangou
Affiliation:
Departments of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
K. Mahon
Affiliation:
Departments of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
R. J. Braga
Affiliation:
Zucker Hillside Hospital – North Shore Long Island Jewish Health System, Glen Oaks, NY, USA
M. Shanahan
Affiliation:
Departments of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
A. K. Malhotra
Affiliation:
Zucker Hillside Hospital – North Shore Long Island Jewish Health System, Glen Oaks, NY, USA
*
*Address for correspondence: K. E. Burdick, Ph.D., Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1230, New York, NY 10029, USA. (Email: Katherine.burdick@mssm.edu)

Abstract

Background

Recent data suggest trait-like neurocognitive impairments in bipolar disorder (BPD), with deficits about 1 s.d. below average, less severe than deficits noted in schizophrenia. The frequency of significant impairment in BPD is approximately 60%, with 40% of patients characterized as cognitively spared. This contrasts with a more homogeneous presentation in schizophrenia. It is not understood why some BPD patients develop deficits while others do not.

Method

A total of 136 patients with BPD completed the MATRICS Consensus Cognitive Battery and data were entered into hierarchical cluster analyses to: (1) determine the optimal number of clusters (subgroups) that fit the sample; and (2) assign subjects to a specific cluster based on individual profiles. We then compared subgroups on several clinical factors and real-world community functioning.

Results

Three distinct neurocognitive subgroups were found: (1) an intact group with performance comparable with healthy controls on all domains but with superior social cognition; (2) a selective impairment group with moderate deficits on processing speed, attention, verbal learning and social cognition and normal functioning in other domains; and (3) a global impairment group with severe deficits across all cognitive domains comparable with deficits in schizophrenia.

Conclusions

These results suggest the presence of multiple cognitive subgroups in BPD with unique profiles and begin to address the relationships between these subgroups, several clinical factors and functional outcome. Next steps will include using these data to help guide future efforts to target these disabling symptoms with treatment.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abood, Z, Sharkey, A, Webb, M, Kelly, A, Gill, M (2002). Are patients with bipolar affective disorder socially disadvantaged? A comparison with a control group. Bipolar Disorder 4, 243248.CrossRefGoogle ScholarPubMed
Altman, EG, Hedeker, DR, Janicak, PG, Peterson, JL, Davis, JM (1994). The Clinician-Administered Rating Scale for Mania (CARS-M): development, reliability, and validity. Biological Psychiatry 36, 124134.CrossRefGoogle ScholarPubMed
Altshuler, LL, Ventura, J, van Gorp, WG, Green, MF, Theberge, DC, Mintz, J (2004). Neurocognitive function in clinically stable men with bipolar I disorder or schizophrenia and normal control subjects. Biological Psychiatry 56, 560569.CrossRefGoogle ScholarPubMed
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn., DSM-IV-TR. American Psychiatric Association: Washington, DC.Google Scholar
Bora, E, Yucel, M, Pantelis, C (2009). Cognitive endophenotypes of bipolar disorder: a meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. Journal of Affective Disorders 113, 120.Google Scholar
Bowie, CR, Depp, C, McGrath, JA, Wolyniec, P, Mausbach, BT, Thornquist, MH, Luke, J, Patterson, TL, Harvey, PD, Pulver, AE (2010). Prediction of real-world functional disability in chronic mental disorders: a comparison of schizophrenia and bipolar disorder. American Journal of Psychiatry 167, 11161124.CrossRefGoogle ScholarPubMed
Burdick, KE, Braga, RJ, Goldberg, JF, Malhotra, AK (2007). Cognitive dysfunction in bipolar disorder: future place for pharmacotherapy. CNS Drugs 21, 971981.Google Scholar
Burdick, KE, Goldberg, JF, Harrow, M (2010). Neurocognitive dysfunction and psychosocial outcome in patients with bipolar I disorder at 15-year follow-up. Acta Psychiatrica Scandinavica 122, 499506.CrossRefGoogle ScholarPubMed
Burdick, KE, Goldberg, TE, Cornblatt, BA, Keefe, RS, Gopin, CB, Derosse, P, Braga, RJ, Malhotra, AK (2011). The MATRICS Consensus Cognitive Battery in patients with bipolar I disorder. Neuropsychopharmacology 36, 15871592.Google Scholar
Daban, C, Martinez-Aran, A, Torrent, C, Tabarés-Seisdedos, R, Balanzá-Martínez, V, Salazar-Fraile, J, Selva-Vera, G, Vieta, E (2006). Specificity of cognitive deficits in bipolar disorder versus schizophrenia. A systematic review. Psychotherapy and Psychosomatics 75, 7284.Google Scholar
Depp, CA, Mausbach, BT, Harmell, AL, Savla, GN, Bowie, CR, Harvey, PD, Patterson, TL (2012). Meta-analysis of the association between cognitive abilities and everyday functioning in bipolar disorder. Bipolar Disorder 14, 217226.CrossRefGoogle ScholarPubMed
Dion, GL, Tohen, M, Anthony, WA, Waternaux, CS (1988). Symptoms and functioning of patients with bipolar disorder six months after hospitalization. Hospital and Community Psychiatry 39, 652657.Google Scholar
Dittmann, S, Hennig-Fast, K, Gerber, S, Seemüller, F, Riedel, M, Emanuel Severus, W, Langosch, J, Engel, RR, Möller, HJ, Grunze, HC (2008). Cognitive functioning in euthymic bipolar I and bipolar II patients. Bipolar Disorder 10, 877887.Google Scholar
Goldstein, G, Allen, DN, Seaton, BE (1998). A comparison of clustering solutions for cognitive heterogeneity in schizophrenia. Journal of the International Neuropsychological Society 4, 353362.CrossRefGoogle ScholarPubMed
Goldstein, G, Beers, SR, Shemansky, WJ (1996). Neuropsychological differences between schizophrenic patients with heterogeneous Wisconsin Card Sorting Test performance. Schizophrenia Research 21, 1318.Google Scholar
Green, MF (1996). What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry 153, 321330.Google Scholar
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 5662.CrossRefGoogle ScholarPubMed
Harvey, PD, Serper, MR (1990). Linguistic and cognitive failures in schizophrenia. A multivariate analysis. Journal of Nervous and Mental Disease 178, 487493.CrossRefGoogle ScholarPubMed
Harvey, PD, Wingo, AP, Burdick, KE, Baldessarini, RJ (2010). Cognition and disability in bipolar disorder: lessons from schizophrenia. Bipolar Disorder 12, 364375.CrossRefGoogle ScholarPubMed
Heinrichs, RW, Awad, AG (1993). Neurocognitive subtypes of chronic schizophrenia. Schizophrenia Research 9, 4958.CrossRefGoogle ScholarPubMed
Heinrichs, RW, Zakzanis, KK (1998). Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 12, 426445.Google Scholar
Hill, SK, Ragland, JD, Gur, RC, Gur, RE (2002). Neuropsychological profiles delineate distinct profiles of schizophrenia, an interaction between memory and executive function, and uneven distribution of clinical subtypes. Journal of Clinical and Experimental Neuropsychology 24, 765780.Google Scholar
Jaeger, J, Berns, SM, Czobor, P (2003). The multidimensional scale of independent functioning: a new instrument for measuring functional disability in psychiatric populations. Schizophrenia Bulletin 29, 153168.CrossRefGoogle ScholarPubMed
Kern, RS, Nuechterlein, KH, Green, MF, Baade, LE, Fenton, WS, Gold, JM, Keefe, RS, Mesholam-Gately, R, Mintz, J, Seidman, LJ, Stover, E, Marder, SR (2008). The MATRICS Consensus Cognitive Battery, Part 2: co-norming and standardization. American Journal of Psychiatry 165, 214220.Google Scholar
Kremen, WS, Seidman, LJ, Faraone, SV, Toomey, R, Tsuang, MT (2000). The paradox of normal neuropsychological function in schizophrenia. Journal of Abnormal Psychology 109, 743752.CrossRefGoogle ScholarPubMed
Kremen, WS, Seidman, LJ, Faraone, SV, Tsuang, MT (2008). IQ decline in cross-sectional studies of schizophrenia: methodology and interpretation. Psychiatry Research 158, 181194.CrossRefGoogle ScholarPubMed
Kupfer, DJ, Frank, E, Grochocinski, VJ, Cluss, PA, Houck, PR, Stapf, DA (2002). Demographic and clinical characteristics of individuals in a bipolar disorder case registry. Journal of Clinical Psychiatry 63, 120125.CrossRefGoogle Scholar
Lee, J, Altshuler, L, Glahn, DC, Miklowitz, DJ, Ochsner, K, Green, MF (2013). Social and nonsocial cognition in bipolar disorder and schizophrenia: relative levels of impairment. American Journal of Psychiatry 170, 334341.CrossRefGoogle ScholarPubMed
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.Google Scholar
Martinez-Aran, A, Torrent, C, Tabares-Seisdedos, R, Salamero, M, Daban, C, Balanza-Martinez, V, Sanchez-Moreno, J, Manuel Goikolea, J, Benabarre, A, Colom, F, Vieta, E (2008). Neurocognitive impairment in bipolar patients with and without history of psychosis. Journal of Clinical Psychiatry 69, 233239.CrossRefGoogle ScholarPubMed
Martinez-Aran, A, Vieta, E, Torrent, C, Sanchez-Moreno, J, Goikolea, JM, Salamero, M, Malhi, GS, Gonzalez-Pinto, A, Daban, C, Alvarez-Grandi, S, Fountoulakis, K, Kaprinis, G, Tabares-Seisdedos, R, Ayuso-Mateos, JL (2007). Functional outcome in bipolar disorder: the role of clinical and cognitive factors. Bipolar Disorder 9, 103113.Google Scholar
Martino, DJ, Strejilevich, SA, Scápola, 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.Google Scholar
Murray, CJ, Lopez, AD (1997). Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 349, 14361442.CrossRefGoogle ScholarPubMed
Nuechterlein, KH, Green, MF, Kern, RS, Baade, LE, Barch, DM, Cohen, JD, Essock, S, Fenton, WS, Frese, FJ 3rd, Gold, JM, Goldberg, T, Heaton, RK, Keefe, RS, Kraemer, H, Mesholam-Gately, R, Seidman, LJ, Stover, E, Weinberger, DR, Young, AS, Zalcman, S, Marder, SR (2008). The MATRICS Consensus Cognitive Battery, part 1: test selection, reliability, and validity. American Journal of Psychiatry 165, 203213.CrossRefGoogle ScholarPubMed
Reichenberg, A, Harvey, PD, Bowie, CR, Mojtabai, R, Rabinowitz, J, Heaton, RK, Bromet, E (2009). Neuropsychological function and dysfunction in schizophrenia and psychotic affective disorders. Schizophrenia Bulletin 35, 10221029.CrossRefGoogle ScholarPubMed
Rosa, AR, Bonnín, CM, Vázquez, GH, Reinares, M, Solé, B, Tabarés-Seisdedos, R, Balanzá-Martínez, V, González-Pinto, A, Sánchez-Moreno, J, Vieta, E (2010). Functional impairment in bipolar II disorder: is it as disabling as bipolar I? Journal of Affective Disorders 127, 7176.Google Scholar
Schooler, NR, Hogarty, GE, Weissman, MM (1979). Social Adjustment Scale II (SAS II). In Resource Materials for Community Mental Health Evaluators (ed. Hargreaves, W. A., Attkisson, C. C. and Sorenson, J. E.), pp. 290330. Department of Mental Health, Education and Welfare: Washington, DC.Google Scholar
Seaton, BE, Allen, DN, Goldstein, G, Kelley, ME, van Kammen, DP (1999). Relations between cognitive and symptom profile heterogeneity in schizophrenia. Journal of Nervous and Mental Disease 187, 414419.Google Scholar
Shamsi, S, Lau, A, Lencz, T, Burdick, KE, DeRosse, P, Brenner, R, Lindenmayer, JP, Malhotra, AK (2011). Cognitive and symptomatic predictors of functional disability in schizophrenia. Schizophrenia Research 126, 257264.Google Scholar
Simonsen, C, Sundet, K, Vaskinn, A, Birkenaes, AB, Engh, JA, Hansen, CF, Jónsdóttir, H, Ringen, PA, Opjordsmoen, S, Friis, S, Andreassen, OA (2008). Neurocognitive profiles in bipolar I and bipolar II disorder: differences in pattern and magnitude of dysfunction. Bipolar Disorder 10, 245255.CrossRefGoogle ScholarPubMed
Sole, B, Bonnin, CM, Torrent, C, Martinez-Aran, A, Popovic, D, Tabarés-Seisdedos, R, Vieta, E (2012). Neurocognitive impairment across the bipolar spectrum. CNS Neuroscience and Therapeutics 18, 194200.CrossRefGoogle ScholarPubMed
Stern, Y (2012). Cognitive reserve in ageing and Alzheimer's disease. Lancet Neurology 11, 10061012.Google Scholar
Tohen, M, Vieta, E, Calabrese, J, Ketter, TA, Sachs, G, Bowden, C, Mitchell, PB, Centorrino, F, Risser, R, Baker, RW, Evans, AR, Beymer, K, Dube, S, Tollefson, GD, Breier, A (2003). Efficacy of olanzapine and olanzapine–fluoxetine combination in the treatment of bipolar I depression. Archives of General Psychiatry 60, 10791088.Google Scholar
Ventura, J, Hellemann, GS, Thames, AD, Koellner, V, Nuechterlein, KH (2009). Symptoms as mediators of the relationship between neurocognition and functional outcome in schizophrenia: a meta-analysis. Schizophrenia Research 113, 189199.Google Scholar
Wilk, CM, Gold, JM, McMahon, RP, Humber, K, Iannone, VN, Buchanan, RW (2005). No, it is not possible to be schizophrenic yet neuropsychologically normal. Neuropsychology 19, 778786.Google Scholar
Wilkinson, GS (1993). Wide Range Achievement Test: Administration Manual, 3rd edn. Del Wide Range Inc.: Wilmington, DE.Google Scholar
Williams, HJ, Craddock, N, Russo, G, Hamshere, ML, Moskvina, V, Dwyer, S, Smith, RL, Green, E, Grozeva, D, Holmans, P, Owen, MJ, O'Donovan, MC (2011). Most genome-wide significant susceptibility loci for schizophrenia and bipolar disorder reported to date cross-traditional diagnostic boundaries. Human Molecular Genetics 20, 387391.CrossRefGoogle ScholarPubMed
Woodberry, KA, Giuliano, AJ, Seidman, LJ (2008). Premorbid IQ in schizophrenia: a meta-analytic review. American Journal of Psychiatry 65, 579587.CrossRefGoogle Scholar
Yatham, LN, Torres, IJ, Malhi, GS, Frangou, S, Glahn, DC, Bearden, CE, Burdick, KE, Martínez-Arán, A, Dittmann, S, Goldberg, JF, Ozerdem, A, Aydemir, O, Chengappa, KN (2010). The International Society for Bipolar Disorders-Battery for Assessment of Neurocognition (ISBD-BANC). Bipolar Disorder 12, 351363.CrossRefGoogle ScholarPubMed