Tsai Shang-Ying, Lee Hsin-Chien, Chen Chiao-Chicy, Huang Yi-Lin
Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan.
Bipolar Disord. 2007 Dec;9(8):868-75. doi: 10.1111/j.1399-5618.2007.00498.x.
Cognitive impairment may interfere with psychosocial functioning in bipolar disorder (BD). There is limited information regarding the cognitive function of elderly bipolar patients with onset at a young age. The present study aimed to investigate the frequency and the determinants of cognitive impairment in elderly early-onset bipolar patients.
Using the Clock-drawing Test (CDT), the Mini Mental State Examination (MMSE), and the Cognitive Abilities Screening Instrument (CASI), we examined euthymic patients with bipolar I disorder in Taiwan, aged 60 years and older. Clinical data were obtained by reviewing medical records and personal interviews with patients and their family members. The onset of BD prior to the age of 40 years is defined as 'early-onset'.
Of the 52 early-onset patients, 42.3% were determined to have cognitive impairment by exhibiting either abnormal CDT or education-adjusted MMSE scores. In a multiple regression model, years of education and the age at the last manic/hypomanic (but not depressive) episode accounted for the greatest variance in both MMSE and CASI scores. While educational level and the age at the last manic/hypomanic episode were not considered in the regression model, onset with depressive syndrome and current age explained 21.5% of the variance in MMSE scores. Age at the first depressive episode, the first manic episode before the age of 40 years, and comorbid diabetes accounted for 16.7% of the variance in CASI scores.
There appeared to be a sizable proportion of elderly early-onset bipolar patients having cognitive impairment. It is suggested that clinical manifestation of first-onset affective episode and impact of medical comorbidity affect the cognition of early-onset BD in later life.
认知障碍可能会干扰双相情感障碍（BD）患者的心理社会功能。关于年轻时起病的老年双相情感障碍患者认知功能的信息有限。本研究旨在调查老年早发性双相情感障碍患者认知障碍的发生率及其决定因素。
我们使用画钟试验（CDT）、简易精神状态检查表（MMSE）和认知能力筛查工具（CASI），对台湾60岁及以上的双相I型障碍病情缓解期患者进行了检查。通过查阅病历以及与患者及其家属进行个人访谈来获取临床数据。BD在40岁之前起病被定义为“早发性”。
在52例早发性患者中，42.3%的患者通过画钟试验异常或经教育程度校正的MMSE评分被判定存在认知障碍。在多元回归模型中，受教育年限以及最后一次躁狂/轻躁狂（而非抑郁）发作时的年龄，在MMSE和CASI评分中解释了最大的方差。虽然回归模型中未考虑教育水平和最后一次躁狂/轻躁狂发作时的年龄，但抑郁综合征起病情况和当前年龄解释了MMSE评分中方差的21.5%。首次抑郁发作时的年龄、40岁之前的首次躁狂发作以及合并糖尿病，解释了CASI评分中方差的16.7%。
似乎有相当比例的老年早发性双相情感障碍患者存在认知障碍。提示首次发作情感事件的临床表现和合并症的影响会影响早发性BD患者晚年的认知。
