Research Department, Riverview Hospital, British Columbia Mental Health and Addictions Services, Coquitlam, British Columbia, Canada.
J Clin Psychiatry. 2010 Sep;71(9):1234-42. doi: 10.4088/JCP.08m04997yel. Epub 2010 Mar 23.
Although cognitive impairment is an important clinical feature of bipolar disorder, it is unknown whether deficits are present at illness onset. The purpose of this study was to determine whether neuropsychological impairments are present in clinically stable patients with bipolar disorder shortly after resolution of their first manic episode.
Within a large university medical center, 45 recently diagnosed (DSM-IV-TR) patients with bipolar disorder type I were evaluated after resolution of their first manic episode, along with 25 matched healthy comparison subjects. Participants were administered a neuropsychological battery evaluating 5 broad cognitive domains, including verbal/premorbid intellectual functioning, learning/memory, spatial/nonverbal reasoning, attention/processing speed, and executive function. Data were collected from July 2004 to August 2007.
Relative to controls, patients showed broad impairments in learning/memory, spatial/nonverbal reasoning, executive function, and some aspects of attention (all P < .01). Specifically, deficits were evident on tests assessing sustained attention, attentional and mental set shifting, spatial working memory, nonverbal reasoning, and verbal learning and recall (all P < .01). Cognitive impairments in patients could not be fully attributed to substance abuse, medication status, or residual mood symptoms.
Results indicate that core neuropsychological deficits in sustained attention, learning and recall, spatial/nonverbal reasoning, and several aspects of executive function are present at illness onset. Cognitive deficits in bipolar disorder are, thus, most likely not exclusively attributable to progressive decline associated with increased illness burden, cumulative treatment effects, or chronicity of illness. These findings may provide etiologic clues into the illness and identify clinical targets for early treatment.
尽管认知障碍是双相情感障碍的一个重要临床特征，但目前尚不清楚在疾病发病时是否存在缺陷。本研究的目的是确定在首次躁狂发作缓解后不久，处于临床稳定状态的双相情感障碍 I 型患者是否存在神经认知障碍。
在一家大型大学医疗中心，对 45 名新诊断为（DSM-IV-TR）的双相情感障碍 I 型患者进行了评估，这些患者在首次躁狂发作缓解后，与 25 名匹配的健康对照者一起进行了评估。参与者接受了一个神经心理学测试，该测试评估了 5 个广泛的认知领域，包括言语/先前智力功能、学习/记忆、空间/非言语推理、注意力/处理速度和执行功能。数据收集于 2004 年 7 月至 2007 年 8 月。
与对照组相比，患者在学习/记忆、空间/非言语推理、执行功能和某些注意力方面存在广泛的损伤（均 P<.01）。具体来说，在评估持续注意力、注意力和心理定势转换、空间工作记忆、非言语推理、言语学习和回忆的测试中，患者表现出缺陷（均 P<.01）。患者的认知障碍不能完全归因于物质滥用、药物状态或残留的情绪症状。
结果表明，在持续注意力、学习和回忆、空间/非言语推理以及执行功能的几个方面存在核心神经认知缺陷。因此，双相情感障碍中的认知缺陷很可能不仅仅归因于与疾病负担增加、累积治疗效果或疾病的慢性有关的进行性下降。这些发现可能为疾病提供病因线索，并确定早期治疗的临床靶点。
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