Department of Psychiatry, University of Oxford, Oxford, UK.
Acta Psychiatr Scand. 2013 Sep;128(3):149-62. doi: 10.1111/acps.12133. Epub 2013 Apr 26.
An association between bipolar disorder and cognitive impairment has repeatedly been described, even for euthymic patients. Findings are inconsistent both across primary studies and previous meta-analyses. This study reanalysed 31 primary data sets as a single large sample (N = 2876) to provide a more definitive view.
Individual patient and control data were obtained from original authors for 11 measures from four common neuropsychological tests: California or Rey Verbal Learning Task (VLT), Trail Making Test (TMT), Digit Span and/or Wisconsin Card Sorting Task.
Impairments were found for all 11 test-measures in the bipolar group after controlling for age, IQ and gender (Ps ≤ 0.001, E.S. = 0.26-0.63). Residual mood symptoms confound this result but cannot account for the effect sizes found. Impairments also seem unrelated to drug treatment. Some test-measures were weakly correlated with illness severity measures suggesting that some impairments may track illness progression.
This reanalysis supports VLT, Digit Span and TMT as robust measures of cognitive impairments in bipolar disorder patients. The heterogeneity of some test results explains previous differences in meta-analyses. Better controlling for confounds suggests deficits may be smaller than previously reported but should be tracked longitudinally across illness progression and treatment.
双相情感障碍与认知障碍之间存在关联，即使是在病情稳定的患者中也是如此。既往的研究结果存在差异，且不一致。本研究通过重新分析 31 个原始数据集（N=2876）作为一个大型样本，以提供更明确的结果。
通过与原始作者联系，获得了来自 11 项常用神经心理学测试的患者和对照组个体数据：加利福尼亚或 Rey 词语学习测试（VLT）、连线测试（TMT）、数字跨度和/或威斯康星卡片分类测试。
在控制年龄、智商和性别后，双相组的所有 11 项测试指标均存在损害（P≤0.001，E.S.=0.26-0.63）。残留的情绪症状会混淆这个结果，但不能解释发现的效应大小。损害似乎与药物治疗无关。一些测试指标与疾病严重程度指标弱相关，这表明一些损害可能与疾病进展有关。
本重新分析支持 VLT、数字跨度和 TMT 作为双相情感障碍患者认知障碍的可靠测量指标。一些测试结果的异质性解释了既往荟萃分析中的差异。更好地控制混杂因素表明，缺陷可能比之前报道的要小，但应在疾病进展和治疗过程中进行纵向跟踪。
