Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052 Australia ; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052 Australia.
Monash Clinical and Imaging Neuroscience (MCIN), School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, 770 Blackburn Rd, Clayton, VIC 3168 Australia.
Int J Bipolar Disord. 2015 Apr 25;3:9. doi: 10.1186/s40345-015-0024-2. eCollection 2015.
There is evidence of cognitive impairment that persists in the remission phase of bipolar disorder; however, the extent of the deficits that occur from the first onset of the disorder remains unclear. This is the first systematic review on cognitive functioning in the early stages of bipolar I disorder. The aim of the study was to identify the patterns and degree of cognitive impairment that exists from first-episode mania. Three electronic databases (MEDLINE, PsycINFO and PubMed) were systematically searched for studies published from January 1980 to June 2014. Eligible studies were separated into two groups: acute and remission. The Newcastle-Ottawa quality assessment scale was utilised to measure the quality of the included studies. A total of seven studies (three acute and four remission), including 230 first-episode mania and 345 healthy control participants, were eligible for the review. The studies in the acute phase only examined aspects of executive functioning, with impairments identified in cognitive flexibility, though not in response inhibition and verbal fluency relative to healthy controls. The most consistent finding during the remission phase was a deficit in working memory, whereas in the other domains, the findings were equivocal. Non-verbal memory and verbal fluency were not impacted in remission from first-episode mania. In conclusion, deficits are present in some but not all areas of cognitive functioning during the early stages of bipolar I disorder. Further research is warranted to understand the longitudinal trajectory of change from first-episode mania.
有证据表明，双相情感障碍缓解期仍存在认知障碍；然而，从疾病首次发作开始出现的缺陷程度尚不清楚。这是第一篇关于双相情感障碍 I 型早期认知功能的系统综述。本研究的目的是确定从首次躁狂发作开始就存在的认知功能障碍的模式和程度。系统地检索了三个电子数据库（MEDLINE、PsycINFO 和 PubMed），以查找 1980 年 1 月至 2014 年 6 月发表的研究。合格的研究分为两组：急性组和缓解组。使用纽卡斯尔-渥太华质量评估量表来衡量纳入研究的质量。共有 7 项研究（3 项急性研究和 4 项缓解研究），包括 230 例首次躁狂发作和 345 例健康对照参与者，符合综述标准。急性组的研究仅检查了执行功能的各个方面，与健康对照组相比，认知灵活性受损，但在反应抑制和言语流畅性方面没有受损。缓解期最一致的发现是工作记忆缺陷，而在其他领域，研究结果则存在争议。非言语记忆和言语流畅性在首次躁狂发作的缓解期不受影响。总之，在双相情感障碍 I 型的早期阶段，认知功能的某些方面存在缺陷，但并非所有方面都存在缺陷。需要进一步的研究来了解从首次躁狂发作开始的变化的纵向轨迹。
