Cullen Breda, Ward Joey, Graham Nicholas A, Deary Ian J, Pell Jill P, Smith Daniel J, Evans Jonathan J
Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
J Affect Disord. 2016 Nov 15;205:165-181. doi: 10.1016/j.jad.2016.06.063. Epub 2016 Jul 5.
Previous reviews have identified medium-large group differences in cognitive performance in adults with bipolar disorder (BD) compared to healthy peers, but the proportion with clinically relevant cognitive impairment has not yet been established. This review aimed to quantify the prevalence of cognitive impairment in euthymic adults with BD, and to describe sociodemographic, clinical and other factors that are significantly associated with cognitive impairment.
Systematic literature review. The population was euthymic community-dwelling adults with BD, aged 18-70 years, and recruited consecutively or randomly. The outcome was cognitive impairment, relative to healthy population norms. Electronic databases and reference lists of relevant articles were searched, and authors were contacted. Original cross-sectional studies published in peer-reviewed English-language journals from January 1994 to February 2015 were included. Methodological bias and reporting bias were assessed using standard tools. A narrative synthesis is presented together with tables and forest plots.
Thirty articles were included, of which 15 contributed prevalence data. At the 5th percentile impairment threshold, prevalence ranges were: executive function 5.3-57.7%; attention/working memory 9.6-51.9%; speed/reaction time 23.3-44.2%; verbal memory 8.2-42.1%; visual memory 11.5-32.9%. More severe or longstanding illness and antipsychotic medication were associated with greater cognitive impairment.
The synthesis was limited by heterogeneity in cognitive measures and impairment thresholds, precluding meta-analysis.
Cognitive impairment affects a substantial proportion of euthymic adults with BD. Future research with more consistent measurement and reporting will facilitate an improved understanding of cognitive impairment burden in BD.
既往综述已发现，与健康同龄人相比，双相情感障碍（BD）成年患者在认知表现上存在中到较大的群体差异，但具有临床相关性认知障碍的患者比例尚未确定。本综述旨在量化心境正常的BD成年患者认知障碍的患病率，并描述与认知障碍显著相关的社会人口学、临床及其他因素。
系统文献综述。研究对象为年龄在18 - 70岁、心境正常、居住在社区的BD成年患者，采用连续或随机招募。结局指标为相对于健康人群常模的认知障碍。检索电子数据库及相关文章的参考文献列表，并与作者联系。纳入1994年1月至2015年2月在同行评审英文期刊上发表的原始横断面研究。使用标准工具评估方法学偏倚和报告偏倚。以叙述性综述结合表格和森林图呈现结果。
纳入30篇文章，其中15篇提供了患病率数据。在第5百分位数的损害阈值下，患病率范围为：执行功能5.3 - 57.7%；注意力/工作记忆9.6 - 51.9%；速度/反应时间23.3 - 44.2%；言语记忆8.2 - 42.1%；视觉记忆11.5 - 32.9%。病情更严重或病程更长以及使用抗精神病药物与更严重的认知障碍相关。
由于认知测量方法和损害阈值的异质性，本综述受限，无法进行荟萃分析。
认知障碍影响相当比例的心境正常的BD成年患者。未来采用更一致测量和报告方法的研究将有助于更好地理解BD患者的认知障碍负担。
