Lecturer, Institute of Health and Wellbeing, University of Glasgow, UK.
Professor, Institute of Health and Wellbeing, University of Glasgow, UK.
Br J Psychiatry. 2019 Nov;215(5):683-690. doi: 10.1192/bjp.2019.188.
Cognitive impairment is strongly linked with persistent disability in people with mood disorders, but the factors that explain cognitive impairment in this population are unclear.
To estimate the total effect of (a) bipolar disorder and (b) major depression on cognitive function, and the magnitude of the effect that is explained by potentially modifiable intermediate factors.
Cross-sectional study using baseline data from the UK Biobank cohort. Participants were categorised as having bipolar disorder (n = 2709), major depression (n = 50 975) or no mood disorder (n = 102 931 and n = 105 284). The outcomes were computerised tests of reasoning, reaction time and memory. The potential mediators were cardiometabolic disease and psychotropic medication. Analyses were informed by graphical methods and controlled for confounding using regression, propensity score-based methods and G-computation.
Group differences of small magnitude were found on a visuospatial memory test. Z-score differences for the bipolar disorder group were in the range -0.23 to -0.17 (95% CI -0.39 to -0.03) across different estimation methods, and for the major depression group they were approximately -0.07 (95% CI -0.10 to -0.03). One-quarter of the effect was mediated via psychotropic medication in the bipolar disorder group (-0.05; 95% CI -0.09 to -0.01). No evidence was found for mediation via cardiometabolic disease.
In a large community-based sample in middle to early old age, bipolar disorder and depression were associated with lower visuospatial memory performance, in part potentially due to psychotropic medication use. Mood disorders and their treatments will have increasing importance for population cognitive health as the proportion of older adults continues to grow.
I.J.D. is a UK Biobank participant. J.P.P. is a member of the UK Biobank Steering Committee.
认知障碍与心境障碍患者持续残疾密切相关，但该人群认知障碍的相关因素尚不清楚。
估计（a）双相情感障碍和（b）重度抑郁症对认知功能的总影响，以及可改变的中介因素解释的影响程度。
使用英国生物库队列的基线数据进行横断面研究。参与者分为双相情感障碍（n = 2709）、重度抑郁症（n = 50975）或无心境障碍（n = 102931 和 n = 105284）。结果为计算机推理、反应时间和记忆测试。潜在的中介因素是心脏代谢疾病和精神药物。分析通过图形方法进行，并使用回归、倾向评分匹配方法和 G 计算控制混杂。
在视觉空间记忆测试中发现了小幅度的组间差异。不同估计方法下，双相情感障碍组的 Z 分数差异范围为-0.23 至-0.17（95% CI -0.39 至-0.03），而重度抑郁症组约为-0.07（95% CI -0.10 至-0.03）。双相情感障碍组中有四分之一的作用通过精神药物来介导（-0.05；95% CI -0.09 至-0.01）。没有证据表明心脏代谢疾病有中介作用。
在中年至早期老年的大型社区样本中，双相情感障碍和抑郁症与较低的视觉空间记忆表现相关，部分原因可能是精神药物的使用。随着老年人口比例的持续增长，心境障碍及其治疗方法对人群认知健康的重要性将越来越大。
I.J.D.是英国生物库的参与者。J.P.P.是英国生物库指导委员会的成员。
