Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. MC 8849, Dallas, TX 75390-8849, USA.
Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. MC 8849, Dallas, TX 75390-8849, USA.
J Affect Disord. 2020 Jul 1;272:355-362. doi: 10.1016/j.jad.2020.03.179. Epub 2020 Apr 29.
Bipolar disorder (BD) frequently co-occurs with substance use disorders (SUDs), and both are associated with cognitive impairment. This study compares cognition between individuals with BD with and without current alcohol use disorder (AUD), cocaine use disorder (CUD), or both, as these disorders may be linked with additive cognitive impairment.
Baseline data were analyzed from five clinical studies of individuals with the aforementioned disorders (N = 373). Participants were grouped as follows: BD-only, BD + AUD, BD + CUD, or BD + AUD + CUD. Cognition was assessed with the Rey Auditory Verbal Learning Test (RAVLT) (verbal learning and memory) and Stroop Color Word Test (executive function). Multiple linear regression models determined if SUD diagnosis, among other demographic and clinical variables, predicted each cognitive test's T-score. Regression equations were used to compute each group's mean T-scores.
All groups demonstrated below-average mean T-scores on all tests, with no significant between-group score differences. RAVLT total T-scores were lower than Stroop color-word T-scores within all groups (non-overlapping 95% confidence intervals). Higher daily cocaine use predicted higher Stroop T-scores (p < 0.01) and RAVLT delayed recall T-scores (p < 0.05). No other non-demographic variable, including AUD/CUD group status, predicted cognitive performance.
A full cognitive battery and some relevant variables (e.g. BD lifetime illness course) were not available. Many participants (42.1%) had additional SUDs.
BD with and without AUD/CUD was found to be associated with greater deficits in verbal learning and memory than in executive function. Addressing these impaired domains in dually-diagnosed patients may improve treatment and functional outcomes.
双相情感障碍（BD）常与物质使用障碍（SUD）共病，且两者均与认知障碍相关。本研究比较了伴有或不伴有当前酒精使用障碍（AUD）、可卡因使用障碍（CUD）或两者均有的 BD 患者的认知情况，因为这些障碍可能与认知障碍的累加有关。
对上述疾病患者的五项临床研究的基线数据进行了分析（N=373）。参与者被分为以下几组：BD 仅、BD+AUD、BD+CUD 或 BD+AUD+CUD。使用 Rey 听觉言语学习测验（RAVLT）（言语学习和记忆）和 Stroop 颜色词测验（执行功能）评估认知。多线性回归模型确定 SUD 诊断是否与其他人口统计学和临床变量一起预测每个认知测试的 T 评分。回归方程用于计算每个组的平均 T 评分。
所有组在所有测试中的平均 T 评分均低于平均水平，且组间无显著差异。在所有组中，RAVLT 总 T 评分均低于 Stroop 颜色词 T 评分（无重叠的 95%置信区间）。更高的每日可卡因使用量预测更高的 Stroop T 评分（p<0.01）和 RAVLT 延迟回忆 T 评分（p<0.05）。包括 AUD/CUD 组状态在内的其他非人口统计学变量均不能预测认知表现。
缺乏完整的认知测试和一些相关变量（例如 BD 终生病程）。许多参与者（42.1%）存在其他 SUD。
BD 无论是否伴有 AUD/CUD，其言语学习和记忆的缺陷程度均大于执行功能的缺陷程度。在双相障碍患者中解决这些受损领域可能会改善治疗和功能结局。
