Tsapekos Dimosthenis, Strawbridge Rebecca, Mantingh Tim, Cella Matteo, Wykes Til, Young Allan H
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London; and South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK.
BJPsych Open. 2020 Oct 30;6(6):e133. doi: 10.1192/bjo.2020.111.
People with bipolar disorder have moderate cognitive difficulties that tend to be more pronounced during mood episodes but persist after clinical remission and affect recovery. Recent evidence suggests heterogeneity in these difficulties, but the factors underlying cognitive heterogeneity are unclear.
To examine whether distinct cognitive profiles can be identified in a sample of euthymic individuals with bipolar disorder and examine potential differences between subgroups.
Cognitive performance was assessed across four domains (i.e. processing speed, verbal learning/memory, working memory, executive functioning) in 80 participants. We conducted a hierarchical cluster analysis and a discriminant function analysis to identify cognitive profiles and considered differences in cognitive reserve, estimated cognitive decline from premorbid cognitive functioning, and clinical characteristics among subgroups.
Four discrete cognitive profiles were identified: cognitively intact (n = 25; 31.3%); selective deficits in verbal learning and memory (n = 15; 18.8%); intermediate deficits across all cognitive domains (n = 30; 37.5%); and severe deficits across all domains (n = 10; 12.5%). Cognitive decline after illness onset was greater for the intermediate and severe subgroups. Cognitive reserve scores were increasingly lower for subgroups with greater impairments. A smaller proportion of cognitively intact participants were using antipsychotic medications compared with all other subgroups.
Our findings suggest that individuals with cognitively impaired profiles demonstrate more cognitive decline after illness onset. Cognitive reserve may be one of the factors underlying cognitive variability across people with bipolar disorder. Patients in the intermediate and severe subgroups may be in greater need of interventions targeting cognitive difficulties.
双相情感障碍患者存在中度认知困难，这些困难在情绪发作期间往往更为明显，但在临床缓解后仍会持续存在并影响康复。最近的证据表明这些困难存在异质性，但认知异质性背后的因素尚不清楚。
检查在双相情感障碍心境正常个体样本中是否可以识别出不同的认知特征，并检查亚组之间的潜在差异。
对80名参与者在四个领域（即处理速度、言语学习/记忆、工作记忆、执行功能）的认知表现进行评估。我们进行了分层聚类分析和判别函数分析以识别认知特征，并考虑了认知储备的差异、从病前认知功能估计的认知衰退以及亚组之间的临床特征。
识别出四种不同的认知特征：认知完好（n = 25；31.3%）；言语学习和记忆选择性缺陷（n = 15；18.8%）；所有认知领域中度缺陷（n = 30；37.5%）；以及所有领域严重缺陷（n = 10；12.5%）。中度和重度亚组发病后的认知衰退更大。损伤越严重的亚组，认知储备得分越低。与所有其他亚组相比，认知完好的参与者使用抗精神病药物的比例较小。
我们的研究结果表明，认知受损特征的个体在发病后表现出更多的认知衰退。认知储备可能是双相情感障碍患者认知变异性的潜在因素之一。中度和重度亚组的患者可能更需要针对认知困难的干预措施。
