Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain.
Barcelona Clínic Schizophrenia Unit, Hospital Clínic of Barcelona, Department of Medicine, Neuroscience Institute, Barcelona, Catalonia, Spain.
J Affect Disord. 2022 Feb 1;298(Pt A):522-531. doi: 10.1016/j.jad.2021.11.028. Epub 2021 Nov 14.
Cognitive profiles of BD patients show a demonstrated heterogeneity among young and middle-aged patients, but this issue has not yet deeply explored in Older Adults with bipolar disorder (OABD). The aim of the present study was to analyze cognitive variability in a sample of OABD.
A total of 138 OABD patients and 73 healthy controls were included in this study. A comprehensive neuropsychological assessment was administered. We performed a k-means cluster analysis method based on the neurocognitive performance to detect heterogeneous subgroups. Demographic, clinical, cognitive and functional variables were compared. Finally, univariate logistic regressions were conducted to detect variables associated with the severity of the cognitive impairment.
We identified three distinct clusters based on the severity of cognitive impairment: (1) a preserved group (n = 58; 42%) with similar cognitive performance to HC, (2) a group showing mild cognitive deficits in all cognitive domains (n = 64; 46%) and, finally, (3) a group exhibiting severe cognitive impairment (n = 16; 12%). Older age, late onset, higher number of psychiatric admissions and lower psychosocial functioning were associated with the greatest cognitive impairment. Lower age, more years of education and higher estimated IQ were associated with a preserve cognitive functioning.
The small sample size of the severely impaired group.
Cognitive heterogeneity remains at late-life bipolar disorder. Demographic and specific illness factors are related to cognitive dysfunction. Detecting distinct cognitive subgroups may have significant clinical implications for tailoring specific intervention strategies adapted to the level of the impairment and also to prevent cognitive decline.
BD 患者的认知特征在年轻和中年患者中表现出明显的异质性，但这一问题在老年双相障碍（OABD）患者中尚未得到深入探讨。本研究旨在分析 OABD 患者样本的认知变异性。
本研究共纳入 138 名 OABD 患者和 73 名健康对照者。进行了全面的神经心理学评估。我们采用基于神经认知表现的 k-均值聚类分析方法来检测异质亚组。比较了人口统计学、临床、认知和功能变量。最后，进行单变量逻辑回归以检测与认知损害严重程度相关的变量。
我们根据认知损害的严重程度确定了三个不同的聚类：（1）保存组（n=58；42%）与 HC 具有相似的认知表现，（2）在所有认知领域均表现出轻度认知缺陷的组（n=64；46%），以及（3）表现出严重认知损害的组（n=16；12%）。年龄较大、发病较晚、精神科住院次数较多和社会心理功能较差与认知损害最严重相关。较低的年龄、较长的受教育年限和较高的估计智商与保留的认知功能相关。
严重受损组的样本量较小。
认知异质性在晚年双相障碍中仍然存在。人口统计学和特定疾病因素与认知功能障碍有关。检测不同的认知亚组可能对制定适应损伤程度的特定干预策略具有重要的临床意义，也可以预防认知能力下降。
