Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark.
Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark.
J Affect Disord. 2022 Aug 15;311:115-125. doi: 10.1016/j.jad.2022.05.045. Epub 2022 May 14.
Cognitive impairments exist in a large proportion of remitted patients with bipolar disorder (BD). However, no study has investigated the cognitive trajectories across neurocognitive subgroups of patients or their unaffected first-degree relatives (UR).
Newly diagnosed BD patients, UR and healthy controls (HC) underwent comprehensive cognitive testing at baseline and at 16-months follow-up. Hierarchical cluster analysis was conducted to identify homogeneous subgroups of patients based on their neurocognitive profile at baseline. Cognitive change across subgroups of patients and UR was assessed with linear mixed-model analyses.
Data from baseline and follow-up were collected from 152 patients, 53 UR and 135 HC. Patients were clustered into three discrete neurocognitive subgroups: 'cognitively normal' (43%), 'mild-moderately impaired' (33%) and 'globally impaired' (24%). While 'mild-moderately impaired' patients and HC showed normative cognitive improvement over time in global cognition (p < .001), 'globally impaired' patients showed greater improvement than all groups (p < .001), whereas 'cognitively normal' patients showed a lack of normative improvement (p = .17). UR of impaired patients showed a lack of normative improvement in executive functions (p = .01). 'Globally impaired' patients also presented with stable impairments in facial expression recognition and emotion regulation.
Follow-up data was available for 62% of participants, possibly reflecting a selection bias.
The greater cognitive improvement in 'globally impaired' patients partly speaks against neuroprogression. However, the lack of normative improvement in 'cognitively normal' patients could indicate negative effects of illness. Further follow-up assessments are warranted to clarify whether lack of normative improvement in executive function in UR represents an illness risk-marker.
在大量缓解期的双相情感障碍（BD）患者中存在认知障碍。然而，尚无研究调查过患者神经认知亚组之间或其未受影响的一级亲属（UR）的认知轨迹。
新诊断的 BD 患者、UR 和健康对照组（HC）在基线和 16 个月随访时接受全面的认知测试。采用层次聚类分析根据基线时的神经认知特征对患者进行同质亚组分类。采用线性混合模型分析评估患者和 UR 亚组的认知变化。
共收集了 152 名患者、53 名 UR 和 135 名 HC 的基线和随访数据。患者分为三个离散的神经认知亚组：“认知正常”（43%）、“轻度中度受损”（33%）和“整体受损”（24%）。虽然“轻度中度受损”患者和 HC 随着时间的推移在整体认知方面表现出正常的认知改善（p<0.001），但“整体受损”患者的改善程度高于所有组（p<0.001），而“认知正常”患者则缺乏正常的改善（p=0.17）。受损患者的 UR 在执行功能方面缺乏正常改善（p=0.01）。“整体受损”患者在面部表情识别和情绪调节方面也表现出稳定的损伤。
只有 62%的参与者提供了随访数据，这可能反映了选择偏倚。
“整体受损”患者的认知改善较大，部分说明没有神经进展。然而，“认知正常”患者缺乏正常改善可能表明疾病有负面影响。需要进一步的随访评估来澄清 UR 中执行功能的正常改善缺乏是否代表疾病风险标志物。
