Wang Zhonggang, Cao Haiyan, Cao Yuying, Song Haining, Jiang Xianfei, Wei Chen, Yang Zhenzhen, Li Jie
Department of Psychiatry, Shandong Daizhuang Hospital, Jining, China.
Institute of Mental Health, Tianjin Anding Hospital, Tianjin, China.
Front Psychiatry. 2023 Sep 28;14:1253088. doi: 10.3389/fpsyt.2023.1253088. eCollection 2023.
In recent years, studies on the clinical features and cognitive impairment of patients with different first-episode types of bipolar disorder have received increasing attention. The patients with bipolar disorder may present with different symptoms at first onset. The aim of this study is to assess the cognitive functions of a patient's index episode of bipolar disorder, depression or mania, on risk factors of effecting on cognitive functions.
One hundred sixty eight patients with bipolar disorder diagnosed for the first time were enrolled in the study. All patients were divided into two groups according to their index episode of bipolar disorder, either depression or mania. Seventy three patients of the cohort had an index episode mania and 95 patients had initial symptoms of depression. Demographic and clinical disease characteristic data of all enrolled patients were collected. Meanwhile, 75 healthy controls were included. Demographic data of controls were collected. The cognitive functions of all patients and controls were detected by continuous performance test (CPT), digital span test (DST) and Wisconsin card sorting test (WCST). The main cognitive functions data were compared among the mania group, depression group and control group. The relevant risk factors affecting cognitive function were analyzed.
(1) Most patients with bipolar disorder had an index episode depression (56.55% vs. 43.45%). Compared with the depression group, the mania group had later age of onset [(24.01 ± 4.254) vs. (22.25 ± 6.472), = 2. 122, 0.035]. The education level of patient groups was lower than control group ( < 0.001). (2) The healthy control group's DST, WCST and CPT scores were better than the patient groups (All 0.05). The mania group's DST (forward, reverse, sum), WCST (total responses, completed classifications, correct responses, incorrect responses, percentage of correct responses, completed the number of responses required for classification, the percentage of conceptualization level, the number of persistent responses, non-persistent errors), CPT (2 digit score, 3 digit score, 4 digit score) was better than the depression group ( 0.05). (3) In mania group, correlation analysis showed that all CPT parameter, inverse digit span, and the sum of DST was negatively correlated with the education level (All 0.05). The CPT-4 digit score was negatively correlated with onset age ( 0.05). In the WCST, the number of correct responses, the percentage of correct responses and the percentage of conceptualization level were positively correlated with the BRMS score (All 0.05). The number of false responses and persistent responses were negatively correlated with the BRMS score (All 0.05). The number of persistent errors and percentage of persistent errors was positively correlated with education years (All 0.05). In depression group, there was a positive correlation between inverse digit span and the education level ( 0.05).
In our study, there were cognitive impairments in attention, memory, and executive function of patients with different onset syndromes of bipolar disorder. Compared with the mania group, the degree of cognitive impairments in bipolar patients with the depressive episode was more severe. The risk factors affecting cognitive impairments included the age of onset, education level, number of hospitalizations and severity of illness.
近年来，关于不同首发类型双相情感障碍患者的临床特征及认知损害的研究受到越来越多的关注。双相情感障碍患者在首次发病时可能表现出不同症状。本研究旨在评估双相情感障碍患者首次发作（抑郁或躁狂）时的认知功能以及影响认知功能的危险因素。
168例首次诊断为双相情感障碍的患者纳入本研究。所有患者根据双相情感障碍的首次发作类型分为两组，即躁狂发作组和抑郁发作组。该队列中73例患者首次发作表现为躁狂，95例患者首发症状为抑郁。收集所有纳入患者的人口统计学和临床疾病特征数据。同时，纳入75名健康对照者，收集其人口统计学数据。采用连续性能测试（CPT）、数字广度测试（DST）和威斯康星卡片分类测试（WCST）检测所有患者及对照者的认知功能。比较躁狂组、抑郁组和对照组的主要认知功能数据，并分析影响认知功能的相关危险因素。
（1）大多数双相情感障碍患者首次发作表现为抑郁（56.55%对43.45%）。与抑郁组相比，躁狂组发病年龄较晚[（24.01±4.254）对（22.25±6.472），P = 2.122，P = 0.035]。患者组的教育水平低于对照组（P < 0.001）。（2）健康对照组的DST、WCST和CPT评分优于患者组（均P < 0.05）。躁狂组的DST（顺背、倒背、总分）、WCST（总反应数、完成分类数、正确反应数、错误反应数、正确反应百分比、完成分类所需反应数、概念化水平百分比、持续性反应数、非持续性错误数）、CPT（两位数评分、三位数评分、四位数评分）优于抑郁组（均P < 0.05）。（3）在躁狂组中，相关性分析显示所有CPT参数、倒背数字广度和DST总分与教育水平呈负相关（均P < 0.05）。CPT四位数评分与发病年龄呈负相关（P < 0.05）。在WCST中，正确反应数、正确反应百分比和概念化水平百分比与BRMS评分呈正相关（均P < 0.05）。错误反应数和持续性反应数与BRMS评分呈负相关（均P < 0.05）。持续性错误数和持续性错误百分比与受教育年限呈正相关（均P < 0.05）。在抑郁组中，倒背数字广度与教育水平呈正相关（P < 0.05）。
在本研究中，不同首发综合征的双相情感障碍患者存在注意力、记忆力和执行功能方面的认知损害。与躁狂组相比，抑郁发作的双相情感障碍患者认知损害程度更严重。影响认知损害的危险因素包括发病年龄、教育水平、住院次数和疾病严重程度。
