Department of Psychiatry, University of California San Diego, San Diego, CA, USA; Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA.
Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
J Affect Disord. 2024 Jun 15;355:231-238. doi: 10.1016/j.jad.2024.03.126. Epub 2024 Mar 26.
Cognitive deficits in bipolar disorder (BD) impact functioning and are main contributors to disability in older age BD (OABD). We investigated the difference between OABD and age-comparable healthy comparison (HC) participants and, among those with BD, the associations between age, global cognitive performance, symptom severity and functioning using a large, cross-sectional, archival dataset harmonized from 7 international OABD studies.
Data from the Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) database, spanning various standardized measures of cognition, functioning and clinical characteristics, were analyzed. The sample included 662 euthymic to mildly symptomatic participants aged minimum 50years (509 BD, 153 HC), able to undergo extensive cognitive testing. Linear mixed models estimated associations between diagnosis and global cognitive performance (g-score, harmonized across studies), and within OABD between g-score and severity of mania and depressive symptoms, duration of illness and lithium use and of global functioning.
After adjustment for study cohort, age, gender and employment status, there was no significant difference in g-score between OABD and HC, while a significant interaction emerged between employment status and diagnostic group (better global cognition associated with working) in BD. Within OABD, better g-scores were associated with fewer manic symptoms, higher education and better functioning.
Cross-sectional design and loss of granularity due to harmonization.
More research is needed to understand heterogenous longitudinal patterns of cognitive change in BD and understand whether particular cognitive domains might be affected in OABD in order to develop new therapeutic efforts for cognitive dysfunction OABD.
双相障碍（BD）患者的认知缺陷会影响其功能，是导致老年 BD（OABD）患者残疾的主要原因。我们通过一项来自 7 项国际 OABD 研究的大型、横断面、档案数据库，调查了 OABD 患者与年龄匹配的健康对照组（HC）之间的差异，以及在 BD 患者中，年龄、整体认知表现、症状严重程度和功能之间的关系。
分析了来自双相障碍全球老龄化和老年化实验（GAGE-BD）数据库的数据，涵盖了各种认知、功能和临床特征的标准化测量。样本包括 662 名年龄在 50 岁及以上（509 名 BD，153 名 HC）、能够接受广泛认知测试的病情稳定或症状轻微的患者。线性混合模型估计了诊断与整体认知表现（g 评分，跨研究协调）之间的关系，以及在 OABD 中 g 评分与躁狂和抑郁症状严重程度、疾病持续时间、锂治疗和整体功能之间的关系。
在调整了研究队列、年龄、性别和就业状况后，OABD 和 HC 之间的 g 评分没有显著差异，而在 BD 中，就业状况和诊断组之间出现了显著的交互作用（与工作相关的整体认知更好）。在 OABD 中，更好的 g 评分与更少的躁狂症状、更高的教育程度和更好的功能有关。
横断面设计和由于协调而丧失的粒度。
需要进一步研究，以了解 BD 中认知变化的异质纵向模式，并了解特定认知领域是否可能在 OABD 中受到影响，以便为 OABD 的认知功能障碍开发新的治疗方法。
