The Relationship Between Cognitive Impairment And Functionality In Euthymic Bipolar Patients: A Case Controlled Study

Özlem, Baş Uluyol; Özge, Şahmelikoğlu Onur

doi:10.15761/0101-60830000000297

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Original Article • Arc. Clin. Psychiatr. 48 (3) • May-Jun 2021 • https://doi.org/10.15761/0101-60830000000297 linkcopy

The Relationship Between Cognitive Impairment And Functionality In Euthymic Bipolar Patients: A Case Controlled Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: We sought to compare differences in cognitive function between patients with bipolar disorder type 1 (BPD-1) and healthy controls (HC) and to investigate the relationship between cognitive functions and functional areas of patients with BPD-1.

Methods: This study included 93 euthymic patients with BPD-1 and 64 healthy age- and sex-matched individuals. All participants completed a sociodemographic form; took the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Montreal Cognitive Assessment Scale (MoCA) assessments; and underwent a neuropsychometric battery. Results pertaining to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth revision Axis I Disorders (SCID-I), Young Mania Rating Scale score, and Bipolar Disorder Functioning Questionnaire score were obtained for the patients; the HC group was investigated using the SCID nonpatient version.

Results: All of the cognitive domain scores were significantly lower in the BPD-1group than in the HC group (p < 0.05). A statistically significant positive correlation was observed between the neurocognitive domains of attention, verbal memory, visual memory, and BPD-1 total functioning (p < 0.05).

Discussion: Impairments in verbal memory, visual memory, and attention among euthymic patients with BPD-1 may cause impaired functionality.

Keywords:
bipolar disorder; cognitive function; funcionality

	BPD1		HC		P
	Mean±SD/n-%		Mean±SD/n-%		P
Age	37.23 ± 9.58		34.53 ± 8.1		0.128	t
Gender
Female	46	49.50%	34	53.10%	0.652	X²
Male	47	50.50%	30	46.90%	0.652	X²
Education (years)	11.31 ± 3.71		11.22 ± 3.84		0.947	m
Employment Status
Employed	41	44.10%	59	92.20%	p<0.001	X²
Unemployed	52	55.90%	5	7.80%	p<0.001	X²
Marital
Single	39	41.90%	20	31.30%	0.038	X²
Married	40	43.00%	40	62.50%
Divorced/Widow	14	15.10%	4	6.30%

	BPD-1			HC			p
	Mean±SD			Mean±SD			p
Attention	-0.09	±	0.47	0.24	±	0.58	p<0.001	m
Excutive Function	0.08	±	0.52	0.38	±	0.57	0.004	m
Verbal Memory	-0.25	±	0.61	0.33	±	0.54	p<0.001	m
Visual Memory	-0.2	±	0.91	0.29	±	0.87	p<0.001	m
MOCA	24.5	±	2.2	26.6	±	1.7	p<0.001	m
BAI	7.5	±	8.4	9.0	±	9.3	0.283	m
BDI	5.6	±	3.3	5.0	±	2.9	0.180	m
mMann-whitney u test

		Attention	Executive Function	Verbal Memory	Visual Memory
Total	r	0.229	0.098	0.410	0.268
Functioning	p	0.041	0.429	p<0.001	p<0.001
Emotional	r	0.240	0.233	0.355	0.299
Functioning	p	0.320	0.058	p<0.001	0.004
Intellectual	r	0.254	0.033	0.343	0.285
Functioning	p	0.023	0.794	0.001	0.006
Sexual	r	0.145	0.101	0.004	0.194
Functioning	p	0.199	0.418	0.973	0.063
Feelings of	r	0.097	0.033	0.194	0.149
Stigmatization	p	0.394	0.792	0.062	0.154
Social	r	0.026	0.106	0.281	0.224
Withdrawal	p	0.817	0.392	0.006	0.031
Household	r	0.115	0.129	0.321	0.184
Relations	p	0.312	0.299	0.002	0.77
Relations with	r	0.41	0.110	0.370	0.123
Friends	p	0.719	0.377	p<0.001	0.240
Participation to	r	0.119	0.40	0.255	0.065
Social Activities	p	0.295	0.749	0.014	0.533
Daily Activities	r	0.117	0.152	0.316	0.211
And Hobbies	p	0.300	0.219	0.002	0.043
Taking Initiative	r	0.251	0.137	0.356	0.187
And Self-sufficiency	p	0.024	0.268	p<0.001	0.072
Occupation	r	0.212	0.097	0.019	0.038
	p	0.059	0.437	0.857	0.716
Spearman correlation

	Low Functionality			High Functionality			p
	Mean±SD			Mean±SD			p
Attention	-0.21	±	0.53	0.04	±	0.35	0.013	m
Excutive Function	-0.02	±	0.48	0.16	±	0.53	0.170	m
Verbal Memory	-0.45	±	0.62	-0.06	±	0.53	0.001	m
Visual Memory	-0.33	±	0.86	-0.09	±	0.94	0.117	m
Age	36.27	±	9.72	38.24	±	9.43	0.268	m
Education	11.97	±	3.64	10.60	±	3.68	0.068	m
Age of onset	21.54	±	5.81	23.82	±	7.06	0.103	m
Number of hospitalizations	2.25	±	2.04	2.04	±	2.23	0.321	m
Duration of episode(days)	15.93	±	7.17	15.52	±	7.00	0.231	m
MOCA	23.9	±	2.12	24.9	±	2.19	0.021	m
BAI	10.6	±	9.92	4.58	±	5.35	p<0.001	m
BDI	7.20	±	2.65	4.10	±	3.13	p<0.001	m
mMann-whitney u test,

		Mean±SD/n-%
Age of onset (years)		22.61 ± 6.5
Number of hospitalizations		2.15 ± 2.13
Duration of episode(days)		15.72 ± 7.05
YMRS		0.8 ± 1.5
BAI		7.5 ± 8.4
BDI		5.6 ± 3.3
		N %
Mood Stabilizator of choice	Li	48 51.60%
	VPA	24 25.80%
	CBZ	2 2.20%
	Lamotrigine	1 1.10%
	Li+VPA	10 10.80%
	Li+CBZ	2 2.20%
	VPA+CBZ	1 1.10%
	VPA+Lamotrigine	1 1.10%
	None	4 4.30%
Additional treatment	Absent	21 22.60%
Additional treatment	Present	72 77.40%
Additional medication	AAP	62 66.70%
	AD	1 1.10%
	AAP+LAI	1 1.10%
	AAP+AD	6 6.50%
	AD+LAI	1 1.10%
	TypicalAP+AAP	1 1.10%

	Univariate Model					Multivariate Model
	OR	0.95			p	OR	0.95			p
MOCA	0.60	-0.14	-	0.08	p<0.001
BAI	1.94	-0.22	-	0.00	p<0.001	1.67	1.02	-	2.72	0.041
BDI	0.94	-0.09	-	-0.02	p<0.001
Attention	0.39	-0.10	-	0.38	0.002
Verbal Memory	0.10	-0.06	-	0.30	p<0.001

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[TFN1] BPD1: Bipolar Disorder type 1, HC: Healthy Control, SD: Standart deviation, n: number of participiants

[TFN2] In BPD-1 group, the employment rate was significantly lower in the HC group (p<0.05). The ratio of single-divorced individuals in BPD-1 group was significantly higher than the HC group (p<0.05) t: independent t test, X²: Chi-square test, m: Mann-Whitney u test