Cognitive impairments linked to mood episode recurrence risk

Cognitive impairments are associated with an increased risk for mood episode recurrence in euthymic patients with bipolar disorder (BD), researchers report.

In a study of 70 euthymic BD patients, the researchers found that those with a clinically significant impairment in any cognitive domain were more than twice as likely to experience a manic/hypomanic or depressive recurrence over a follow-up period of more than a year as those without cognitive impairments.

"These associations remained significant after adjusting for several potential confounders such as number of previous episodes, time since last episode, clinical subtype of BD, exposure to antipsychotics, and subclinical symptoms," explain Diego Martino and team from Favaloro University in Buenos Aires, Argentina.

"Our results provide useful information about the relationship between neurocognitive functioning and clinical course in BD," they add.

All of the participants, who were aged between 18 and 60 years, were assessed at baseline using an extensive battery of neuropsychologic tests, and were followed up for mood episode recurrences over a mean period of 16.3 months.

In total, 41 (58.6%) patients showed evidence of clinically significant impairment in at least one cognitive domain at baseline. And during follow up, 48 (68.6%) patients experienced a mood episode recurrence.

After accounting for confounding factors, the researchers found that patients with impairments in at least one cognitive domain at baseline were 3.13 times more likely to experience any mood episode recurrence during follow up than those without cognitive impairments.

Specifically, the risk for manic/hypomanic episodes was increased 2.42-fold and the risk for depressive episodes was increased 3.84-fold in patients with cognitive impairments compared with those without.

Martino and team conclude: "Our results suggest that… cognitive impairment increase[s] the risk of recurrence and might contribute to understand differences in clinical course of patients with bipolar disorder."

They add: "Further longitudinal studies are needed to confirm this finding and to further clarify the potential causal pathways of this association."

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