Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Oct;44(14):3083-96.
doi: 10.1017/S0033291714000439. Epub 2014 Mar 11.

Empirical evidence for discrete neurocognitive subgroups in bipolar disorder: clinical implications

K E Burdick  1 , M Russo  1 , S Frangou  1 , K Mahon  1 , R J Braga  2 , M Shanahan  1 , A K Malhotra  2
Affiliations

Empirical evidence for discrete neurocognitive subgroups in bipolar disorder: clinical implications

K E Burdick et al. Psychol Med. 2014 Oct.

Abstract

Background: Recent data suggest trait-like neurocognitive impairments in bipolar disorder (BPD), with deficits about 1 s.d. below average, less severe than deficits noted in schizophrenia. The frequency of significant impairment in BPD is approximately 60%, with 40% of patients characterized as cognitively spared. This contrasts with a more homogeneous presentation in schizophrenia. It is not understood why some BPD patients develop deficits while others do not.

Method: A total of 136 patients with BPD completed the MATRICS Consensus Cognitive Battery and data were entered into hierarchical cluster analyses to: (1) determine the optimal number of clusters (subgroups) that fit the sample; and (2) assign subjects to a specific cluster based on individual profiles. We then compared subgroups on several clinical factors and real-world community functioning.

Results: Three distinct neurocognitive subgroups were found: (1) an intact group with performance comparable with healthy controls on all domains but with superior social cognition; (2) a selective impairment group with moderate deficits on processing speed, attention, verbal learning and social cognition and normal functioning in other domains; and (3) a global impairment group with severe deficits across all cognitive domains comparable with deficits in schizophrenia.

Conclusions: These results suggest the presence of multiple cognitive subgroups in BPD with unique profiles and begin to address the relationships between these subgroups, several clinical factors and functional outcome. Next steps will include using these data to help guide future efforts to target these disabling symptoms with treatment.

PubMed Disclaimer

Conflict of interest statement

Declaration of Interest

K.E.B. has served on an advisory board for Dainippon Sumitomo Pharma. A.K.M. has served as consultant or speaker for Bristol-Myers Squibb, Merck, AstraZeneca, Vanda Pharmaceuticals and Clinical Data Inc., and has received research support from Pfizer, Janssen Pharmaceuticals, Bristol-Myers Squibb and Eli Lilly. S.F. serves on advisory boards for Enzymotec and Janssen-Cilag.

Figures

Fig. 1
Fig. 1
Graphical agglomeration of bipolar disorder (BPD) subjects using discriminant function analysis. The figure represents the agglomeration of subjects using the three clusters emerged from the hierarchical cluster analysis. The centroids (■) are the mean score for each cluster. Cluster 1 is the global impairment group, cluster 2 is the selective impairment group and cluster 3 is the intact group (see text).
Fig. 2
Fig. 2
Neurocognitive profiles of bipolar disorder clusters and the schizophrenia sample. The X-axis indicates the MATRICS Consensus Cognitive Battery (MCCB) domains. The Y-axis depicts a Z-scale score with a mean of 0 and a standard deviation of 1. Z scores were computed based upon the healthy control sample. Patients are divided into lines based on scoring for each cognitive domain. Statistical comparisons among groups are specified in Table 2.
See this image and copyright information in PMC

Comment in

References

    1. Abood Z, Sharkey A, Webb M, Kelly A, Gill M. Are patients with bipolar affective disorder socially disadvantaged? A comparison with a control group. Bipolar Disorder. 2002;4:243–248. - PubMed
    1. Altman EG, Hedeker DR, Janicak PG, Peterson JL, Davis JM. The Clinician-Administered Rating Scale for Mania (CARS-M): development, reliability, and validity. Biological Psychiatry. 1994;36:124–134. - PubMed
    1. Altshuler LL, Ventura J, van Gorp WG, Green MF, Theberge DC, Mintz J. Neurocognitive function in clinically stable men with bipolar I disorder or schizophrenia and normal control subjects. Biological Psychiatry. 2004;56:560–569. - PubMed
    1. APA. Diagnostic and Statistical Manual of Mental Disorders. 4. American Psychiatric Association; Washington, DC: 2000. DSM-IV-TR.
    1. Bora E, Yucel M, Pantelis C. Cognitive endophenotypes of bipolar disorder: a meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. Journal of Affective Disorders. 2009;113:1–20. - PubMed

Publication types