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. 2023 Oct;53(13):6316-6324.
doi: 10.1017/S0033291722003622. Epub 2022 Dec 5.

A cross-sectional study of cognitive performance in bipolar disorder across the lifespan: the cog-BD project

Brett D M Jones  1 , Brisa S Fernandes  1 , M Ishrat Husain  1   2 , Abigail Ortiz  1   2 , Tarek K Rajji  1   2   3 , Daniel M Blumberger  1   2 , Meryl A Butters  4 , Ariel G Gildengers  4 , Tatiana Shablinski  2 , Aristotle Voineskos  1   2 , Benoit H Mulsant  1   2   3   4
Affiliations

A cross-sectional study of cognitive performance in bipolar disorder across the lifespan: the cog-BD project

Brett D M Jones et al. Psychol Med. 2023 Oct.

Abstract

Background: Neuroprogressive models of the trajectory of cognitive dysfunction in patients with bipolar disorder (BD) have been proposed. However, few studies have explored the relationships among clinical characteristics of BD, cognitive dysfunction, and aging.

Methods: We conducted a cross-sectional analysis in euthymic participants with the MATRICS Cognitive Consensus Battery, the Trail Making Test B, the Stroop Test, and the Wechsler Test of Adult Reading. Age- and gender-equated control participants without a mental disorder ['Healthy Controls' - HC)] were assessed similarly. We compared cognitive performance both globally and in seven domains in four groups: younger BD (age ⩽49 years; n = 70), older BD (age ⩾50 years; n = 48), younger HC (n = 153), and older HC (n = 44). We also compared the BD and HC groups using age as a continuous measure. We controlled for relevant covariates and applied a Bonferroni correction.

Results: Our results support both an early impairment ('early hit') model and an accelerated aging model: impairment in attention/vigilance, processing speed, and executive function/working memory were congruent with the accelerated aging hypothesis whereas impairment in verbal memory was congruent with an early impairment model. BD and HC participants exhibited similar age-related decline in reasoning/problem solving and visuospatial memory. There were no age- or diagnosis-related differences in social cognition.

Conclusion: Our findings support that different cognitive domains are affected differently by BD and aging. Longitudinal studies are needed to explore trajectories of cognitive performance in BD across the lifespan.

Keywords: Bipolar disorder; cognition; geriatric psychiatry; mood disorder.

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Conflict of interest statement

BHM currently receives or has received with the past five years research support from Brain Canada, the Canadian Institutes of Health Research (CIHR), the CAMH Foundation, the Patient-Centered Outcomes Research Institute (PCORI), the US National Institute of Health (NIH), Capital Solution Design LLC (software used in a study founded by CAMH Foundation), Eli Lilly (medications for a NIH-funded clinical trial), HAPPYneuron (software used in a study founded by Brain Canada), and Pfizer (medications for a NIH-funded clinical trial). He has also been an unpaid consultant to Myriad Neuroscience. AGG and MAB receive research support from the NIH. BDMJ has received research support from the CIHR, Physicians Services Incorporated Foundations, and the University of Toronto. BSF no disclosure related to this manuscript. MIH and receives support from a CIHR Tier 2 Canada Research Chair and Academic Scholars Award from the Department of Psychiatry, University of Toronto. He currently receives or has received with the past five years research support from the Brain and Behavior Research Foundation, CAMH Foundation, CIHR, Compass Pathways, Physicians Services Incorporated Foundation, and the University of Toronto. He has been a consultant to Mindset Pharma, Psyched Therapeutics, and Wake Network. AO receives support from the Academic Scholars Award from the Department of Psychiatry, University of Toronto. She currently receives research support from the US National Institutes of Health (NIH), CIHR, and the University of Toronto. No disclosures related to this manuscript. DMB receives research support from the CIHR, National Institutes of Health – US (NIH), Brain Canada Foundation and the Temerty Family through the CAMH Foundation and the Campbell Family Research Institute. He received research support and in-kind equipment support for an investigator-initiated study from Brainsway Ltd. and he was the site principal investigator for three sponsor-initiated studies for Brainsway Ltd. He received in-kind equipment support from Magventure for investigator-initiated studies. He received medication supplies for an investigator-initiated trial from Indivior. He has participated in an advisory board for Janssen. He has participated in an advisory board for Welcony Inc. Dr Rajji has received research support from Brain Canada, Brain and Behavior Research Foundation, BrightFocus Foundation, Canada Foundation for Innovation, Canada Research Chair, CIHR, Centre for Aging and Brain Health Innovation, National Institutes of Health, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research and Innovation, and the Weston Brain Institute. Dr Rajji also received for an investigator-initiated study in-kind equipment support from Newronika, and in-kind research online accounts from Scientific Brain Training Pro, and participated in 2021 in one advisory board meeting for Biogen Canada Inc. Dr Rajji is also an inventor on the United States Provisional Patent No. 17/396 030 that describes cell-based assays and kits for assessing serum cholinergic receptor activity.

Figures

Fig. 1.
Fig. 1.
Cognitive performance across the life-span. Bar Graphs (Left): Multiple linear regression adjusted for years of education, Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS) scores, lifetime number of depressive episodes, lifetime history of psychosis, and lifetime history of smoking. A multiple linear regression was statistically significant if its p-value were <0.004 (Bonferroni correction, p< 0.05/12). When the p-value of the model was <0.004, we proceed with Sidak post-test to ascertain where the difference between the groups was found. The p-values above the lines refers to the Sidak post-test; the lines without a p-value denote lack of statistical significance after the Sidak post-test. 1=BD-Y, 2=HC=Y, 3=BD-O, 4=HC-O Linear Regression Graphs (Right): Regression models with cognitive measures as dependent variables and the above covariates including age. The interaction between age in years and diagnosis (bipolar disorder vs. comparator) was analyzed in a full factorial. *Stroop represents executive function.
Fig. 2.
Fig. 2.
Theoretical model of cognitive function across the lifespan. The figure represents the theoretical model of cognitive function across the life span. The dashed lines represent controls and the solid lines represent BD.
See this image and copyright information in PMC

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