Evidence for cognitive subgroups in bipolar disorder and the influence of subclinical depression and sleep disturbances
Abstract
Recent research in bipolar disorder (BD) points to the relevance and persistence of cognitive deficits even in euthymia. Up to now, the mechanisms behind why some bipolar patients (BP) do not reach their former level of cognitive performance and psychosocial functioning while others remit completely, are not understood. In this study we aimed to identify a "cognitive deficit" vs. "non-deficit" subgroup within BD by using an extensive neuropsychological test battery. The test performance of 70 euthymic outpatients (BD-I and II, recruited as a sample of convenience from our bipolar disorder programme) was compared to 70 matched, healthy controls (HC). Furthermore, we investigated the association between demographic/clinical variables and the cognitive performance of BP. As expected, our sample of euthymic BP performed significantly worse than HC in psychomotor speed, divided attention, working memory, verbal memory, word fluency and problem solving. However, 41.4% of the patients did not have any neurocognitive deficits at all, and whether or not a patient belonged to the non-deficit group was not influenced by disease severity. Instead, our results demonstrate that patients suffering from persistent sleep disturbances and sub-threshold depressive symptomatology show more severe cognitive dysfunctions. In addition, antipsychotic treatment and comorbid anxiety disorder were associated with cognitive deficits. In sum, these results suggest that a major part of cognitive impairment is due to current symptomatology, especially sleep disorder and sub-syndromal depression. Rigorous treatment of these symptoms thus might well improve cognitive deficits and, as a consequence, overall functioning in BD.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Increased cardio-metabolic dysfunction has been associated with worse mental and cognitive symptoms in people with schizophrenia, major depressive disorder, bipolar disorder and binge eating disorder.
“Moreover, increased cardio-metabolic dysfunction has been associated with worse mental and cognitive symptoms in those with schizophrenia [98], MDD [99], bipolar disorder [100] and binge eating disorder [101].”
From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [100]
Cites
Development and validation of brief measures of positive and negative affect: The PANAS scales.
Watson, D., Clark, L. A., & Tellegen, A. (1988) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.54.6.1063 · Cited by 32,433 · see citing works
(1998) · The Journal of Clinical Psychiatry · Cited by 19,139 · see citing works
A new depression scale designed to be sensitive to change
Montgomery, S. A., & Åsberg, M. (1979) · British Journal of Psychiatry · doi:10.1192/bjp.134.4.382 · Cited by 13,962 · see citing works
A Rating Scale for Mania: Reliability, Validity and Sensitivity
Young, R. C., Biggs, J. T., Ziegler, V. E., & Meyer, D. A. (1978) · British Journal of Psychiatry · doi:10.1192/bjp.133.5.429 · Cited by 8,744 · see citing works
Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients
Beck, A. T., Steer, R. A., Ball, R., & Ranieri, W. F. (1996) · Journal of Personality Assessment · doi:10.1207/s15327752jpa6703_13 · Cited by 5,965 · see citing works
The mini international neuropsychiatric interview
Lecrubier, Y., Sheehan, D. V., Hergueta, T., & Weiller, E. (1998) · European Psychiatry · doi:10.1016/s0924-9338(99)80239-9 · Cited by 5,882 · see citing works
Neurocognitive consequences of sleep deprivation
Goel, N., Rao, H., Durmer, J., & Dinges, D. (2009) · Seminars in Neurology · doi:10.1055/s-0029-1237117 · Cited by 2,154 · see citing works
Lupien, S. J., Maheu, F., Tu, M., Fiocco, A., & Schramek, T. E. (2007) · Brain and Cognition · doi:10.1016/j.bandc.2007.02.007 · Cited by 1,474 · see citing works
Neurocognitive Consequences of Sleep Deprivation
Durmer, J. S., & Dinges, D. F. (2005) · Seminars in Neurology · doi:10.1055/s-2005-867080 · Cited by 1,473 · see citing works
Millan, M. J., Agid, Y., Brüne, M., Bullmore, E. T., Carter, C. S., Clayton, N. S., Connor, R., Davis, S., Deakin, B., DeRubeis, R. J., et al. (2012) · Nature Reviews Drug Discovery · doi:10.1038/nrd3628 · Cited by 1,292 · see citing works
Cognitive Function Across Manic or Hypomanic, Depressed, and Euthymic States in Bipolar Disorder
Martínez‐Arán, A., Vieta, E., Reinares, M., Colom, F., Torrent, C., Sánchez‐Moreno, J., Benabarre, A., Goikolea, J. M., Comes, M., & Salamero, M. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.2.262 · Cited by 1,106 · see citing works
Global Assessment of Functioning
Hall, R. C. W. (1995) · Psychosomatics · doi:10.1016/s0033-3182(95)71666-8 · Cited by 1,099 · see citing works
Bora, E., Yücel, M., & Pantelis, C. (2008) · Journal of Affective Disorders · doi:10.1016/j.jad.2008.06.009 · Cited by 1,021 · see citing works
Bourne, C., Aydemır, Ö., Balanzá‐Martínez, V., Bora, E., Brissos, S., Cavanagh, J., Clark, L., Çubukçuoğlu, Z., Dias, V. V., Dittmann, S., et al. (2013) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12133 · Cited by 647 · see citing works
Multiple choice vocabulary test MWT as a valid and short test to estimate premorbid intelligence
Lehrl, S., Triebig, G., & Fischer, B. (1995) · Acta Neurologica Scandinavica · doi:10.1111/j.1600-0404.1995.tb07018.x · Cited by 619 · see citing works
Neuropsychological Function and Dysfunction in Schizophrenia and Psychotic Affective Disorders
Reichenberg, A., Harvey, P. D., Bowie, C. R., Mojtabai, R., Rabinowitz, J., Heaton, R. K., & Bromet, E. J. (2008) · Schizophrenia Bulletin · doi:10.1093/schbul/sbn044 · Cited by 516 · see citing works
Svanborg, P., & Åsberg, M. (2001) · Journal of Affective Disorders · doi:10.1016/s0165-0327(00)00242-1 · Cited by 481 · see citing works
Neurocognitive impairment in euthymic patients with bipolar affective disorder
Thompson, J. M., Gallagher, P., Hughes, J. H., Watson, S., Gray, J. M., Ferrier, I. N., & Young, A. H. (2005) · The British Journal of Psychiatry · doi:10.1192/bjp.186.1.32 · Cited by 433 · see citing works
Mann-Wrobel, M. C., Carreno, J. T., & Dickinson, D. (2011) · Bipolar Disorders · doi:10.1111/j.1399-5618.2011.00935.x · Cited by 328 · see citing works
Altshuler, L. L., Ventura, J., van Gorp, W. G., Green, M. F., Theberge, D. C., & Mintz, J. (2004) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.08.002 · Cited by 290 · see citing works
Cognitive impairment in bipolar II disorder
Torrent, C., Martínez‐Arán, A., Daban, C., Sánchez‐Moreno, J., Comes, M., Goikolea, J. M., Salamero, M., & Vieta, E. (2006) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.105.017269 · Cited by 272 · see citing works
Bora, E., Yücel, M., & Pantelis, C. (2009) · Schizophrenia Bulletin · doi:10.1093/schbul/sbp094 · Cited by 272 · see citing works
Increased cerebral response during a divided attention task following sleep deprivation
Drummond, S. P. A., Gillin, J. C., & Brown, G. G. (2001) · Journal of Sleep Research · doi:10.1046/j.1365-2869.2001.00245.x · Cited by 255 · see citing works
Circadian rhythms and sleep in bipolar disorder
Murray, G., & Harvey, A. G. (2010) · Bipolar Disorders · doi:10.1111/j.1399-5618.2010.00843.x · Cited by 250 · see citing works
López‐Jaramillo, C., Lopera-Vásquez, J. P., Gallo, A., Ospina‐Duque, J., Bell, V., Torrent, C., Martínez‐Arán, A., & Vieta, E. (2010) · Bipolar Disorders · doi:10.1111/j.1399-5618.2010.00835.x · Cited by 223 · see citing works
Effects of antidepressants on cognitive functions: a review
Amado-Boccara, I. (1995) · Neuroscience & Biobehavioral Reviews · doi:10.1016/0149-7634(94)00068-c · Cited by 206 · see citing works
Adult ADHD and its comorbidities, with a focus on bipolar disorder
Klassen, L. J., Katzman, M. A., & Chokka, P. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.06.036 · Cited by 205 · see citing works
Burdick, K. E., Goldberg, J. F., & Harrow, M. (2010) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2010.01590.x · Cited by 194 · see citing works
Subthreshold symptoms in bipolar disorder: Impact on neurocognition, quality of life and disability
Bonnín, C. M., Sánchez-Moreno, J., Martínez-Arán, A., Solé, B., Reinares, M., Rosa, A. R., Goikolea, J. M., Benabarre, A., Ayuso-Mateos, J. L., Ferrer, M., et al. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.10.012 · Cited by 190 · see citing works
A test battery for attentional performance
ZIMMERMANN, P., & Fimm, B. (2004) · Psychology Press eBooks · doi:10.4324/9780203307014-12 · Cited by 186 · see citing works
Cognitive impairment in bipolar disorder and schizophrenia: a systematic review
Vöhringer, P. A., Barroilhet, S. A., Amerio, A., Reale, M. L., Alvear, K., Vergne, D., & Ghaemi, S. N. (2013) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2013.00087 · Cited by 165 · see citing works
Long-Term Outcome of Cognitive Impairment in Bipolar Disorder
Torrent, C., Martínez‐Arán, A., Bonnín, C. D. M., Reinares, M., Daban, C., Solé, B., Rosa, A. R., Tabarés‐Seisdedos, R., Popović, D., Salamero, M., et al. (2012) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.11m07471 · Cited by 164 · see citing works
Meta-analytic review of neurocognition in bipolar II disorder
Bora, E., Yücel, M., Pantelis, C., & Berk, M. (2010) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2010.01638.x · Cited by 161 · see citing works
Heterogeneity in cognitive functioning among patients with bipolar disorder
Martino, D. J., Strejilevich, S., Scápola, M., Igoa, A., Marengo, E. B., Ais, E. D., & Perinot, L. (2008) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.12.232 · Cited by 160 · see citing works
Pharmacological approaches in bipolar disorders and the impact on cognition: a critical overview
Dias, V. V., Balanzá‐Martinez, V., Soeiro‐de‐Souza, M. G., Moreno, R. A., Figueira, M. L., Machado‐Vieira, R., & Vieta, E. (2012) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2012.01910.x · Cited by 146 · see citing works
Sleep disturbance in euthymic bipolar patients
Sylvia, L. G., Dupuy, J. M., Ostacher, M. J., Cowperthwait, C. M., Hay, A. C., Sachs, G. S., Nierenberg, A. A., & Perlis, R. H. (2011) · Journal of Psychopharmacology · doi:10.1177/0269881111421973 · Cited by 130 · see citing works
Diniz, B., Machado-Vieira, R., & Forlenza (2013) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s33086 · Cited by 128 · see citing works
Reinares, M., Papachristou, E., Harvey, P. D., Bonnín, C. D. M., Sánchez‐Moreno, J., Torrent, C., Ayuso‐Mateos, J. L., Ploubidis, G. B., Vieta, E., & Frangou, S. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.06.005 · Cited by 124 · see citing works
Identifying a cognitive impairment subgroup in adults with mood disorders
Iverson, G. L., Brooks, B. L., Langenecker, S. A., & Young, A. H. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.03.001 · Cited by 124 · see citing works
Morselli, P. L., Elgie, R., & Cesana, B. (2004) · Bipolar Disorders · doi:10.1111/j.1399-5618.2004.00160.x · Cited by 113 · see citing works
Effects of atypical antipsychotics on neurocognition in euthymic bipolar patients
Torrent, C., Martínez‐Arán, A., Daban, C., Amann, B. L., Balanzá‐Martínez, V., Bonnín, C. D. M., Cruz, N., Franco, C., Tabarés‐Seisdedos, R., & Vieta, E. (2011) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2010.12.009 · Cited by 111 · see citing works
A 2-year naturalistic study on cognitive functioning in bipolar disorder
Arts, B. M. G., Jabben, N., A, L. K. M., & van Os, J. (2010) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2010.01601.x · Cited by 109 · see citing works
Predictors of employment in bipolar disorder: A systematic review
Gilbert, E., & Marwaha, S. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.07.009 · Cited by 106 · see citing works
Cognitive functioning in euthymic bipolar I and bipolar II patients
Dittmann, S., Hennig‐Fast, K., Gerber, S., Seemüller, F., Riedel, M. J., Severus, W. E., Langosch, J. M., Engel, R. R., Möller, H., & Grunze, H. (2008) · Bipolar Disorders · doi:10.1111/j.1399-5618.2008.00640.x · Cited by 105 · see citing works
Boland, E. M., & Alloy, L. B. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.10.001 · Cited by 101 · see citing works
Impact of ADHD on the Neurocognitive Functioning of Adolescents with Bipolar Disorder
Rucklidge, J. J. (2006) · Biological Psychiatry · doi:10.1016/j.biopsych.2006.03.067 · Cited by 96 · see citing works
McKay, A., Tarbuck, A. F., Shapleske, J., & McKenna, P. (1995) · The British Journal of Psychiatry · doi:10.1192/bjp.167.1.51 · Cited by 90 · see citing works
Pålsson, E., Figueras, C., Johansson, A. G. M., Ekman, C. J., Hultman, B., Östlind, J., & Landén, M. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-165 · Cited by 88 · see citing works
Neurocognitive functioning in patients recently diagnosed with bipolar disorder
Hellvin, T., Sundet, K. S., Simonsen, C., Aminoff, S. R., Lagerberg, T. V., Andreassen, O. A., & Melle, I. S. (2012) · Bipolar Disorders · doi:10.1111/j.1399-5618.2012.01004.x · Cited by 86 · see citing works
Prevalence and Clinical Correlates of Residual Depressive Symptoms in Bipolar II Disorder
Benazzi, F. (2001) · Psychotherapy and Psychosomatics · doi:10.1159/000056260 · Cited by 83 · see citing works
Differential executive functioning performance by phase of bipolar disorder
Ryan, K. A., Vederman, A. C., McFadden, E. M., Weldon, A. L., Kamali, M., Langenecker, S. A., & McInnis, M. G. (2012) · Bipolar Disorders · doi:10.1111/j.1399-5618.2012.01032.x · Cited by 76 · see citing works
The neurocognitive performance of drug‐free and medicated euthymic bipolar patients do not differ
Goswami, U., Sharma, A., Varma, A., Gulrajani, C., Ferrier, I. N., Young, A. H., Gallagher, P., Thompson, J. M., & Moore, P. B. (2009) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2009.01390.x · Cited by 75 · see citing works
Chaves, O. C., Lombardo, L., Bearden, C. E., Woolsey, M. D., Martinez, D., Barrett, J. A., Miller, A. L., Velligan, D. I., & Glahn, D. C. (2011) · Bipolar Disorders · doi:10.1111/j.1399-5618.2011.00888.x · Cited by 74 · see citing works
Neurocognitive functions in euthymic bipolar patients
Jamrozinski, K., Gruber, O., Kemmer, C., Falkai, P., & Scherk, H. (2008) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2008.01320.x · Cited by 71 · see citing works
McKenna, B. S., & Eyler, L. T. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.07.003 · Cited by 69 · see citing works
Vieta, E., Sánchez‐Moreno, J., Lahuerta, J. J., & Domingo, S. Z. (2007) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.08.007 · Cited by 69 · see citing works
Neuropsychological evidence for abnormal neurodevelopment associated with early-onset psychoses
Bombín, I., Mayoral, M., Castro‐Fornieles, J., González-Pinto, A. M., de la Serna, E., Rapado‐Castro, M., Barbeito, S., Parellada, M., Baeza, I., Graell, M., et al. (2012) · Psychological Medicine · doi:10.1017/s0033291712001535 · Cited by 63 · see citing works
Levy, B., Medina, A. M., & Weiss, R. D. (2013) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2012.12.018 · Cited by 59 · see citing works
Giglio, L. M. F., Andreazza, A. C., Andersen, M. L., Ceresér, K. M., Walz, J. C., Sterz, L., & Kapczinski, F. P. (2008) · Sleep And Breathing · doi:10.1007/s11325-008-0215-5 · Cited by 54 · see citing works
Neurocognitive features in subgroups of bipolar disorder
Aminoff, S. R., Hellvin, T., Lagerberg, T. V., Berg, A. O., Andreassen, O. A., & Melle, I. S. (2013) · Bipolar Disorders · doi:10.1111/bdi.12061 · Cited by 50 · see citing works
Executive deficits: A continuum schizophrenia–bipolar disorder or specific to schizophrenia?
Ancín, I., Cabranes, J. A., Santos, J. L., Sánchez‐Morla, E. M., & Barabash, A. (2013) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2013.07.008 · Cited by 40 · see citing works
Clinical parameters of circadian rhythms in affective disorders
Scott, J. L. (2011) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2011.07.006 · Cited by 39 · see citing works
Autonomic nervous system arousal and cognitive functioning in bipolar disorder
Levy, B. (2012) · Bipolar Disorders · doi:10.1111/bdi.12028 · Cited by 38 · see citing works
Brissos, S., Dias, V. V., Soeiro‐de‐Souza, M. G., Balanzá‐Martínez, V., & Kapczinski, F. P. (2011) · Brazilian Journal of Psychiatry · doi:10.1590/s1516-44462011000400008 · Cited by 30 · see citing works
The effect of comorbid anxiety disorder on neuropsychological function in bipolar II disorder
Wu, H., Chang, Y.-H., Lai, C., Wu, J. Y., Chen, S., Chu, C., Lee, I. H., Yeh, T. L., Tzeng, N., Huang, S., et al. (2011) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2011.07.013 · Cited by 27 · see citing works
Sleep Disturbances in Euthymic Bipolar Patients
Brill, S., Penagaluri, P., Roberts, R. J., Gao, Y., & El‐Mallakh, R. S. (2011) · Annals of Clinical Psychiatry · doi:10.1177/104012371102300205 · Cited by 23 · see citing works
Vieta, E., de Arce, R., Jiménez-Arriero, M. A., Rodriguez, A., Balanzá, V., Cobaleda, S., & SIN-DEPRES Group (2010) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.09m05177gre · Cited by 20 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Ashdown-Franks, G., Firth, J., Carney, R., Carvalho, A. F., Hallgren, M., Koyanagi, A., Rosenbaum, S., Schuch, F. B., Smith, L., Solmi, M., et al. (2020) · Sports Medicine · doi:10.1007/s40279-019-01187-6 · Cited by 446 · see citing works
Cognitive Impairment in Bipolar Disorder: Treatment and Prevention Strategies
Solé, B., Jiménez, E., Torrent, C., Reinares, M., Bonnin, C. D. M., Torres, I., Varo, C., Grande, I., Valls, E., Salagre, E., et al. (2017) · International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyx032 · Cited by 299 · see citing works
Cognition as a target in schizophrenia, bipolar disorder and depression
Martinez-Aran, A., & Vieta, E. (2015) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2015.01.007 · Cited by 101 · see citing works
Morton, E., & Murray, G. (2020) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2433 · Cited by 29 · see citing works
Comment caractériser et traiter les plaintes de sommeil dans les troubles bipolaires ?
Geoffroy, P. A., Micoulaud Franchi, J.-A., Lopez, R., Poirot, I., Brion, A., Royant-Parola, S., & Etain, B. (2017) · L'Encéphale · doi:10.1016/j.encep.2016.06.007 · Cited by 26 · see citing works
- Authors
- Volkert, J., Kopf, J., Kazmaier, J., Glaser, F., Zierhut, K. C., Schiele, M. A., Kittel-Schneider, S., & Reif, A.
- Affiliations
- University of Würzburg (DE)
- Corresponding author
- Volkert, J.
- Venue
- European Neuropsychopharmacology
- Publisher
- Elsevier BV
- Published
- 2015-02
- Volume
- 25
- Issue
- 2
- Pages
- 192-202
- ISSN
- 0924-977X (ISSN-L)
- OpenAlex
- W2048549939
- Cited by
- 83
- References
- 67
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 4 · 2023: 5 · 2022: 4 · 2021: 6 · 2020: 9 · 2019: 10 · 2018: 4 · 2017: 10 · 2016: 12 · 2015: 9
- FWCI
- 7.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Neuropsychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- bipolar disorder, cognitive impairment, euthymia, cognitive subgroups, sleep disorders, subthreshold depression, psychomotor speed, divided attention, working memory, verbal memory, verbal fluency, problem solving, antipsychotic drugs, anxiety comorbidity, disease severity
- MeSH terms
- Adult, Bipolar Disorder, Cognition, Cognition Disorders, Depression, Female, Humans, Male, Neuropsychological Tests, Outpatients, Psychiatric Status Rating Scales, Sleep Wake Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
