Two-year course of cognitive function and instrumental activities of daily living in older adults with bipolar disorder: evidence for neuroprogression?

Gildengers, A. G.; Chisholm, D.; Butters, M. A.; Anderson, S. J.; Begley, A.; Holm, M.; Rogers, J. C.; Reynolds, C. F.; Mulsant, B. H.

doi:10.1017/s0033291712001614

Cited by 89Bipolar Disorder and TreatmentDementia and Cognitive Impairment ResearchSchizophrenia research and treatment

Two-year course of cognitive function and instrumental activities of daily living in older adults with bipolar disorder: evidence for neuroprogression?

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Gildengers, A. G., Chisholm, D., Butters, M. A., Anderson, S. J., Begley, A., Holm, M., Rogers, J. C., Reynolds, C. F. +1 more·2013·Psychological Medicine

DOI 10.1017/s0033291712001614PMC PMC3593938

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Abstract

Background: While bipolar disorder (BD) is a leading cause of disability, and an important contributor to disability in BD is cognitive impairment, there is little systematic research on the longitudinal course of cognitive function and instrumental activities of daily living (IADLs) in late-life. In this report, we characterize the 2-year course of cognitive function and IADLs in older adults with BD. Method: We recruited non-demented individuals 50 years and older with BD I or BD II (n = 47) from out-patient clinics or treatment studies at the University of Pittsburgh. Comparator subjects (‘controls’) were 22 individuals of comparable age and education with no psychiatric or neurologic history, but similar levels of cardiovascular disease. We assessed cognitive function and IADLs at baseline, 1- and 2-year time-points. The neuropsychological evaluation comprised 21 well-established and validated tests assessing multiple cognitive domains. We assessed IADLs using a criterion-referenced, performance-based instrument. We employed repeated-measures mixed-effects linear models to examine trajectory of cognitive function. We employed non-parametric tests for analysis of IADLs. Results: The BD group displayed worse cognitive function in all domains and worse IADL performance than the comparator group at baseline and over follow-up. Global cognitive function and IADLs were correlated at all time-points. The BD group did not exhibit accelerated cognitive decline over 2 years. Conclusions: Over 2 years, cognitive impairment and associated functional disability of older adults with BD appear to be due to long-standing neuroprogressive processes compounded by normal cognitive aging rather than accelerated cognitive loss in old age.

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Cognitive dysfunction in bipolar disorder is related to the number of mood episodes earlier in life.
“This cognitive dysfunction is relatively stable, related to the number of mood episodes earlier in life, and does not appear to exceed normal aging in 2‐5‐year follow‐up.634, 635, 636”
From Canadian Network for Mood and Anxiety Treatments ( <scp>CANMAT</scp> ) and International Society for Bipolar Disorders ( <scp>ISBD</scp> ) 2018 guidelines for the management of patients with bipolar disorder (2018) · cites this paper as [634]
The Introduction (page unavailable) says cognitive dysfunction appears related to illness severity, which broadly supports the proposed relationship. It does not specify the number of mood episodes earlier in life. The Discussion (page unavailable) says the study had too few mood episodes to examine their effect on cognitive trajectory. (LLM, conf=0.78)
Experimental — accuracy not yet measured
Cognitive dysfunction in bipolar disorder does not appear to exceed normal aging in 2-5-year follow-up.
“This cognitive dysfunction is relatively stable, related to the number of mood episodes earlier in life, and does not appear to exceed normal aging in 2‐5‐year follow‐up.634, 635, 636”
From Canadian Network for Mood and Anxiety Treatments ( <scp>CANMAT</scp> ) and International Society for Bipolar Disorders ( <scp>ISBD</scp> ) 2018 guidelines for the management of patients with bipolar disorder (2018) · cites this paper as [634]
The Discussion reports that older adults with bipolar disorder did not decline faster than similar-aged comparators over two years. It also says that 3–5-year follow-up was still planned, so this paper does not establish the claim across a 2–5-year period or for people with bipolar disorder generally. Page numbers are not provided in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Cognitive dysfunction in bipolar disorder is relatively stable.
“This cognitive dysfunction is relatively stable, related to the number of mood episodes earlier in life, and does not appear to exceed normal aging in 2‐5‐year follow‐up.634, 635, 636”
From Canadian Network for Mood and Anxiety Treatments ( <scp>CANMAT</scp> ) and International Society for Bipolar Disorders ( <scp>ISBD</scp> ) 2018 guidelines for the management of patients with bipolar disorder (2018) · cites this paper as [634]

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Authors: Gildengers, A. G., Chisholm, D., Butters, M. A., Anderson, S. J., Begley, A., Holm, M., Rogers, J. C., Reynolds, C. F., & Mulsant, B. H.
Affiliations: University of Pittsburgh (US)
Centre for Addiction and Mental Health (CA)
Corresponding author: Butters, M. A.
ORCID: Gildengers, A. G.
Chisholm, D.
Butters, M. A.
Anderson, S. J.
Holm, M.
Rogers, J. C.
Reynolds, C. F.
Mulsant, B. H.
Venue: Psychological Medicine
Publisher: Cambridge University Press (CUP)
Published: 2012-07-30
Volume: 43
Issue: 4
Pages: 801-811
ISSN: 0033-2917 (ISSN-L)
1469-8978
DOI: 10.1017/s0033291712001614
PMC: PMC3593938
OpenAlex: W2150650493
Cited by: 89
References: 45
Citations by year: 2026: 5 · 2025: 4 · 2024: 4 · 2023: 2 · 2022: 5 · 2021: 7 · 2020: 9 · 2019: 3 · 2018: 6 · 2017: 18 · 2016: 7 · 2015: 7 · 2014: 6 · 2013: 6
FWCI: 4.34
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.cambridge.org/core/terms (unspecified)
Locations: Psychological Medicine (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (UL1TR000005)
National Institute on Aging (P30AG024827)
National Institute of Mental Health (U01 MH68846, P30 MH68446, R01MH072947, U01MH068846, P30MH090333, R01MH084921, R01MH080240, K23MH073772, P30MH071944, K24MH069430, R01MH043832)
National Center for Advancing Translational Sciences
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords: bipolar disorder, older adults, cognitive impairment, instrumental activities of daily living, functional disability, neuroprogression, cognitive aging, longitudinal cognitive trajectories, cognitive decline
MeSH terms: Activities of Daily Living, Aged, Aged, 80 and over, Aging, Bipolar Disorder, Cognition, Cognition Disorders, Female, Humans, Interview, Psychological, Longitudinal Studies, Male, Middle Aged, Neuropsychological Tests, Linear Models, Case-Control Studies, Disease Progression, Statistics, Nonparametric

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Two-year course of cognitive function and instrumental activities of daily living in older adults with bipolar disorder: evidence for neuroprogression?

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