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

Published online by Cambridge University Press:  11 March 2014

K. E. Burdick ,
M. Russo ,
S. Frangou ,
K. Mahon ,
R. J. Braga ,
M. Shanahan  and
A. K. Malhotra
K. E. Burdick*
Affiliation:
Departments of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
M. Russo
Affiliation:
Departments of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
S. Frangou
Affiliation:
Departments of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
K. Mahon
Affiliation:
Departments of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
R. J. Braga
Affiliation:
Zucker Hillside Hospital – North Shore Long Island Jewish Health System, Glen Oaks, NY, USA
M. Shanahan
Affiliation:
Departments of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
A. K. Malhotra
Affiliation:
Zucker Hillside Hospital – North Shore Long Island Jewish Health System, Glen Oaks, NY, USA
*
* Address for correspondence: K. E. Burdick, Ph.D., Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1230, New York, NY 10029, USA. (Email: Katherine.burdick@mssm.edu)
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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.

Keywords

Bipolar disordercluster analysiscognitive heterogeneityfunctional outcomeneurocognitionschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 14 , October 2014 , pp. 3083 - 3096
Copyright
Copyright © Cambridge University Press 2014 

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