Cognitive impairment in patients with a schizoaffective disorder: a comparison with bipolar patients in euthymia

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Objectives Several studies have shown persistent neurocognitive impairment in patients with a bipolar affective disorder (BD) even in euthymia as well as in patients with a schizoaffective disorder (SAD). The aim of our study was to compare the neuropsychological performance between these two groups. Confounding variables were controlled to enhance our understanding of cognitive dysfunction in both BD and SAD. Methods Several domains of neurocognitive function, executive function, memory, attention, concentration and perceptuomotor function were examined in 28 euthymic SAD patients and 32 BD patients by using a neuropsychological test battery. The Hamilton Depression Rating Scale (HAMD), Montgomery-Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) were used to evaluate the patients' clinical status. Data analysis was performed by using a multivariate analysis of covariance (ANCOVA/MANCOVA). Results Euthymic SAD patients showed greater cognitive impairment than euthymic BD patients in the tested domains including declarative memory and attention. Putative significant group differences concerning cognitive flexibility vanished when controlled for demographic and clinical variables. Age and medication were robust predictors to cognitive performance of both SAD and BD patients. Conclusions Our results point out the worse cognitive outcome of SAD compared to BD patients in remission. Remarkably, the variance is higher for some of the test results between the groups than within each group, this being discussed in light of the contradictive concept of SAD.

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Publié le 01 janvier 2010
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Langue English

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70 EUr J Med ReS (2010) 15: 70-78
EuRoPEan JouRnal of MEDICal REsEaRCH
febrUàrY 26, 2010
© I. HOLZàpFeL PUbLiSherS 2010
CognItIvEIMPaIRMEnt InPatIEnts wItH a sCHIzoaffECtIvEDIsoRDER: a CoMPaRIson wItHBIPolaRPatIEnts InEutHyMIa
1 12 13 41 1 g. sTUdeNTkOWSki , D. scheeLe , P. CàLàbreSe , f. BàLkàU , J. HöFFLer , t. aUbeL , M.-a. EdeL , g. JUckeL , 5 H.-J. aSSiON
1 DepàrTmeNT OF PSYchiàTrY àNd PSYchOTheràpY, lwl HOSpiTàL, RUhr-uNiVerSiTY BOchUm, germàNY; 2 DepàrTmeNT OF PSYchOLOGY, uNiVerSiTY OF BàSeL, sWiTZerLàNd, 3 DepàrTmeNT OF PSYchiàTrY àNd PSYchOTheràpY, MàrTiN-lUTher HOSpiTàL, BOchUm, germàNY, 4 DepàrTmeNT OF PSYchiàTrY àNd PSYchOTheràpY, lwl HOSpiTàL, DOrTmUNd, germàNY, 5 DepàrTmeNT OF PSYchiàTrY àNd PSYchOTheràpY, GpZ, DeTmOLd, germàNY
Abstract Objectives:seVeràL STUdieS hàVe ShOWN perSiSTeNT NeU-rOcOGNiTiVe impàirmeNT iN pàTieNTS WiTh à bipOLàr àF-FecTiVe diSOrder (BD) eVeN iN eUThYmià àS WeLL àS iN pàTieNTS WiTh à SchiZOàFFecTiVe diSOrder (saD). the àim OFOUr STUdY WàS TO cOmpàre The NeUrOpSYchOLOG-icàL perFOrmàNce beTWeeN TheSe TWO GrOUpS. CON-FOUNdiNG VàriàbLeS Were cONTrOLLed TO eNhàNce OUr UN-derSTàNdiNG OFcOGNiTiVe dYSFUNcTiON iN bOTh BD àNd saD. Methods:NeUrOcOGNiTiVe FUNcTiON,seVeràL dOmàiNS OF execUTiVe FUNcTiON, memOrY, àTTeNTiON, cONceNTràTiON àNd percepTUOmOTOr FUNcTiON Were exàmiNed iN 28 eU-ThYmic saD pàTieNTS àNd 32 BD pàTieNTS bY USiNG à NeUrOpSYchOLOGicàL TeST bàTTerY. the HàmiLTON De-preSSiON RàTiNG scàLe (HaMD), MONTGOmerY-aSberG DepreSSiON RàTiNG scàLe (MaDRs) àNd yOUNG MàNià RàTiNG scàLe (yMRs) Were USed TO eVàLUàTe The pà-TieNTS’ cLiNicàL STàTUS. DàTà àNàLYSiS WàS perFOrmed bY USiNG à mULTiVàriàTe àNàLYSiS OFcOVàriàNce (anCo-va/ManCova). Results:EUThYmic saD pàTieNTS ShOWed GreàTer cOGNi-TiVe impàirmeNT ThàN eUThYmic BD pàTieNTS iN The TeST-ed dOmàiNS iNcLUdiNG decLàràTiVe memOrY àNd àTTeN-TiON. PUTàTiVe SiGNiFicàNT GrOUp diFFereNceS cONcerNiNG cOGNiTiVe FLexibiLiTY VàNiShed WheN cONTrOLLed FOr de-mOGràphic àNd cLiNicàL VàriàbLeS. aGe àNd medicàTiON Were rObUST predicTOrS TO cOGNiTiVe perFOrmàNce OF bOTh saD àNd BD pàTieNTS. Conclusions:oUr reSULTS pOiNT OUT The WOrSe cOGNiTiVe OUTcOme OFsaD cOmpàred TO BD pàTieNTS iN remiS-SiON. RemàrkàbLY, The VàriàNce iS hiGher FOr SOme OF The TeST reSULTS beTWeeN The GrOUpS ThàN WiThiN eàch GrOUp, ThiS beiNG diScUSSed iN LiGhT OFThe cONTràdic-TiVe cONcepT OFsaD.
Key words:bipOLàr diSOrder, SchiZOàFFecTiVe diSOrder, cOGNiTiON, NeUrOpSYchOLOGY
IntRoDuCtIon
IT hàS beeN eSTimàTed ThàT beTWeeN 0.5% àNd 0.8% OF The GeNeràL pOpULàTiON SUFFer FrOm à SchiZOàFFecTiVe diSOrder (saD) [3]. DeSpiTe SLiGhTLY diFFereNT cONcepTS
OF TheDsM-Iv àNd ICD-10 diàGNOSTic criTerià, The cOre FeàTUre OFsaD iN bOTh màNUàLS iS The cONcUr-reNT Or cONSecUTiVe OccUrreNce OFpSYchOTic àNd àFFec-TiVe SYmpTOmàTOLOGY. the ONGOiNG debàTe WheTher saD dOeS reàLLY exiST Or iS ràTher àN àrTiFiciàL Or iNTer-mediàTe càTeGOrY, pàrTicULàrLY àriSeS FrOm The diFFeriNG saD diàGNOSTic criTerià. IN à FiVe-YeàrS reTrOSpecTiVe STUdY OF61 pàTieNTS WiTh iNiTiàL diàGNOSiS OFsaD à prOpOrTiON OF37 pàTieNTS ShiFTed TO The diàGNOSiS OF bipOLàr diSOrder (BD) dUriNG The ObSerVàTiONàL periOd [36]. CONSeqUeNTLY, MàrNerOS àNd gOOdWiN [30] SUG-GeSTed àN àdàpTàTiON OFThe ICD-10 cLàSSiFicàTiON àNd TO SUbSUme saD TO The àFFecTiVe càTeGOrY ràTher ThàN TO The SpecTrUm OFSchiZOphreNià (sz). IT iS FUrTher kNOWN ThàT cOGNiTiVe impàirmeNT iS à chàràcTeriSTic FeàTUre OFsaD àNd cONSidered TO be à cOre SYmpTOm OFbOTh BD àNd sz. COGNiTiVe deFiciTS àre NeiTher excLUSiVeLY à reSULT OFThe àFFecTiVe SYmpTO-màTOLOGY NOr SOLeLY à cONSeqUeNce OFphàrmàcOLOGi-càL TreàTmeNT [20]. MOST OFThe STUdieS cONcerNiNG cOGNiTiVe FUNcTiON-iNG hàVe ShOWN cOGNiTiVe deFiciTS iN bipOLàr depreS-SiON. IN receNT YeàrS, perSiSTeNT cOGNiTiVe deFiciTS hàVe beeN repOrTed eVeN iN eUThYmià iN àbOUT ONe Third OF bipOLàr pàTieNTS [19]. PàTieNTS WiTh BD exhibiT à re-dUced VerbàL [51] àNd SpàTiàL WOrkiNG memOrY [16]. EVeN WheN cONTrOLLed FOr àGe, premOrbid IQ Or reSid-UàL depreSSiVe SYmpTOmàLOGY, The perFOrmàNce iS pOOrer cONcerNiNG LeàrNiNG, ShOrT àNd deLàYed recàLL àS WeLL àS recOGNiTiON TàSkS [32]. the VerbàL recOVerY OF iNFOrmàTiON beST predicTS The OUTcOme OFpSYchOSO-ciàL FUNcTiONiNG OFbipOLàr pàTieNTS, àNd cONSeqUeNTLY cOrreLàTeS WiTh SeriOUS OccUpàTiONàL Or reLàTiONàL prOb-LemS [31]. HOWeVer, CLàrk, IVerSeN àNd gOOdWiN [9] àLSO cONTrOLLed FOr miLd àFFecTiVe SYmpTOmS àNd FOUNd à redUced SUSTàiNed àTTeNTiON, ONLY. a redUced SeLec-TiVe àTTeNTiON WàS eVàLUàTed USiNG The sTrOOp wOrd COLOUr teST [50]. MOreOVer, SeVere deFiciTS iN execU-TiVe dYSFUNcTiON Were ObSerVed iN màNY STUdieS. a prOLONGed pLàNNiNG Time [40], redUced VerbàL FLUeNcY [22] àNd impàired WOrkiNG memOrY [46] Were The màiN cOGNiTiVe dOmàiNS FOUNd iN TheSe STUdieS. the reSULT WàS ThàT The cOGNiTiVe FLexibiLiTY WàS àLSO impàired, àNd àppeàred TO be diSTiNcTiVe FOr bipOLàr pàTieNTS WiTh