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Web of Science (Free Access)

Abstract

Objective Distinct cognitive subgroups are seen in patients with long duration bipolar I disorder (BDI), possibly reflective of underlying pathophysiological differences. It is unknown whether such cognitive heterogeneity is present at illness onset. We applied latent class analysis (LCA) to cognitive test scores in first episode BDI patients. Exploratory analysis elucidated whether impaired subgroups were characterized by 'early neurodevelopmental' (low premorbid IQ and intracranial volume) versus 'later neurodevelopmental' (decline from premorbid to current IQ, changes in relative grey (GM)/white (WM) matter volumes) pathology.Methods Recently recovered first manic episode BDI patients (n = 91) and healthy controls (HC, n = 63) comprised the study sample. LCA identified subgroups based on processing speed, verbal memory, non-verbal memory, executive functioning, attention and working memory scores. Subgroups were compared amongst each other and HC on premorbid/current IQ, intracranial (ICV), total brain and regional volumes.Results Three cognitive subgroups emerged: (i) globally impaired (GI, n = 31), scoring 0.5-1 SD below demographically corrected norms across domains, (ii) selectively impaired (SI, n = 47), with predominant processing speed deficits and (iii) high performing (HP, n = 13), with above-average cognitive performance. GI patients showed a 'later neurodevelopmental' pattern, with normal ICV, significant decline from premorbid to current IQ, higher total GM and lower total WM (with respect to total brain volume) versus SI and HC (p = 0.003). GI patients had higher left frontal pole GM versus HC (p < 0.05, FWE corrected).Conclusions A globally impaired patient subgroup is identifiable in first episode BDI, possibly characterized by unique neurodevelopmental pathologic processes proximal to illness onset.

Authors

Chakrabarty, Trisha; Torres, Ivan J.; Su, Weizhong W.; Sawatzky, Richard; Keramatian, Kamyar; Yatham, Lakshmi N.

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"Cognitive subgroups in first episode bipolar I disorder: Relation to clinical and brain volumetric variables" on Publons

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Web of Science (Free Access) Abstract Objective Distinct cognitive subgroups are seen in patients with long duration bipolar I disorder (BDI), possibly reflective of underlying pathophysiological differences. It is unknown whether such cognitive heterogeneity is present at illness onset. We applied latent class analysis (LCA) to cognitive test scores in first episode BDI patients.

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- Bruger en tværsnitsundersøgelse til at udtale sig om en longitudinelt spørgsmål (korrelation mellem præmorbid IQ og NART er cirka r = 0,60)
- Små gruppestørrelser (for HP er n = 13) - dette blev først "fanget" i peer review
- Anvender en patientgruppe i remission, men skriver "not all patients were strictly euthymic" - uklart hvor meget dette varierer
- Vurderer ikke debut for depressive episoder
- Ret lille samplesize til LCA (større margin of error end ønskværdigt?)

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- Undersøge de samme kognitive funktioner longitudinelt
- Undersøge om subgrupper af bipolar lidelse har kvalitativ forskellige kognitive vanskeligheder --> så behandlingen i så fald kan tilrettelægges efter dette

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- Tilrettelegge behandling etter subgruppeproblemer
-  Legger grunnlag for videre forskning på de ulike subgruppers prognose og alvorlighetsgrad
- Kan forske på effekten av faramkologi på de ulike subgrupper, også ifht livskvalitet
- Kan måske brukes til diagnostisering

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- De har både kognitive data, samt også strukturelle data (testbatteri + MR).
- Der er en kontrol gruppe, der gør et stærkere design.
- Bred gruppe af deltagere (Måske mere repræsentativt af populationen?).
- Man har rekrutteret tidligt i sygdomsforløbet (det er noget der er tilstede, allerede efter den første mani).
- De er meget data drevne, der arbejder ikke ud fra forudindtagede hypoteser.
- De tager forbehold for mulige confounders og korrigerer for både ADHD, barndomstraumer, medicin og om de har haft en depression lige inden mv.
- De har et meget udtømmende testbatteri, der måler på flere kognitive domæner.

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Ved å identifisere subgruppe-forskjeller i kognitiv fungering allerede ved første sykdomsepisode, kan man også individualisere behandlingstilnærming

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32 YMRS

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33 blev vi enige om

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6. Tale
8. Tankeindhold

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32 YMRS

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I alt 34 YMRS