Journal
PSYCHOLOGICAL MEDICINE
Volume 43, Issue 4, Pages 801-811Publisher
CAMBRIDGE UNIV PRESS
DOI: 10.1017/S0033291712001614
Keywords
Aged adults; bipolar disorder; cognition; disease progression
Categories
Funding
- Public Health Service [K23 MH 073772, R01 MH 084921, R01 MH072947, P30 MH071944, P30 MH68446, K24 MH069430, U01 MH68846]
- UPMC (University of Pittsburgh Medical Center) Endowment in Geriatric Psychiatry
- John A. Hartford Center of Excellence in Geriatric Psychiatry
- Northstar Neuroscience
- Medtronic
- Fox Learning Systems [via National Institutes of Health (NIH)-funded small business innovation research (SBIR)]
- GlaxoSmithKline
- NIH
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- Wyeth
- Forest
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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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