Expert: Ivan Goldberg, M.D. - 1/24/2011

Question
Dear doctor,
I´ve read about cognitive impairments in individuals with bipolar disorder, and a correlation between mania and depression and these impairments. Does hypomania also have this effect in the long term? And is there any other reason to the impairment, besides the mood episodes?
Thank you very much!!

Answer
Hi Helmut . . .

If I understand your question I think you are asking the following:
"It seems to be established that repeated episodes of mania and/or depression are associated with long-lasting impairments of cognition. It is also true that repeated episodes of hypomania are associated with long-lasting cognitive impairments?"

If that is the question, the answer is that there is no evidence that hypomania is associated with long-lasting cognitive changes.

I was able to locate one article that deals with the neuropsychological changes that accompany hypomania, but there is no evidence that such changes persist.  Please note that since the patients in this study were diagnosed with Bipolar-I disorder that at some time they all experiences episodes of mania in addition to the mentioned hypomania. Below you will find an abstract:

Bipolar Disord. 2007 Feb-Mar;9(1-2):114-25.

Neuropsychological deficits and functional impairment in bipolar depression, hypomania and euthymia.
Malhi GS, Ivanovski B, Hadzi-Pavlovic D, Mitchell PB, Vieta E, Sachdev P.

Academic Discipline of Psychological Medicine, Northern Clinical School, University of Sydney, Sydney, NSW, Australia. ginmalhi@gmail.com

Abstract
OBJECTIVE: To examine whether patients with bipolar disorder (BD) have subtle neuropsychological deficits that manifest clinically as cognitive and functional compromise, and this study attempted to determine the pattern of such cognitive deficits and their functional impact across all three phases of BD. We hypothesized that euthymia does not equate with normal neuropsychological function and that each phase has a characteristic pattern of deficits, with disturbance in attention and memory being common across all phases of the illness: (i) bipolar depression - psychomotor slowing and impairment of memory; (ii) hypomania by frontal-executive deficits and (iii) euthymia - a mild disturbance of attention, memory and executive function.

METHODS: Twenty-five patients with a diagnosis of bipolar I disorder underwent neuropsychological testing over a period of 30 months in the natural course of their illness while hypomanic and/or depressed and/or euthymic. The results from these assessments were compared with findings from neuropsychological tests conducted on 25 healthy controls matched for age, sex, education and handedness.

RESULTS: Initial analyses revealed modest impairment in executive functioning, memory and attention in both hypomanic and depressed bipolar patients, with additional fine motor skills impairment in the latter. Memory deficits, also noted in euthymic patients, were non-significant after controlling for confounding variables, although bipolar depressed patients remained significantly impaired on tests of verbal recall. Bipolar depressed and hypomanic patients differed with respect to the nature of their memory impairment. Depressed patients were more impaired as compared with euthymic patients on tests of verbal recall and fine motor skills. Psychosocial functioning was impaired across all three patient groups, but only in depressed and hypomanic patients did this correlate significantly with neuropsychological performance.

CONCLUSIONS: The mood-state-related cognitive deficits in both bipolar depression and hypomania compromise psychosocial function when patients are unwell. In euthymic patients, subtle impairments in attention and memory suggest that an absence of symptoms does not necessarily equate to 'recovery'. The possibility of persistent cognitive deficits in BD is an issue of profound clinical and research interest that warrants further investigation; however, future research needs to adopt more sophisticated neuropsychological probes that are able to better define state and trait deficits and determine their functional impact.

PMID: 17391355 [PubMed - indexed for MEDLINE]


Best regards . . .

Ivan
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