Andreas Elleby Jespersen

Objectives: Persons with bipolar disorder (BD) often present with cognitive complaints even in the absence of objective cognitive impairment as measured with neuropsychological tests. It remains unclear whether cognitive complaints reflect negative bias or illness‐related decline from premorbid functioning, affecting functioning and quality of life (QoL). Methods: Data from n = 498 persons with BD and n = 320 healthy controls (HC) were included from a database based on seven studies. We calculated IQ‐objective cognition discrepancy scores (−10 to +10; negative scores = lower cognitive performance than premorbid IQ, i.e., estimated ‘loss of function’) and subjective‐objective cognitive discrepancy scores (−10 to +10; negative scores = less subjective than objective difficulties; positive scores = more subjective than objective impairments). We investigated associations between these variables and subjective cognitive complaints, functioning, and QoL with multiple regression models. Results: Subjective cognitive complaints were associated with poorer global cognitive performance relative to premorbid IQ (i.e., estimated ‘loss of function’). More subjective than objective cognitive difficulties was associated with diminished functioning and QoL. A similar association was seen for objective cognitive performance. Conclusions: Subjective complaints may indicate a decline from premorbid cognitive function, even if objective cognitive performance is within the normal range after illness onset. More subjective than objective impairment correlates with poorer functioning and QoL. Hence, cognitive management initiatives should be centered around patients with cognitive complaints independent of objective cognitive status.

Cognitive impairments are prevalent during remission in bipolar disorder (BD), but existing cognitive screening tools are time- and resource-intensive. Digital, web-based options can facilitate detection and monitoring of these impairments across clinical and research settings. This cross-sectional study investigated psychometric properties of the Internet-based Cognitive Assessment Tool (ICAT) when self-administered in home-based settings. Newly diagnosed, remitted outpatients with BD and healthy controls (HC) underwent cognitive testing with the standard paper-pencil tool Screen for Cognitive Impairment in Psychiatry (SCIP) in-clinic and ICAT at-home as part of baseline assessments for an intervention trial (ClinicalTrials ID: 2021-000862-14). Data were analyzed for 31 BD patients and 29 HC. We demonstrated a strong positive correlation between at-home ICAT and in-clinic SCIP total scores within patients with BD (r(29) = 0.66, p < .001), which survived subsyndromal mood symptoms adjustment (partial r(25) = 0.67, p < .001), indicating adequate concurrent validity. There was a moderate positive correlation between ICAT and SCIP total scores across the entire sample (r(54) = 0.56, p < .001) and between subtest scores (r = 0.29-0.61, ps ≤ .03), except the executive functions tasks (p = .1). BD patients exhibited no impaired performance compared to HC on ICAT or SCIP (ps ≥ .08). ICAT is a valid and feasible online tool for remote cognitive screening in remitted patients with BD. Web-based screening constitutes an accessible and efficient approach for implementing systematic cognitive screening in BD.

Identification of comorbid attention-deficit/hyperactivity disorder (ADHD) in patients with bipolar disorder (BD) is complicated by overlapping cognitive symptoms and methodological challenges. This cross-sectional study investigated whether virtual reality (VR)-based cognitive assessment that mimics daily life cognitive challenges can aid in the detection of sustained attention impairment in BD individuals with comorbid ADHD (BD + ADHD). Forty-nine fully or partially remitted outpatients with BD, of whom 14 (24%) had BD + ADHD, were assessed with the Cognition Assessment in Virtual Reality (CAVIR) test, including a sustained attention test that involves distractions, and the Screen for Cognitive Impairment in Psychiatry (SCIP). Patients were also rated for mood symptoms and functioning and completed questionnaires assessing subjective cognition and quality of life. Patients' cognitive impairment on the SCIP was estimated with reference to n = 100 demographically comparable healthy control participants. BD + ADHD participants exhibited more pronounced performance deficits on the CAVIR sustained attention test (t(48) = 2.15, p = .037, d = .66). Notably, deficits on this test were proportional to self-reported daily life concentration difficulties in BD + ADHD individuals. Exploratory analyses revealed that BD + ADHD participants also displayed greater impairment on the SCIP working memory- and delayed verbal learning subtests and greater subjective cognitive complaints than BD patients without this comorbidity (p-levels < .001), but only the difference in subjective cognition survived correction for multiple comparisons (F(1,47) = 14.13, p = .005, np2 = 0.24). Screening for deficits in sustained attention with an ecologically valid VR test involving distracting stimuli may be useful for identifying BD + ADHD individuals.