HC > PBD, p < .05. MCAS. 54.74 ± .45. 47.8 ± 4.21. PBD < HC, p < .001. CONCLUSIONS. Table 1. MCCB Domains and Measures. Speed of Processing.
Assessment of Cognitive Dysfunction in Psychotic Bipolar Disorder using the MATRICS Consensus Cognitive Battery Sperry, S.H.1, O’Connor, L.K. 1, Keshavan, M.S.2,3, Cohen, B.M.1,2, Öngür, D.1,2, & Lewandowski, K.E.1,2 1
Schizophrenia and Bipolar Disorder Program, McLean Hospital, 2 Harvard Medical School, 3 Beth Israel Deaconess Medical Center
ABSTRACT Introduction: Cognitive dysfunction is a core feature of schizophrenia and highly associated with functional outcomes. Patients with bipolar disorder with psychotic features (PBD) may exhibit cognitive dysfunction similar to patients with schizophrenia. The Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Initiative developed a consensus battery (MCCB) for the assessment of neurocognitive functioning in schizophrenia to aid in clinical trials; however, no such battery exists for use in patients with PBD. We aimed to examine the MCCB for use in PBD and its ability to predict community functioning. Methods: 46 PBD patients and 26 healthy controls underwent neurocognitive testing using the MCCB. Community functioning was assessed using a wellvalidated measure, the Multnomah Community Ability Scale (MCAS). Results: Patients exhibited poorer neurocognitive and community functioning than healthy controls except in Social Cognition. MCCB scores were not associated with community functioning. Conclusions: An adapted version of the MCCB with different Social Cognitive measures would be useful for the study of cognition in bipolar disorder. Interview-based measures of functional capacity may not capture the relationship between cognition and community functioning.
Table 1. MCCB Domains and Measures Speed of Processing
Specific Aims: a) Investigate neurocognitive deficits in patients with PBD compared to healthy controls (HC) using the MCCB. b) Investigate whether MCCB predicts community functioning in patients with PBD.
Working Memory Verbal Learning
Wechsler Memory Scale III: Spatial Span Letter Number Span Hopkins Verbal Learning Test – Revised
Visual Learning
Brief Visuospatial Memory Test – Revised
Reasoning and Problem Solving Social Cognition
Analysis • T-test and chi-square analyses were conducted to examine group differences on demographic and cognitive variables. • Post-hoc t-tests were conducted to investigate PBD performance compared to normative means. • Correlations were conducted to investigate the relationship between composite score and community functioning. Study Procedure PBD and HC subjects completed the MCCB (see Table 1) as part of two separate but related studies investigating cognitive remediation and brain functioning. Both were administered the MCAS, an interview based measure of independent living and social and occupational functioning.
Neuropsychological Functioning • Patients with PBD performed significantly worse than HC on 5 of 7 domains and the composite. • Patients with PBD performed significantly worse than normative means (T-score of 50) on 5 of 7 domains and the composite. • PBD and HC did not differ on level of education. Community Functioning • Patients with PBD had significantly worse community functioning than HC. • MCCB scores were not associated with community functioning scores on the MCAS.
Neuropsychological Assessment Battery Mazes Mayer-Salovey-Caruso Emotional Intelligence Test: Managing Emotions
Figure 1. Neurocognitive Performance by Group 65
CONCLUSIONS • Patients with PBD performed worse than controls (and normative means) on most MCCB cognitive domains.
60
T-score
55
50
HC PBD Norm
45
40
• The MCCB Social Cognition measure (MSCEIT) does not seem to capture the difficulties in social functioning of patients with BD as it does with patients with SZ, suggesting that deficits in social cognition may differ between these patient groups. • Future work should consider modification of the MCCB for BD by replacing the MSCEIT with measures of social cognition that are known to differentiate functioning in BD from healthy adults.
35
MATERIALS AND METHODS Participants • N=72 (PBD=46, HC=26) • Ages 18 to 50 • No substance abuse/dependence, head trauma with LOC, anticholinergic or Topomax use, and history of seizure. • PBD were clinically stable at time of testing.
Trails Making Test A Brief Assessment of Cognition in Schizophrenia: Symbol Coding Fluency Continuous Performance Test: Identical Pairs
Attention/Vigilance
BACKGROUND AND SIGNIFICANCE The MCCB was created to specifically identify cognitive deficits in schizophrenia, however it may be useful for use in PBD. Cognitive dysfunction is increasingly recognized as a major feature of PBD and is strongly associated with functional outcomes similar to schizophrenia (2-4). Researchers are increasingly recognizing the importance of treating these deficits in not just schizophrenia but also other psychiatric disorders. This highlights the importance of having a consensus battery that spans cross-diagnostically.
RESULTS
Table 2. Subject Characteristics HC
PBD
Test Statistic
Age
26.4 ± 7.2
30 ± 7.3
PBD > HC , p PBD, p < .05
MCAS
54.74 ± .45
47.8 ± 4.21
PBD < HC, p < .001
• MCCB scores were not associated with MCAS scores of community functioning. Future studies should use performance based measures of functional capacity as recommended by the FDA and MATRICS(6).
Table 3. Neuropsychological Performance HC
PBD
HC vs. PBD
Norm
PBD vs. Norm
Processing Speed
59.78
45.93
p
