title: The impact of neurocognitive impairment on occupational recovery of clinically stable patients with bipolar disorder: a prospective study.
abstract: OBJECTIVE
  Many patients with bipolar disorder do not regain their premorbid level of occupational functioning even after mood episodes have resolved. The reasons for this are not well understood. We evaluated the relationship between neurocognition and occupational function in bipolar disorder patients, following symptomatic recovery.
  
  
  METHODS
  A total of 79 previously employed adults with bipolar I disorder who achieved symptomatic recovery (i.e., at least six weeks clinically euthymic) following a manic episode underwent a neurocognitive evaluation and assessment of occupational functioning. Study participants were evaluated every three months thereafter for up to nine months. Factor analysis was applied to reduce the initial set of neurocognitive variables to five domains: episodic memory, working memory/attention, executive function, visual scanning, and speed of processing. Multiple logistic regression models were used to examine the joint predictive values of these domains for determining occupational recovery.
  
  
  RESULTS
  At the time of symptomatic recovery, four of five neurocognitive factors were significant predictors of concomitant occupational recovery and the fifth, executive function, showed a trend in the same direction. For those not occupationally recovered at baseline, longitudinal analyses revealed that changes between baseline and the three-month follow-up timepoint in most cognitive domains were robust and highly significant predictors of occupational recovery at three months.
  
  
  CONCLUSIONS
  These findings indicate that better neurocognitive function in multiple domains and improvement in these domains over time are strongly predictive of subsequent occupational recovery. Treatments that target cognitive deficit may therefore have potential for improving long-term vocational functioning in bipolar illness.
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA. cbearden@mednet.ucla.edu
authors.forename: Carrie E
authors.initials: CE
authors.lastname: Bearden
authors.forename: Vivian H
authors.initials: VH
authors.lastname: Shih
authors.forename: Michael F
authors.initials: MF
authors.lastname: Green
authors.forename: Michael
authors.initials: M
authors.lastname: Gitlin
authors.forename: Kenneth N
authors.initials: KN
authors.lastname: Sokolski
authors.forename: Eric
authors.initials: E
authors.lastname: Levander
authors.forename: Susan
authors.initials: S
authors.lastname: Marusak
authors.forename: Constance
authors.initials: C
authors.lastname: Hammen
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Sugar
authors.forename: Lori L
authors.initials: LL
authors.lastname: Altshuler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001714:Bipolar Disorder / Q000150:complications* / Q000523:psychology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D003430:Cross-Sectional Studies; D004651:Employment; D005163:Factor Analysis, Statistical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult