title: The influence of cognitive reserve on psychosocial and neuropsychological functioning in bipolar disorder.
abstract: Cognitive reserve (CR) refers to the hypothesized capacity of an adult brain to cope with brain pathology in order to minimize symptomatology. CR was initially investigated in dementia and acute brain damage, but it is being applied to other neuropsychiatric conditions. The present study aims at examining the fit of this concept to a sample of euthymic bipolar patients compared with healthy controls in order to investigate the role of CR in predicting psychosocial and cognitive outcome in bipolar disorder (BD). The sample included 101 subjects: 52 patients meeting DSM-IV-TR criteria for BD type I or II and 49 healthy controls (HC) matched for age and gender. They were all assessed with a cognitive battery tapping into executive and memory functioning. CR was obtained using three different proxies: education-occupation, leisure activities and premorbid IQ. Psychosocial functioning was evaluated by means of the Functioning Assessment Short Test (FAST). MANCOVAs were performed to determine differences in cognitive and functioning variables. Linear regression analyses were carried out to predict neuropsychological and psychosocial outcomes. Euthymic bipolar patients showed worse neuropsychological performance and psychosocial functioning than HC. The linear regression models revealed that CR was significantly predictive of FAST score (β = -0.47, p < 0.0001), Executive Index (β = 0.62, p < 0.0001) and Visual Memory Index (β = 0.44, p = 0.0004), indicating that CR is a significant predictor of cognitive and psychosocial functioning in euthymic bipolar outpatients. Therefore, CR may contribute to functional outcome in BD and may be applied in research and clinical interventions to prevent cognitive and functional impairment.
authors.affiliation: Psychiatric Service, Hospital Santa Maria, University of Lleida, IRBLleida (Biomedicine Research Institute), Lleida, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Forcada
authors.affiliation: Psychiatric Service, Hospital Santa Maria, University of Lleida, IRBLleida (Biomedicine Research Institute), Lleida, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Mur
authors.affiliation: Children and Adolescents Center of Mental Health, Sant Joan de Déu, University of Lleida, IRBLleida (Biomedicine Research Institute), Lleida, Spain.
authors.forename: Ester
authors.initials: E
authors.lastname: Mora
authors.affiliation: Bipolar Disorders Program, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
authors.affiliation: Departament de Psiquiatria i Psicobiologia Clínica, Fac. Medicina, Universitat de Barcelona, Institut d׳Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Bartrés-Faz
authors.affiliation: Departament de Psiquiatria, Institut d׳Investigacions Biomèdiques-Sant Pau (IIB-Sant Pau), Hospital de la Sant Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBERSAM, Sant Antoni Ma. Claret 167, 08025 Barcelona, Spain. Electronic address: MPortella@santpau.cat.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Portella
mesh_terms: D000704:Analysis of Variance; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology*; D058245:Cognitive Reserve; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests
keywords: Bipolar disorder; Cognitive reserve; Neuropsychology; Psychosocial functioning