Abstract

Cognitive impairment is consistently reported in bipolar disorder (BD), but few studies have characterised which memory component processes are affected. Further, it is unknown whether the component processes underlying memory impairment are moderated by sex. The present study examined diagnosis and sex differences in both verbal and visual memory/learning domains in patients with BD and psychiatrically healthy controls. Verbal and visual memory/learning were measured using the Hopkins Verbal Learning Test-Revised (HVLT-R) and Brief Visuospatial Memory Test-Revised (BVMT-R). 114 patients with BD (n = 50 males, n = 64 females), were compared to 105 psychiatrically healthy controls (n = 42 males, n = 63 females). Patients with BD had worse performance in verbal and visual immediate and total recall, verbal and visual delayed free recall, and verbal recognition discrimination scores, but there were no group differences in learning slopes and cumulative learning index scores. There were trends for BD females to outperform BD males in visual memory/learning free recall and cumulative learning, but these results did not survive multiple testing correction. These findings did not change in a secondary sensitivity analysis comparing only strictly euthymic BD patients to controls (n = 64). The present study found trait-like verbal and visual memory/learning impairment in BD that was attributable to deficient encoding and/or consolidation processes rather than deficits in learning. We did not find marked sex differences in either visual or verbal memory/learning measures, although some trend level effects were apparent and deserve exploration in future studies.

Highlights

  • Neurocognitive impairment is a major predictor of functional disability in bipolar disorder (BD), with 40–60% of patients showing symptoms of cognitive dysfunction (Burdick et al, 2014; Martinez-Aran et al, 2004; Sole et al, 2017; Van Rheenen et al, 2017)

  • There were no significant differences between male and female patients with BD for any of the clinical variables measured (i.e. Montgomery-Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), age of diagnosis, symptom status, BD subtype, psychosis history, current comorbid anxiety or substance use, family history of BD, rapid cycling, medication use and type; Table 2)

  • This study aimed to present new knowledge on the underlying component processes involved in verbal and visual memory/learning in BD and whether these are moderated by sex

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Summary

Introduction

Neurocognitive impairment is a major predictor of functional disability in bipolar disorder (BD), with 40–60% of patients showing symptoms of cognitive dysfunction (Burdick et al, 2014; Martinez-Aran et al, 2004; Sole et al, 2017; Van Rheenen et al, 2017). Several meta-analyses have highlighted that neurocognitive impairments in BD are significant in the areas of memory/learning, attention, processing speed, executive function, response inhibition and set shifting; and are present during both symptomatic and euthymic illness phases (Arts, Jabben, Krabbendam & van Os, 2008; Bora, Yucel & Pantelis, 2009; Robinson et al, 2006; Torres, Boudreau & Yatham, 2007). Another study showed that male patients with BD had worse verbal memory/learning performance compared to male controls, but this deficit was not observed when comparing female patients with BD to female controls (Carrus et al, 2010). These studies focused on single measures of memory/learning but did not analyse the influence of sex on the component processes involved. Understanding the specific fundamental processes that contribute to memory deficits in BD is important for knowing where to focus cognitive treatments that might aim to remediate these impairments

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