Abstract
Background: Metabolic syndrome (MetS) is more prevalent in individuals with bipolar disorder and has a negative impact on cognition, in particular on executive function, which is already impaired in individuals with bipolar disorder compared to healthy controls.Methods: In a cross-sectional study, we compared 148 euthymic patients with bipolar disorder and 117 healthy controls in cognitive function depending on the diagnosis of MetS. A neuropsychological test battery was used including the Trail Making Test A/B, Stroop Color and Word Interference Test, the d2 Test of Attention Revised, and the California Verbal Learning Test. In addition, MetS variables as well as the defining variables waist circumference, serum triglyceride levels, high-density lipoprotein cholesterol levels, blood pressure, fasting glucose levels, and body mass index were compared between patients and controls. In addition, illness-related variables were associated with MetS in individuals with bipolar disorder.Results: The prevalence of MetS in patients with bipolar disorder was higher than in controls (30.4 vs. 15.4%). Patients with bipolar disorder with MetS had impaired executive function compared to patients without MetS or healthy controls with and without MetS (p = 0.020). No MetS effects or interaction MetS × Group was found in attention/processing speed (p = 0.883) and verbal learning/memory (p = 0.373). Clinical variables (illness duration, suicidality, number of affective episodes, medication, age of onset, and history of psychosis) did not relate to MetS in bipolar disorder (p > 0.05).Conclusion: Bipolar disorder comorbid with MetS bears additional risk for impaired executive function. Executive function includes action planning, inhibition, and impulse control and could play a critical role in keeping long-term goals in mind associated with gaining and maintaining a healthy weight.
Highlights
Bipolar disorder (BD) is a neuropsychiatric illness that occurs in early adulthood (American Psychiatric Association, 2013) and is prevalent in 1–2% of the population (Merikangas et al, 2011; Blanco et al, 2017)
For each primary cognitive measure, the subjects’ raw scores were converted into z-scores and summed up into three cognitive domain z-scores: (a) attention/processing speed (TMTA, Stroop color word reading, Stroop color naming, and d2 Test of Attention Revised (d2-R)), (b) executive function (TMT-B and Stroop interference), and (c) verbal learning/memory (CVLT trial 1–5, California Verbal Learning Test (CVLT) short delay free recall, CVLT short delay cued recall, CVLT long delay free recall, and CVLT long delay cued recall), which served as primary neuropsychological outcome variables
The results showed that the prevalence of Metabolic syndrome (MetS) was 30.4% among patients with BD and 15.4% in HC
Summary
Bipolar disorder (BD) is a neuropsychiatric illness that occurs in early adulthood (American Psychiatric Association, 2013) and is prevalent in 1–2% of the population (Merikangas et al, 2011; Blanco et al, 2017). Most studies agree that the prevalence of MetS is significantly higher in individuals with BD than in healthy controls (HC; Czepielewski et al, 2013; Vancampfort et al, 2016; Almasabi et al, 2020), with an odds ratio (OR) as high as 2.94 (95% CI, 2.08–4.17; Almasabi et al, 2020) and that there is an increase in the MetS prevalence among patients with BD in the longitudinal course (Almasabi et al, 2020; Grover et al, 2020). Metabolic syndrome (MetS) is more prevalent in individuals with bipolar disorder and has a negative impact on cognition, in particular on executive function, which is already impaired in individuals with bipolar disorder compared to healthy controls
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