Ecologically valid tests of cognitive function appear to be sensitive for detecting cognitive impairment in euthymic bipolar disorder patients, research shows.

Rory O’Shea and colleagues note that ecologically valid tests, such as the Test of Everyday Attention (TEA) and The Rivermead Behavioural Memory Test, Extended Version (RBMT-E), “have greater face validity and are likely to reflect patient’s functional abilities better than traditional tests.”

They add: “They can define areas where cognitive rehabilitation should focus.”

The researchers administered the TEA, the RBMT-E and the Behavioral Assessment of the Dysexecutive Syndrome (BADS), as a measure of executive function, to 29 euthymic bipolar disorder patients and 29 mentally healthy individuals, as well as carrying out clinical, functional, and mood assessments.

The two groups had similar scores on the Mini-Mental State Examination. However, patients were significantly impaired in general and social occupational functioning compared with controls, with average scores on the Global Assessment of Functioning and the Social and Occupational Functioning Assessment Scale of 69.55 versus 84.03 and 71.48 versus 85.55, respectively.

The patients also had significantly worse overall scores than controls on the TEA (66.29 vs 89.86), the RBMT-E (25.07 vs 32.45), and the BADS (95.93 vs 108.17).

The researchers note that these cognitive impairments were not accounted for by residual mood symptoms, as there was no difference in scores between the two groups on mood scales.

Cognitive impairment did worsen in line with a greater number of past manic episodes, however, which the researchers say “supports the intuitive clinical supposition that multiple manic episodes are poor long-term prognostic indicators.”

They were surprised to find that cognitive function did not correlate with general or social and occupational functioning, but note in the Journal of Affective Disorders that euthymic bipolar disorder patients with poorer attention were more likely to be unemployed.

“This study points to the value of using ecologically valid tests of cognitive function during the recovery phase and when patients are considering re-entering the workforce,” O’Shea and team suggest.

“Clinicians should consider using these tests… as they may be particularly helpful in showing where rehabilitation should focus.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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