Neurocognitive Impairment in Middle-Aged and Older Adults With Bipolar Disorder: Comparison to Schizophrenia and Normal Comparison Subjects

J Affect Disord. 2007 Aug;101(1-3):201-9. doi: 10.1016/j.jad.2006.11.022. Epub 2007 Jan 16.


Background: The frequency, pattern, and correlates of neurocognitive impairment in older patients with bipolar disorder have received little study. We examined neurocognitive abilities in middle-aged and older adults with bipolar disorder to groups with schizophrenia or normal subjects, as well as the relation of neurocognition to clinical characteristics.

Method: We administered a battery of neurocognitive and clinical measures to older (45-85 years) outpatients with bipolar disorder (n=67), schizophrenia (n=150), and normal comparison subjects (n=85). Within the bipolar group, we assessed the association between neurocognitive performance and psychiatric symptoms, quality of life, and medication status.

Results: The group with bipolar disorder differed on nearly all neuropsychological tests compared to normal subjects, with medium effect sizes. Bipolar patients as impaired as those with schizophrenia on half of the tests administered, and performed better on the remaining tests, with small effect sizes. Neurocognitive deficits in bipolar disorder group related to lower quality of life, but not to psychiatric symptom severity or duration of illness.

Limitations: Samples were outpatients with mild-moderate symptoms, and findings may not generalize to acutely ill populations. We lacked data on illness history to examine the cumulative impact of psychopathology.

Conclusions: Among clinically stable middle-aged and older outpatients, bipolar disorder was associated with substantial neurocognitive impairment, with a pattern that was somewhat distinct from that found in schizophrenia. Deficits in the bipolar group were not related to severity or duration of psychiatric symptoms, but were related to quality of life. Bipolar disorder often involve disabling and enduring cognitive impairments in older outpatients.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Bipolar Disorder / diagnosis*
  • Bipolar Disorder / psychology
  • Cognition Disorders / diagnosis*
  • Cognition Disorders / psychology
  • Diagnosis, Differential
  • Female
  • Humans
  • Infant, Newborn
  • Male
  • Middle Aged
  • Neuropsychological Tests*
  • Psychiatric Status Rating Scales
  • Quality of Life
  • Schizophrenia / diagnosis*
  • Schizophrenic Psychology*
  • Statistics as Topic