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. 2011 Jun;13(4):323-33.
doi: 10.1111/j.1399-5618.2011.00928.x.

The impact of neurocognitive impairment on occupational recovery of clinically stable patients with bipolar disorder: a prospective study

Carrie E Bearden  1 , Vivian H Shih, Michael F Green, Michael Gitlin, Kenneth N Sokolski, Eric Levander, Susan Marusak, Constance Hammen, Catherine A Sugar, Lori L Altshuler
Affiliations

The impact of neurocognitive impairment on occupational recovery of clinically stable patients with bipolar disorder: a prospective study

Carrie E Bearden et al. Bipolar Disord. 2011 Jun.

Abstract

Objective: Many patients with bipolar disorder do not regain their premorbid level of occupational functioning even after mood episodes have resolved. The reasons for this are not well understood. We evaluated the relationship between neurocognition and occupational function in bipolar disorder patients, following symptomatic recovery.

Methods: A total of 79 previously employed adults with bipolar I disorder who achieved symptomatic recovery (i.e., at least six weeks clinically euthymic) following a manic episode underwent a neurocognitive evaluation and assessment of occupational functioning. Study participants were evaluated every three months thereafter for up to nine months. Factor analysis was applied to reduce the initial set of neurocognitive variables to five domains: episodic memory, working memory/attention, executive function, visual scanning, and speed of processing. Multiple logistic regression models were used to examine the joint predictive values of these domains for determining occupational recovery.

Results: At the time of symptomatic recovery, four of five neurocognitive factors were significant predictors of concomitant occupational recovery and the fifth, executive function, showed a trend in the same direction. For those not occupationally recovered at baseline, longitudinal analyses revealed that changes between baseline and the three-month follow-up timepoint in most cognitive domains were robust and highly significant predictors of occupational recovery at three months.

Conclusions: These findings indicate that better neurocognitive function in multiple domains and improvement in these domains over time are strongly predictive of subsequent occupational recovery. Treatments that target cognitive deficit may therefore have potential for improving long-term vocational functioning in bipolar illness.

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Conflict of interest statement

MG serves on the speakers bureau for Eli Lilly & Co., Bristol-Myers Squibb, and AstraZeneca; and has received an honorarium from Servier Pharmaceuticals (all unrelated to this study). KNS is a member of the speakers bureaus for Bristol-Myers Squibb and AstraZeneca (unrelated to this study). LLA currently serves on the advisory boards for Forest Laboratories and Merck Pharmaceuticals; and is on the speakers bureau for AstraZeneca. CEB, VHS, MFG, EL, SM, CH, and CAS have no conflicts of interest to report.

Figures

Fig. 1
Fig. 1
Flow chart of Phase I and Phase II study procedures.
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