Aberrant cognition in newly diagnosed patients with bipolar disorder and their unaffected relatives

Psychol Med. 2020 Aug;50(11):1808-1819. doi: 10.1017/S0033291719001867. Epub 2019 Aug 28.


Background: Patients with bipolar disorder (BD) experience persistent impairments in both affective and non-affective cognitive function, which is associated with a worse course of illness and poor functional outcomes. Nevertheless, the temporal progression of cognitive dysfunction in BD remains unclear and the identification of objective endophenotypes can inform the aetiology of BD.

Methods: The present study is a cross-sectional investigation of cognitive baseline data from the longitudinal Bipolar Illness Onset-study. One hundred seventy-two remitted patients newly diagnosed with BD, 52 of their unaffected relatives (UR), and 110 healthy controls (HC) were compared on a large battery of behavioural cognitive tasks tapping into non-affective (i.e. neurocognitive) and affective (i.e. emotion processing and regulation) cognition.

Results: Relative to HCs, patients with BD exhibited global neurocognitive deficits (ps < 0.001), as well as aberrant emotion processing and regulation (ps ⩽ 0.011); including decreased emotional reactivity to positive social scenarios, impaired ability to down-regulate positive emotion, as well as a specific deficit in the ability to recognise surprised facial expressions. Their URs also showed a trend towards difficulties identifying surprised faces (p = 0.075). No other differences in cognitive function were found for URs compared to HCs.

Conclusions: Neurocognitive deficits and impairments within emotion processing and regulation may be illness-related deficits of BD that present after illness-onset, whereas processing of emotional faces may represent an early risk marker of BD. However, longitudinal studies are needed to examine the association between cognitive impairments and illness progression in BD.

Keywords: Affective cognition; bipolar disorder; emotion; endophenotypes; neurocognition regulation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Bipolar Disorder / genetics
  • Bipolar Disorder / psychology*
  • Case-Control Studies
  • Cognition*
  • Cross-Sectional Studies
  • Endophenotypes*
  • Facial Expression
  • Female
  • Genetic Predisposition to Disease
  • Humans
  • Male
  • Neuropsychological Tests
  • Recognition, Psychology*
  • Siblings*
  • Young Adult