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

Authors

  • Carrie E Bearden,

    1. Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California, Los Angeles
    2. Department of Psychology, University of California, Los Angeles
    Search for more papers by this author
  • Vivian H Shih,

    1. Department of Biostatistics, UCLA School of Public Health
    Search for more papers by this author
  • Michael F Green,

    1. Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California, Los Angeles
    2. VA Greater Los Angeles Healthcare System, Los Angeles
    Search for more papers by this author
  • Michael Gitlin,

    1. Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California, Los Angeles
    Search for more papers by this author
  • Kenneth N Sokolski,

    1. VA Greater Los Angeles Healthcare System, Los Angeles
    2. Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
    Search for more papers by this author
  • Eric Levander,

    1. Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California, Los Angeles
    2. VA Greater Los Angeles Healthcare System, Los Angeles
    Search for more papers by this author
  • Susan Marusak,

    1. Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California, Los Angeles
    2. VA Greater Los Angeles Healthcare System, Los Angeles
    Search for more papers by this author
  • Constance Hammen,

    1. Department of Psychology, University of California, Los Angeles
    Search for more papers by this author
  • Catherine A Sugar,

    1. Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California, Los Angeles
    2. Department of Biostatistics, UCLA School of Public Health
    Search for more papers by this author
  • Lori L Altshuler

    1. Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California, Los Angeles
    2. VA Greater Los Angeles Healthcare System, Los Angeles
    Search for more papers by this author

  • 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.

Corresponding author:
Carrie E. Bearden, Ph.D.
Department of Psychiatry and Biobehavioral Sciences
University of California, Los Angeles
300 Building Medical Plaza, Suite 2265
Los Angeles, CA 90095, USA
Fax: 310-794-9517
E-mail: cbearden@mednet.ucla.edu

Abstract

Bearden CE, Shih VH, Green MF, Gitlin M, Sokolski KN, Levander E, Marusak S, Hammen C, Sugar CA, Altshuler LL. The impact of neurocognitive impairment on occupational recovery of clinically stable patients with bipolar disorder: a prospective study.
Bipolar Disord 2011: 13: 323–333. © 2011 The Authors.
Journal compilation © 2011 John Wiley & Sons A/S.

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.

Ancillary