Understanding the Neurocognitive Heterogeneity in Bipolar Disorder

描述(由申请人提供)：双相情感障碍(BPD)患者曾经被认为可以实现完全发作间歇恢复，特别是在认知功能障碍方面。最近的数据表明，即使在情感缓解期间，BPD患者的神经认知障碍也存在持续的、特征样的模式。在群体层面，这些缺陷的严重程度比平均水平低3/4至1全标准差，明显低于精神分裂症(SZ)的严重程度。然而，最近的证据表明，优良型BPD患者认知障碍的发生率约为40%-60%，其中相当大一部分患者的特征是认知功能不受影响。这与深圳这种表型的相对同质性形成对比，在深圳，90%的患者表现出明显的损害。更好地理解BPD患者的认知异质性，即为什么一些患者会出现严重的认知困难，而另一些患者则不会，这对优化患者的生活质量至关重要。目前的建议旨在使用一种新的方法来确定350名BPD患者认知障碍的临床和生物学预测因素。我们将在基于样本的神经认知表现中对同质亚组进行经验性测试，并测试临床特征和生物标记物作为潜在的损伤预测指标。我们还将在职业、社会和独立生活能力方面调查神经认知功能和日常功能能力之间的关系。数据将提供有关BPD神经认知的潜在结构及其病因的重要信息，指导未来通过治疗来针对这些致残症状的努力。

DESCRIPTION (provided by applicant): Patients with bipolar disorder (BPD) were once thought to achieve complete inter-episode recovery, particularly with regard to cognitive dysfunction. More recent data suggest a persistent, trait-like pattern of neurocognitive impairments in BPD, even during periods of affective remission. At the group level, the severity of these deficits is 3/4 to 1 full standard deviation below average, which is significantly less severe than deficits noted in schizophrenia (SZ). Recent evidence, however, suggests that the frequency of cognitive impairment in euthymic BPD patients is ~40-60%, with a substantial proportion of patients characterized as cognitively- spared. This contrasts with the relative homogeneity of this phenotype in SZ where > 90% of patients demonstrates significant impairment. A better understanding of the cognitive heterogeneity in BPD, why some patients develop significant cognitive difficulties while others do not, is critical toward optimizing patiets' quality of life. The current proposal aims to determine the clinical and biological predictors of cognitive impairment in 350 patients with BPD using a novel approach. We will empirically test for homogeneous subgroups within the sample based neurocognitive performance and test a cassette of clinical features and biomarkers as potential predictors of impairment. We will also investigate the relationship between neurocognitive functioning and everyday functional capacity in the areas of occupational, social and independent living ability. Data will provide important information on the underlying structure of neurocognition in BPD and its etiology, guiding future efforts to target these disabling symptoms with treatment.