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Inicio Revista Colombiana de Psiquiatría What is the Contribution of Executive Dysfunction to the Cognitive Profile of Bi...
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Vol. 40. Issue S.
Pages 64S-75S (January 2011)
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Vol. 40. Issue S.
Pages 64S-75S (January 2011)
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What is the Contribution of Executive Dysfunction to the Cognitive Profile of Bipolar Disorder? A Well-Controlled Direct Comparison Study
¿Cuál es la contribución de la disfunción ejecutiva al perfil cognitivo del trastorno bipolar? Un estudio comparativo bien controlado
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Juan Lopera-Vasquez1,1, Vaughan Bell1,1, Carlos López-Jaramillo2,
Corresponding author
clopez@medicina.udea.edu.co

Corresponding author, Carlos López-Jaramillo, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Calle 64 No. 51 D 38, Medellín, Colombia
1 Research Group on Psychiatric Disorders, Department of Psychiatry, School of Medicine, University of Antioquia, Medellín, Colombia
1 Chairman Department of Psychiatry School of Medicine, University of Antioquia, Medellín, Colombia
2 Coordinator of the Psychiatry Research Group (GIPSI) and Chair of the Department of Psychiatry at the Medicine School of the University of Antioquia. Medellín, Colombia
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Abstract
Background

Large scale neuropsychological studies of patients with bipolar disorder have reported verbal memory and executive function deficits that persist during remission. A recent analysis by Thompson et al. (2009) indicated that verbal memory deficits could be entirely explained by the statistical variance attributed to primary executive function deficits. This study tests the hypothesis that verbal memory deficits in bipolar patients are largely the result of executive difficulties by direct comparison of verbal neuropsychological tests primarily differing in their executive load as well as examining potential interactions with medication status.

Methods

33 Bipolar I patients not taking medication, 40 Bipolar I patients taking medication, and 28 healthy controls were compared on measures of IQ, verbal fluency, category fluency, verbal recall, and category prompted recall.

Results

After controlling for IQ, performance on tasks that involved additional executive involvement was significantly worse. Medication had a small but reliable effect on cognitive performance.

Conclusions

The results provide support to the hypothesis that the most significant source of cognitive impairment in bipolar disorder stems from executive impairment and that verbal memory deficits may arise as a result of this, rather than from primary impairment to core verbal memory mechanisms.

Key words:
Bipolar disorders
memory
neuropsychology
executive function
Resumen
Introducción

Los estudios neuropsicológicos a gran escala de pacientes con trastorno bipolar han reportado déficits en la memoria verbal y en la función ejecutiva que persisten durante la remisión. Un análisis reciente realizado por Thompson et al. indicó que los déficits en la memoria verbal podían explicarse enteramente por la varianza estadística atribuida a los déficits en la función ejecutiva primaria. Este estudio demuestra la hipótesis de que los déficits en la memoria verbal de pacientes bipolares son mayormente el resultado de las dificultades ejecutivas mediante una comparación directa de pruebas neuropsicológicas verbales, que difieren principalmente en su carga ejecutiva, como también mediante la examinación las interacciones potenciales con el estado de la medicación.

Métodos

Se compararon 33 pacientes con trastorno bipolar I que no estaban tomando medicamentos con 28 controles saludables respecto a sus medidas de coeficiente intelectual (CI), fluidez verbal, fluidez de categorías, memoria verbal y memoria alentada por categorías.

Resultados

Después de realizar controles relacionados con el CI, el desempeño que requería un mayor involucramiento ejecutivo era significativamente peor. Los medicamentos tenían un efecto pequeño pero confiable sobre el desempeño cognitivo.

Conclusiones

Los resultados soportan la hipótesis de que la fuente más significativa de trastornos cognitivos en el trastorno bipolar es el trastorno ejecutivo y que pueden surgir déficits en la memoria verbal como resultado de este, y no de un trastorno primario de los mecanismos centrales de la memoria verbal.

Palabras clave:
Trastorno bipolar
memoria
neuropsicología
función ejecutiva
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Conflicts of interest: The authors have not conflicts of interest.

Copyright © 2011. Asociación Colombiana de Psiquiatría
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