There’s not a lot that makes you feel better about yourself than someone flat-out telling you you’re stupid.
My doctor seems to think if he gives lots of reasons for my stupidity, excusing me for being a somewhat of an idiot, I’ll feel better about it . It makes me wonder about him.
My family has different technique. They silently acknowledge that well yes, stupid is in there, but they try to make me feel better by pointing out areas where idiocy hasn’t hit. It’s a subtle technique–but I appreciate all efforts.
And all this time I’ve been viewing my befuddlement and lack of acuity as the result of a three-pronged attack of ECT (which certainly didn’t help, anyone would acknowledge)–and little was I to know that it was my illness that was sapping IQ points, seemingly while I slept.
My research – which has been handicapped, I must admit, by all the press surrounding Catherine Zeta Jones (you try a good bipolar Google search) – on BD often sticks to the latest news. But there’s no avoiding this finding.
So breaking news it isn’t. I guess anyone who’s anyone knows that bipolar disorder can be accompanied by mood instability, difficulty getting back to work, a number of comorbidities and. . .cognitive impairment. Very nice. Very, very nice.
In fact, I thought this was a nice touch. Martinez et al in 2011 start off their piece–first line, no padding, with the following sentence: “Neurocognitive impairment constitutes a core feature of bipolar illness.”
You know–I appreciate when people don’t beat around the bush.
And some points had to be granted. For example, one Dr. Eduard Vieta, of the Department of Psychiatry at the University of Barcelona in Spain, noted that there is impairment in attention, concentration, and memory during both the depressed and manic poles of BD.
But things were downhill from there.
For there’s been new excitement–not really new at all any more–but at least a decade old–when researchers realized that the impairment displayed by patients during manic and depressive phases, which really aren’t any surprise, carry through into what researchers love to call the ‘euthymic phase,’ which just means, like, ‘normal.’ (I guess if I were really pushed to add something to that it would have to come to not too depressed and not too manic–you know, normal.)
So here we were, starting, I’m guessing, around 2002–and all of a sudden everyone and their brother is researching how, just when you think you’re normal, apparently you’re a few IQ points short of a full deck. Or, as Martinez-Aran, one of the early researchers on this topic, put it so much more elegantly, “Recent studies have suggested that the presence of persistent cognitive dysfunctions in bipolar patients is not restricted to acute episodes, but they persist even in remission states.”
Okay, okay, he wins in the eloquence contest. But what’s a little disheartening is that if you go take a look at what the recent research is saying, it seems to be saying the same thing over and over [and how are people still getting grants for this? Do we really need to hear again that BD patients in remission are performing poorly on neuropsychological testing? Can’t they go make some other group look stupid for a while?].
For example, Thompson et al (2005) studied 63 euthymic bipolar patients matched against a control group of the same size. Across the domains tested (e.g. psychomotor performance, attention and executive function), they found that the BD patients were “significantly impaired across a broad range” of domains. And ultimately they concluded that clinically significant cognitive impairment was found in [get ready for this span] 3-42% of patients.
As a non-statistician, this strikes me as an alarmingly large range–“well, it could be 3 people out of 100–or it could be 42,” doesn’t strike me as completely satisfactory, but perhaps someone can explain it to me.
Bourne et al (2013) analyzed 2876 euthymic bipolar patients using 11 measures from common neuropsychological tests (anyone up on these? They’re truly exciting, as reflected in their names, like Digit Span, or Wisconsin Card Sorting Task.).
Lest there be a moment where we can actually feel good about ourselves, let me tell you that Bourne and his colleagues found impairments for ALL 11 test-measures (and, again, for those big in testing: they controlled for age, for IQ, for gender, etc). They conclude that the tests are “robust measures of cognitive impairments in bipolar disorder patients.” Robust, huh? Nothing good can come of that.
I must admit that for a while I was sulking too much to even go into which area I was impaired in–not just when depressed, I’m reminded, not just when I’m manic, but when I feel fine (not that that happens too much, actually. But apparently when it does, I should still remember that my brain isn’t working right and I’m one card short of a full deck). But Robinson et al (2006) ran a metaanalysis, which I love, because it means they’ve looked through tons of articles–and I don’t have to.
So they–seriously–searched the electronic databases Medline, Embase, Web of Knowledge, and PyschInfo (that should have kept them busy), using these search terms: bipolar disorder or manic depress⁎, and cognit⁎, attention, learning, memory, executive, or neuropsych⁎ (to identify relevant studies). They then write–and I couldn’t make this up–the search was “limited” to studies available in English (fair enough) and between 1980 and 2005 (that’s not much of a limitation, is it?).
But to get to the point (and it’s a little ‘testy’ here in the language, so hang in there) : They found “strong evidence” of cognitive impairments in executive functioning and verbal learning. “Large effect sizes were noted for two aspects of executive function” (those were category fluency and mental manipulation), and one of verbal learning.
Only “moderate” effect sizes were found for “indices of short and long delay verbal memory, response inhibition, sustained attention, psychomotor speed, abstraction and set-shifting.”
And as for the “small effect sizes”? Those were noted for “verbal fluency by letter, immediate memory and sustained attention sensitivity.”
For those of you who weren’t born with neuropsychologists for parents, I’ll do a quick review of what that might mean. “Large” impairment in executive functioning definitely isn’t something you want. Executive functioning is basically a person’s ability to organize. . .his life, pretty much: to prioritize tasks, manage time, make decisions–be a grownup. Category fluency measures verbal memory, and semantic memory, processing and knowledge. Usually the testee has to say as many words as possible from a given category in 60 seconds–she might have to name fruits, or, say, Ivy League colleges, or baseball players who got nailed for steroids–you get the idea. And in this case ‘mental manipulation’ involved the tester reading as series of number to the poor participant, who is supposed to read them back–backwards. The people who make up these tests must be sadists. Now, for the life of me I could not figure out how verbal learning differed significantly from category fluency (which we’ve had) or verbal memory (which is coming up). I’m quite willing to be educated.