Ecologically valid cognitive tests and everyday functioning in euthymic bipolar disorder patients.

Background: In euthymic bipolar disorder patients, scores on the Mini-Mental State Examination (MMSE) are not abnormal but general functioning remains impaired. Recent studies provide ample evidence that euthymic patients show significant impairment on more comprehensive neuropsychological test batteries. There is no definitive relationship between performance on neuropsychological test batteries and the ability to cope in everyday life. Ecologically valid tests of cognitive function aim to bridge this gap as they use everyday tasks to explore cognitive function. The aims of the study were to examine if euthymic bipolar disorder patients were impaired on ecologically valid tests of cognitive function and measures of general, social and occupational function. We examined the relationships between cognitive impairment and residual symptoms, clinical history, general functioning and employment.

Method: Cognitive tasks, functional assessments and mood scales were administered to 29 euthymic bipolar disorder patients and 29 matched controls.

Results: Patients were impaired on ecologically valid tests of attention, memory and executive function. Patients showed impairment in general, social and occupational functioning. Unemployment was associated with impairment in attention. Memory impairment correlated with number of previous manic episodes.

Limitations: All patients were on psychotropic medication, which may affect cognition. Traditional neuropsychological tests were not performed concurrently with ecologically valid tests.

Conclusions: Ecologically valid tests of cognitive function are sensitive in detecting cognitive impairment in euthymic bipolar disorder. Clinicians should consider using these tests in the recovery phase of bipolar illness, as they may be particularly helpful in showing where rehabilitation should focus.