Psychological Medicine

Review Article

Meta-analyses of cognitive functioning in euthymic bipolar patients and their first-degree relatives

B. Artsa1 c1, N. Jabbena1, L. Krabbendama1 and J. van Osa1a2

a1 Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO Box 616 (KAP2), 6200 MD Maastricht, The Netherlands

a2 Division of Psychological Medicine, Institute of Psychiatry, London, UK


Background Previous work suggests that impairments in executive function and verbal memory in particular may persist in euthymic bipolar patients and serve as an indicator of genetic risk (endophenotype).

Method A systematic review of the literature was undertaken. Effects sizes were extracted from selected papers and pooled using meta-analytical techniques.

Results In bipolar patients, large effect sizes (d>0.8) were noted for executive functions (working memory, executive control, fluency) and verbal memory. Medium effect sizes (0.5<d<0.8) were reported for aspects of executive function (concept shifting, executive control), mental speed, visual memory, and sustained attention. Small effect sizes (d<0.5) were found for visuoperception. In first-degree relatives, effect sizes were small (d<0.5), but significantly different from healthy controls for executive function and verbal memory in particular.

Conclusions Executive function and verbal memory are candidate bipolar endophenotypes given large deficits in these domains in bipolar patients and small, but intermediate, cognitive impairments in first-degree relatives.

(Received January 25 2007)

(Revised July 20 2007)

(Accepted August 07 2007)

(Online publication October 09 2007)