Psychological Medicine

Original Articles

Affective symptoms and intra-individual variability in the short-term course of cognitive functioning in bipolar disorder

C. A. Deppa1 c1, G. N. Savlaa1, L. A. Vergel de Diosa1, B. T. Mausbacha1 and B. W. Palmera1a2

a1 Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA

a2 Veterans Medical Research Foundation, VA San Diego, La Jolla, CA, USA


Background Few studies have examined the short-term course of cognitive impairments in bipolar disorder (BD). Key questions are whether trajectories in symptoms covary with cognitive function and whether BD is associated with increased intra-individual variability in cognitive abilities.

Method Forty-two out-patients with BD and 49 normal comparison (NC) subjects were administered a battery of neuropsychological tests at baseline, 6, 12 and 26 weeks, along with concurrent ratings of depressive and manic symptom severity. Mixed-effects regressions were used to model relationships between time, diagnosis and symptom severity on composite cognitive performance. Within-person variance in cognitive functioning across time was calculated for each subject.

Results BD patients had significantly worse performance in cognitive ability across time points, but both groups showed significant improvement in cognitive performance over repeated assessments (consistent with expected practice effects). BD was associated with significantly greater intra-individual variability in cognitive ability than NCs; within-person variation was negatively related to baseline cognitive ability in BD but not NC subjects. Changes in affective symptoms over time did not predict changes in cognitive ability.

Conclusions Moderate changes in affective symptoms did not covary with cognitive ability in BD. The finding of elevated intra-individual variability in BD may reduce capacity to estimate trajectories of cognitive ability in observational and treatment studies.

(Received May 06 2011)

(Revised October 13 2011)

(Accepted October 25 2011)

(Online publication December 09 2011)


c1 Address for correspondence: C. A. Depp, Ph.D., University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive (0664), La Jolla, CA 92093-0664, USA. (Email: