Cognitive impairment in first-episode mania: a systematic review of the evidence in the acute and remission phases of the illness

Daglas, Rothanthi; Yücel, Murat; Cotton, Sue; Allott, Kelly; Hetrick, Sarah; Berk, Michael

doi:10.1186/s40345-015-0024-2

International Journal of Bipolar Disorders

Table 4 Summary of findings for the FEM remission studies

From: Cognitive impairment in first-episode mania: a systematic review of the evidence in the acute and remission phases of the illness

Cognitive function			Controls		FEM		Statistics		Study
Domain	Test	Specific	n	Mean (SD)	n	Mean (SD)	p value	Effect size	First author (year)
Processing speed	Colour-word interference (D-KEFS)	Colour naming	110	28.2 (4.8)	34	31.6 (7.3)	0.002^b,e	0.08^g	Hellvin et al. (2012)
		Colour naming	110	28.2 (4.8)	21^a	32.2 (9.2)	0.002^b,e	0.08^g
		Word naming	110	21.5 (3.3)	34	22.1 (3.5)	0.161^b	0.02^g
		Word naming	110	21.5 (3.3)	21^a	23.1 (4.4)	0.161^b	0.02^g
	Grooved pegboard	N/A	110	64.0 (7.7)	34	74.7 (16.0)	<0.001^b,e	0.20^g
	Grooved pegboard	N/A	110	64.0 (7.7)	21^a	77.4 (16.6)	<0.001^b,e	0.20^g
	Stroop	Word naming	25	103.2 (13.7)	45	100.2 (12.9)	>0.05^c,f	0.09^h	Torres et al. (2010)
	Stroop	Colour naming	25	73.7 (12.3)	45	72.5 (11.8)	>0.05^c,f	0.07^h	Torres et al. (2010)
	Trail Making Test	A	50	83.70 (4.21)	50	94.00 (7.72)	<0.001^c	NR	Elshahawi et al. (2011)
			66	55.89 (19.99)	24	52.50 (18.27)	>0.05^d	<0.2ⁱ	Lopez-Jaramillo et al. (2010)
			25	20.8 (6.4)	45	26.0 (7.8)	>0.05^c,f	0.55^h	Torres et al. (2010)
	WAIS/WAIS-III	Digit symbol coding	50	11.02 (2.48)	50	7.36 (0.53)	<0.001^b	NR	Elshahawi et al. (2011)
			66	40.92 (12.92)	24	38.63 (12.37)	>0.05^d	<0.2ⁱ	Lopez-Jaramillo et al. (2010)
			110	78.1 (14.6)	34	66.8 (14.8)	<0.001^b,e	0.11^g	Hellvin et al. (2012)
			110	78.1 (14.6)	21^a	67.6 (14.3)	<0.001^b,e	0.11^g	Hellvin et al. (2012)
Attention	CANTAB	RVIP	25	0.92 (0.04)	45	0.89 (0.05)	0.008^c,e,f	0.62^h	Torres et al. (2010)
	CVLT	Trial 1	25	7.0 (1.6)	45	6.5 (1.9)	>0.05^c,f	0.28^h	Torres et al. (2010)
	WAIS-III/WMS/WMS-Revised	Digit span forward	110	6.2 (1.1)	34	5.9 (1.2)	0.33^b	0.01^g	Hellvin et al. (2012)
			110	6.2 (1.1)	21^a	6.0 (1.3)	0.33^b	0.01^g	Hellvin et al. (2012)
			66	5.39 (1.14)	24	5.42 (0.97)	>0.05^d	<0.2ⁱ	Lopez-Jaramillo et al. (2010)
			50	6.44 (0.54)	50	4.14 (0.35)	<0.001^c	NR	Elshahawi et al. (2011)
Learning and memory	CANTAB	Pattern recognition	25	97.0 (3.3)	45	94.6 (7.0)	>0.05^c,f	0.27^h	Torres et al. (2010)
		Spatial recognition	25	83.2 (11.8)	45	76.8 (15.2)	>0.05^c,f	0.40^h
		Paired associates	25	4.9 (5.4)	45	9.1 (6.5)	>0.05^c,f	0.45^h
	CVLT	Total trials 1 to 5	110	57.2 (9.2)	34	53.8 (13.7)	0.158^b	0.02^g	Hellvin et al. (2012)
			110	57.2 (9.2)	21^a	54.0 (10.6)	0.158^b	0.02^g	Hellvin et al. (2012)
			25	58.7 (7.7)	45	51.6 (11.6)	0.004^c,e,f	0.61^h	Torres et al. (2010)
		Delayed recall	110	13.2 (2.4)	34	11.3 (4.2)	0.007^b,e	0.06^g	Hellvin et al. (2012)
			110	13.2 (2.4)	21^a	12.5 (3.0)	>0.05^b	0.06^g	Hellvin et al. (2012)
			25	12.7 (2.7)	45	10.9 (3.0)	>0.05^c,f	0.57^h	Torres et al. (2010)
	Rey Complex Figure	Delayed recall	109	22.8 (6.1)	34	20.8 (7.5)	0.030^b	0.04^g	Hellvin et al. (2012)
		Delayed recall	109	22.8 (6.1)	21^a	19.1 (6.0)	0.030^b	0.04^g	Hellvin et al. (2012)
		Immediate recall	66	18.33 (10.98)	24	14.79 (5.09)	>0.05^d	<0.4ⁱ	Lopez-Jaramillo et al. (2010)
	WMS	Logical memory (LM)	66	10.05 (3.64)	24	8.92 (2.78)	>0.05^d	<0.4ⁱ	Lopez-Jaramillo et al. (2010)
		Visual reproduction	66	8.70 (2.83)	24	7.71 (3.38)	>0.05^d	<0.4ⁱ
		Associated pairs	66	14.86 (3.46)	24	13.69 (4.15)	>0.05^d	<0.4ⁱ
		LM recognition	66	17.29 (3.13)	24	18.53 (2.14)	>0.05^d	<0.6ⁱ
	WMS-Revised	Information	50	5.98 (0.14)	50	5.32 (0.47)	<0.001^c	NR	Elshahawi et al. (2011)
		Mental control	50	5.78 (0.76)	50	4.78 (1.27)	<0.001^c	NR
		Logical memory	50	13.93 (1.72)	50	11.91 (1.19)	<0.001^c	NR
		Visual reproduction	50	10.66 (0.96)	50	10.80 (1.01)	0.479^c	NR
		Total memory	50	74.51 (4.08)	50	62.93 (3.30)	<0.001^c	NR
	WMS-III	LM, learning	110	26.5 (6.5)	34	24.9 (7.9)	0.381^b	0.01^g	Hellvin et al. (2012)
		LM, learning	110	26.5 (6.5)	21^a	24.9 (4.5)	0.381^b	0.01^g
		LM, recall	110	23.8 (7.2)	34	20.9 (8.2)	0.084^b	0.03^g
		LM, recall	110	23.8 (7.2)	21^a	21.4 (5.3)	0.084^b	0.03^g
Visuospatial processing	Benton	Judgement of line orientation	25	29.0 (2.0)	45	27.4 (3.0)	>0.05^c,f	0.45^h	Torres et al. (2010)
Executive functions	CANTAB	Stockings	25	10.4 (1.6)	45	9.0 (2.4)	0.002^c,e,f	0.64^h	Torres et al. (2010)
	CANTAB	I/E-D	25	3.1 (5.2)	45	7.8 (8.9)	0.002^c,e,f	0.61^h	Torres et al. (2010)
	Colour-word interference (D-KEFS)	Inhibition	110	49.4 (10.5)	34	59.9 (26.6)	<0.001^b,e	0.09^g	Hellvin et al. (2012)
		Inhibition	110	49.4 (10.5)	21^a	61.1 (18.9)	<0.001^b,e	0.09^g
		Inhibition/switching	110	55.6 (12.5)	34	60.9 (25.4)	0.033^b	0.04^g
		Inhibition/switching	110	55.6 (12.5)	21^a	65.1 (20.6)	0.033^b	0.04^g
	Letter-number sequencing	N/A	109	11.2 (2.3)	34	9.6 (3.1)	<0.001^b,e	0.09^g
			109	11.2 (2.3)	20^a	9.4 (2.4)	<0.001^b,e	0.09^g
			25	12.0 (3.1)	45	10.8 (2.6)	>0.05^c,f	0.37^h	Torres et al. (2010)
	Spatial working memory	N/A	25	9.2 (16.7)	45	21.0 (20.1)	<0.001^c,e,f	0.72^h	Torres et al. (2010)
	Stroop	Conflict time	66	62.91 (13.78)	24	65.04 (11.91)	>0.05^d	<0.2ⁱ	Lopez-Jaramillo et al. (2010)
		Conflict errors	66	2.02 (2.00)	24	2.25 (2.95)	>0.05^d	<0.2ⁱ	Lopez-Jaramillo et al. (2010)
		Interference	25	49.7 (12.4)	45	47.0 (9.3)	>0.05^c,f	0.20^h	Torres et al. (2010)
	Trail Making Test	B	50	232.50 (23.24)	50	264.50 (40.19)	<0.001^c	NR	Elshahawi et al. (2011)
			66	106.95 (55.88)	24	127.67 (90.48)	>0.05^d	<0.4ⁱ	Lopez-Jaramillo et al. (2010)
			25	46.1 (12.6)	45	58.5 (23.8)	>0.05^c,f	0.58^h	Torres et al. (2010)
	WAIS-III	Digit span backward	110	4.8 (1.2)	34	4.1 (1.1)	0.009^b,e	0.06^g	Hellvin et al. (2012)
	WAIS-III	Digit span backward	110	4.8 (1.2)	21^a	4.3 (1.2)	>0.05^b	0.06^g	Hellvin et al. (2012)
	WCST	Perseveration errors	50	10.52 (3.73)	50	26.14 (6.92)	<0.001^c	NR	Elshahawi et al. (2011)
		Perseveration responses	72	7.1 (3.7)	34	7.8 (3.5)	0.703^b	<0.01^g	Hellvin et al. (2012)
		Perseveration responses	72	7.1 (3.7)	15^a	7.5 (3.3)	0.703^b	<0.01^g	Hellvin et al. (2012)
		Category completion	50	5.84 (0.42)	50	4.40 (1.44)	<0.001^c	NR	Elshahawi et al. (2011)
			72	3.7 (1.2)	34	3.8 (1.2)	0.962^b	<0.01^g	Hellvin et al. (2012)
			72	3.7 (1.2)	15^a	3.7 (1.3)	0.962^b	<0.01^g
		Total errors	72	14.4 (6.4)	26	15.4 (7.2)	0.713^b	<0.01^g
		Total errors	72	14.4 (6.4)	15^a	15.6 (6.2)	0.713^b	<0.01^g
	WCST (short version)	Perseverative responses	66	16.56 (6.74)	24	19.29 (8.61)	>0.05^d	<0.4ⁱ	Lopez-Jaramillo et al. (2010)
		Perseverative errors	66	25.17 (7.42)	24	26.42 (8.37)	>0.05^d	<0.2ⁱ
		Categories	66	2.79 (1.21)	24	2.67 (1.24)	>0.05^d	<0.2ⁱ
	WMS/WMS-Revised	Digit span backward	66	3.08 (1.06)	24	3.83 (1.02)	0. 005^d	0.73ⁱ	Lopez-Jaramillo et al. (2010)
	WMS/WMS-Revised	Digit span backward	50	5.30 (0.79)	50	3.66 (0.48)	<0.001^c	NR	Elshahawi et al. (2011)
	Verbal fluency (DKEFS)	Letter	110	43.0 (10.1)	34	41.3 (13.3)	0.755^b	<0.01^g	Hellvin et al. (2012)
		Letter	110	43.0 (10.1)	21^a	42.3 (13.6)	0.755^b	<0.01^g
		Category	110	48.9 (8.5)	34	44.9 (11.0)	0.208^b	0.02^g
		Category	110	48.9 (8.5)	21^a	45.8 (11.7)	0.208^b	0.02^g
		Category switching	110	14.9 (2.4)	34	14.0 (2.8)	0.199^b	0.02^g
		Category switching	110	14.9 (2.4)	21^a	14.5 (3.6)	0.199^b	0.02^g
	Verbal fluency	Semantic	66	18.08 (3.53)	24	17.60 (3.21)	>0.05^d	<0.2ⁱ	Lopez-Jaramillo et al. (2010)
		Phonological	66	12.31 (3.64)	24	11.23 (2.94)	>0.05^d	<0.4^h	Lopez-Jaramillo et al. (2010)
		FAS	25	41.4 (12.6)	45	38.5 (9.7)	>0.05^c,f	0.23^h	Torres et al. (2010)
Intelligence	K-BIT	Vocabulary score	25	103.5 (9.6)	45	102.3 (11.3)	>0.05^c,f	0.09^h
	K-BIT	Matrices	25	113.4(7.7)	45	106.6(11.6)	0.01^c,e,f	0.59^h
	WAIS	Verbal IQ	50	100.58 (9.71)	50	90.22 (6.02)	<0.001^b	NR	Elshahawi et al. (2011)
		Performance IQ	50	104.06 (9.83)	50	84.86 (4.80)	<0.001^b	NR
		Full scale IQ	50	100.80 (8.87)	50	86.58 (4.62)	<0.001^b	NR
		Full scale IQ	66	99.53 (14.2)	24	96.24 (14.7)	0.002^b	0.10ⁱ	Lopez-Jaramillo et al. (2010)
	WASI	Vocabulary	110	60.6 (7.3)	34	60.3 (8.8)	0.902^b	<0.01^g	Hellvin et al. (2012)
		Vocabulary	110	60.6 (7.3)	21^a	61.2 (6.6)	0.902^b	<0.01^g
		Similarities	110	38.5 (5.2)	34	37.4 (5.1)	0.555^b	<0.01^g
		Similarities	110	38.5 (5.2)	21^a	37.9 (4.1)	0.555^b	<0.01^g
		Block design	110	55.6 (10.2)	34	47.2 (15.9)	<0.001^b,e	0.11^g
		Block design	110	55.6 (10.2)	21^a	46.0 (12.2)	<0.001^b,e	0.11^g
		Matrix reasoning	110	28.2 (3.3)	34	27.8 (5.8)	0.042^b	0.04^g
		Matrix reasoning	110	28.2 (3.3)	21^a	25.7 (4.8)	0.042^b	0.04^g
		Full scale IQ	110	111.6 (11.4)	34	108.6 (14.7)	0.159^b	0.02^g
		Full scale IQ	110	111.6 (11.4)	21^a	106.9 (9.6)	0.159^b	0.02^g

FEM, first-episode mania; D-KEFS, Delis-Kaplan Executive System; WAIS, Wechsler Adult Intelligence Scale; CANTAB, Cambridge Neuropsychological Test Automated Battery; CVLT, California Verbal Learning Test; WMS, Wechsler Memory Scale; K-BIT, Kaufman Brief Intelligence Test; WASI, Wechsler Abbreviated Scale of Intelligence; RVIP, Rapid Information Visual Processing; I/E-D, intra/extra-dimensional test; NR, not reported. ^aFEM participants with previously untreated manic symptoms; ^bone-way ANOVA or univariate ANOVA; ^ctwo-tailed, independent-samples t-test, univariate t-test or student t-test; ^dMann-Whitney U test; ^esignificant difference after Bonferroni correction, ANOVA and t-test; ^fz-scores used in main analysis and effect size; ^geta squared; ^hCohen’s d with Hedges’ correction; ⁱeffect size (ES) calculation for Mann-Whitney U, ES > 0.70 was considered significant.

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