TY - JOUR

T1 - Bipolar-ADHD comorbidity

T2 - screening for differences in neurocognition and virtual reality-based cognitive performance

AU - Jespersen, Andreas E.

AU - Obel, Zacharias

AU - Lumbye, Anders

AU - Kessing, Lars V.

AU - Miskowiak, Kamilla W.

N1 - Publisher Copyright: © 2024 The Nordic Psychiatric Association.

PY - 2024

Y1 - 2024

N2 - Objectives: Identification of comorbid attention-deficit/hyperactivity disorder (ADHD) in patients with bipolar disorder (BD) is complicated by overlapping cognitive symptoms and methodological challenges. This cross-sectional study investigated whether virtual reality (VR)-based cognitive assessment that mimics daily life cognitive challenges can aid in the detection of sustained attention impairment in BD individuals with comorbid ADHD (BD + ADHD). Methods: Forty-nine fully or partially remitted outpatients with BD, of whom 14 (24%) had BD + ADHD, were assessed with the Cognition Assessment in Virtual Reality (CAVIR) test, including a sustained attention test that involves distractions, and the Screen for Cognitive Impairment in Psychiatry (SCIP). Patients were also rated for mood symptoms and functioning and completed questionnaires assessing subjective cognition and quality of life. Patients’ cognitive impairment on the SCIP was estimated with reference to n = 100 demographically comparable healthy control participants. Results: BD + ADHD participants exhibited more pronounced performance deficits on the CAVIR sustained attention test (t(48) = 2.15, p =.037, d =.66). Notably, deficits on this test were proportional to self-reported daily life concentration difficulties in BD + ADHD individuals. Exploratory analyses revealed that BD + ADHD participants also displayed greater impairment on the SCIP working memory- and delayed verbal learning subtests and greater subjective cognitive complaints than BD patients without this comorbidity (p-levels <.001), but only the difference in subjective cognition survived correction for multiple comparisons (F(1,47) = 14.13, p =.005, np2 = 0.24). Conclusion: Screening for deficits in sustained attention with an ecologically valid VR test involving distracting stimuli may be useful for identifying BD + ADHD individuals.

AB - Objectives: Identification of comorbid attention-deficit/hyperactivity disorder (ADHD) in patients with bipolar disorder (BD) is complicated by overlapping cognitive symptoms and methodological challenges. This cross-sectional study investigated whether virtual reality (VR)-based cognitive assessment that mimics daily life cognitive challenges can aid in the detection of sustained attention impairment in BD individuals with comorbid ADHD (BD + ADHD). Methods: Forty-nine fully or partially remitted outpatients with BD, of whom 14 (24%) had BD + ADHD, were assessed with the Cognition Assessment in Virtual Reality (CAVIR) test, including a sustained attention test that involves distractions, and the Screen for Cognitive Impairment in Psychiatry (SCIP). Patients were also rated for mood symptoms and functioning and completed questionnaires assessing subjective cognition and quality of life. Patients’ cognitive impairment on the SCIP was estimated with reference to n = 100 demographically comparable healthy control participants. Results: BD + ADHD participants exhibited more pronounced performance deficits on the CAVIR sustained attention test (t(48) = 2.15, p =.037, d =.66). Notably, deficits on this test were proportional to self-reported daily life concentration difficulties in BD + ADHD individuals. Exploratory analyses revealed that BD + ADHD participants also displayed greater impairment on the SCIP working memory- and delayed verbal learning subtests and greater subjective cognitive complaints than BD patients without this comorbidity (p-levels <.001), but only the difference in subjective cognition survived correction for multiple comparisons (F(1,47) = 14.13, p =.005, np2 = 0.24). Conclusion: Screening for deficits in sustained attention with an ecologically valid VR test involving distracting stimuli may be useful for identifying BD + ADHD individuals.

KW - ADHD

KW - bipolar disorder

KW - Cognition

KW - cognitive impairments

KW - virtual reality

U2 - 10.1080/08039488.2024.2309496

DO - 10.1080/08039488.2024.2309496

M3 - Journal article

C2 - 38294688

AN - SCOPUS:85184203171

VL - 78

SP - 238

EP - 246

JO - Nordic Journal of Psychiatry, Supplement

JF - Nordic Journal of Psychiatry, Supplement

SN - 0803-9496

IS - 3

ER -