Characteristics of Bipolar Patients with Cognitive Impairment of Suspected Neurodegenerative Origin: A Multicenter Cohort

Bipolar disorder is associated with an increased risk of dementia with aging. Little is known regarding this association, limiting appropriate diagnosis and management. We aimed to describe the characteristics of bipolar patients with late cognitive impairment for whom the hypothesis of an underlyin...

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Autores principales:	Esteban Munoz Musat, Emeline Marlinge, Mélanie Leroy, Emilie Olié, Eloi Magnin, Florence Lebert, Audrey Gabelle, Djamila Bennabi, Fréderic Blanc, Claire Paquet, Emmanuel Cognat
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	bipolar disorder cognition dementia Alzheimer’s disease biomarkers Parkinsonism Medicine R
Acceso en línea:	https://doaj.org/article/59bc676a75a9492095818f61c6a466b9
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spelling	oai:doaj.org-article:59bc676a75a9492095818f61c6a466b92021-11-25T18:07:51ZCharacteristics of Bipolar Patients with Cognitive Impairment of Suspected Neurodegenerative Origin: A Multicenter Cohort10.3390/jpm111111832075-4426https://doaj.org/article/59bc676a75a9492095818f61c6a466b92021-11-01T00:00:00Zhttps://www.mdpi.com/2075-4426/11/11/1183https://doaj.org/toc/2075-4426Bipolar disorder is associated with an increased risk of dementia with aging. Little is known regarding this association, limiting appropriate diagnosis and management. We aimed to describe the characteristics of bipolar patients with late cognitive impairment for whom the hypothesis of an underlying neurodegenerative disease had been raised. We performed a retrospective multicenter study, recruiting bipolar patients over 50 years old from five French tertiary memory centers who had undergone cerebrospinal fluid (CSF) biomarker assessment for Alzheimer’s disease (AD). Clinical, neuropsychological, and paraclinical characteristics were analyzed and 78 patients were included. The mean age at the onset of cognitive impairment was 62.4 years (±9.2). The mean MMSE score was 22.8 (±4.5), the mean FAB was 11.7 (±3.9), and the mean FCRST was 15.8 (±7.4)/36.8 (±9.7) (free/total recall). A total of 48.6% of the patients displayed cognitive fluctuations, and 38.2% showed cognitive improvement during follow-ups; and 56.3% of the patients showed Parkinsonism, of which 12.7% had never received antipsychotics. Among patients who underwent DAT-scans, 35.3% displayed dopaminergic denervation; 10.3% of patients had CSF AD biological signature (“A+ T+” profile), while 56.4% had other abnormal CSF profiles. Thus, clinical presentation was dominated by executive dysfunction, episodic memory impairment, fluctuating cognition, and a high frequency of Parkinsonism. Specifically, high frequency of delusional episodes suggests limited tolerance of psychotropic drugs. Most patients had abnormal CSF biomarker profiles, but only a minority displayed AD’s specific biomarker signature. Therefore, while our results unveil shared common neurocognitive features in bipolar patients with cognitive impairment of suspected neurodegenerative origin they suggest a participation of various underlying pathologies rather than a common degenerative mechanism in the pathophysiology of this condition.Esteban Munoz MusatEmeline MarlingeMélanie LeroyEmilie OliéEloi MagninFlorence LebertAudrey GabelleDjamila BennabiFréderic BlancClaire PaquetEmmanuel CognatMDPI AGarticlebipolar disordercognitiondementiaAlzheimer’s diseasebiomarkersParkinsonismMedicineRENJournal of Personalized Medicine, Vol 11, Iss 1183, p 1183 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	bipolar disorder cognition dementia Alzheimer’s disease biomarkers Parkinsonism Medicine R
spellingShingle	bipolar disorder cognition dementia Alzheimer’s disease biomarkers Parkinsonism Medicine R Esteban Munoz Musat Emeline Marlinge Mélanie Leroy Emilie Olié Eloi Magnin Florence Lebert Audrey Gabelle Djamila Bennabi Fréderic Blanc Claire Paquet Emmanuel Cognat Characteristics of Bipolar Patients with Cognitive Impairment of Suspected Neurodegenerative Origin: A Multicenter Cohort
description	Bipolar disorder is associated with an increased risk of dementia with aging. Little is known regarding this association, limiting appropriate diagnosis and management. We aimed to describe the characteristics of bipolar patients with late cognitive impairment for whom the hypothesis of an underlying neurodegenerative disease had been raised. We performed a retrospective multicenter study, recruiting bipolar patients over 50 years old from five French tertiary memory centers who had undergone cerebrospinal fluid (CSF) biomarker assessment for Alzheimer’s disease (AD). Clinical, neuropsychological, and paraclinical characteristics were analyzed and 78 patients were included. The mean age at the onset of cognitive impairment was 62.4 years (±9.2). The mean MMSE score was 22.8 (±4.5), the mean FAB was 11.7 (±3.9), and the mean FCRST was 15.8 (±7.4)/36.8 (±9.7) (free/total recall). A total of 48.6% of the patients displayed cognitive fluctuations, and 38.2% showed cognitive improvement during follow-ups; and 56.3% of the patients showed Parkinsonism, of which 12.7% had never received antipsychotics. Among patients who underwent DAT-scans, 35.3% displayed dopaminergic denervation; 10.3% of patients had CSF AD biological signature (“A+ T+” profile), while 56.4% had other abnormal CSF profiles. Thus, clinical presentation was dominated by executive dysfunction, episodic memory impairment, fluctuating cognition, and a high frequency of Parkinsonism. Specifically, high frequency of delusional episodes suggests limited tolerance of psychotropic drugs. Most patients had abnormal CSF biomarker profiles, but only a minority displayed AD’s specific biomarker signature. Therefore, while our results unveil shared common neurocognitive features in bipolar patients with cognitive impairment of suspected neurodegenerative origin they suggest a participation of various underlying pathologies rather than a common degenerative mechanism in the pathophysiology of this condition.
format	article
author	Esteban Munoz Musat Emeline Marlinge Mélanie Leroy Emilie Olié Eloi Magnin Florence Lebert Audrey Gabelle Djamila Bennabi Fréderic Blanc Claire Paquet Emmanuel Cognat
author_facet	Esteban Munoz Musat Emeline Marlinge Mélanie Leroy Emilie Olié Eloi Magnin Florence Lebert Audrey Gabelle Djamila Bennabi Fréderic Blanc Claire Paquet Emmanuel Cognat
author_sort	Esteban Munoz Musat
title	Characteristics of Bipolar Patients with Cognitive Impairment of Suspected Neurodegenerative Origin: A Multicenter Cohort
title_short	Characteristics of Bipolar Patients with Cognitive Impairment of Suspected Neurodegenerative Origin: A Multicenter Cohort
title_full	Characteristics of Bipolar Patients with Cognitive Impairment of Suspected Neurodegenerative Origin: A Multicenter Cohort
title_fullStr	Characteristics of Bipolar Patients with Cognitive Impairment of Suspected Neurodegenerative Origin: A Multicenter Cohort
title_full_unstemmed	Characteristics of Bipolar Patients with Cognitive Impairment of Suspected Neurodegenerative Origin: A Multicenter Cohort
title_sort	characteristics of bipolar patients with cognitive impairment of suspected neurodegenerative origin: a multicenter cohort
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/59bc676a75a9492095818f61c6a466b9
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Characteristics of Bipolar Patients with Cognitive Impairment of Suspected Neurodegenerative Origin: A Multicenter Cohort

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