Bipolar-ADHD comorbidity: screening for differences in neurocognition and virtual reality-based cognitive performance

Abstract

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.

Keywords:

• Cognition
• cognitive impairments
• virtual reality
• bipolar disorder
• ADHD

Acknowledgments

Trygfonden is acknowledged for financial support for the study (grant no. 127318).

Authors’ contributions

All authors met all four ICMJE criteria for authorship. All authors were involved in the initial conception and design of the study. Zacharias Obel and Andreas Jespersen were responsible for the acquisition and analysis of data. Zacharias Obel and Andreas Jespersen wrote the first draft in collaboration under the supervision of Kamilla Miskowiak. All authors approved the final version to be published and agree to be accountable for all aspects of the work.

Disclosure statement

Kamilla Miskowiak has received consultancy fees from Lundbeck, Angelini, Gedeon Richter and Janssen-Cilag in the past three years. Lars Vedel Kessing has been a consultant for Lundbeck and Teva for the last three years. Anders Lumbye, Andreas Jespersen and Zacharias Obel report no conflicts of interest.