Relationships between daily mood states and real-time cognitive performance in individuals with bipolar disorder and healthy comparators: A remote ambulatory assessment study

ABSTRACT

Objective

Neuropsychological impairments are observed in individuals with Bipolar Disorder (BD), yet knowledge of how cognitive deficits unfold in real-time remains limited. Given intraindividual variability in mood observed in people with BD, and the potential for mood and cognition to be mutually influential, we employed ambulatory assessment technologies to examine potential contemporaneous (same survey) and lagged (next survey) relationships of congition and mood.

Methods

Outpatients with BD (n = 46) or no psychiatric disorders (heathy volunteers [HV]; n = 20) completed in-laboratory neurobehavioral assessments and 14 days of smartphone-administered mobile cognitive tests and ratings of affective variables. Linear mixed-effects models were used to analyze real-time relationships between mobile cognitive test performance and mood.

Results

On in-laboratory tests, participants with BD showed worse cognitive performance than HVs as well as mild depression severity; mood and cognitive performance were unrelated. On mobile cognitive tests and surveys, participants with BD showed somewhat worse cognitive performance and ratings of lower energy and greater sadness relative to HV participants. Among those with BD, mania and sadness earlier in the day related to worse processing speed and better working memory performance, respectively, on the next survey. In contrast, same survey ratings of greater stress related to better working memory, and greater happiness related to better processing speed.

Conclusions

Real-time assessments of mood and cognition provide incremental information beyond what can be gleaned from laboratory assessments. Understanding how these affect-related changes in processing speed emerge and play out in daily life may provide clinically useful information for treatment planning.

KEYWORDS:

• Neuropsychiatric populations
• digital neuropsychology
• depression
• mania
• mobile health
• ecological momentary asssessment

Disclosure statement

Dr. Moore is a co-founder of KeyWise, Inc. and a consultant for NeuroUX. The terms of this arrangement have been reviewed and approved by UC San Diego in accordance with its conflict of interest policies. Dr. Moore was not involved in analyses of the NeuroUX data.

Ethical Standards statement

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committee on human experimentation with the Helsinki Declaration of 1975, as revised in 2008. The study protocol was approved by the ethics committee of each participating institution. The authors assert that ethical approval for publication of this report has been provided by their local Ethics Committee.

Additional information

Funding

This work was supported by the National Institute of Mental Health [MH116104] awarded to Dr. Moore and VA CSR&D [CX001600] awarded to Dr. Bomyea, and by the Desert Pacific Mental Illness Research Education and Clinical Center.