309. Cognitive correlates of functional recovery in remitted bipolar disorder

Abstract

Abstract Background Cognitive impairment often persists even during remission in bipolar disorder and is recognized as a major determinant of functional recovery. However, the relative contributions of specific cognitive domains to global functioning remain unclear. Aims & Objectives This study aimed to compare the predictive value of distinct cognitive domains for functional outcomes in patients with bipolar disorder during remission. Method Sixty-nine remitted patients with bipolar disorder completed neuropsychological assessments covering four cognitive domains: executive function, processing speed, working memory and attention, and verbal learning. Global functioning was measured using the Global Assessment of Functioning (GAF) scale. Hierarchical regression analyses were conducted to identify domain-specific predictors. Estimated premorbid intelligence was evaluated using the Vocabulary subtest of the Wechsler Adult Intelligence Scale–Fourth Edition (WAIS-IV). Executive function was assessed via the Trail Making Test–Part B (TMT-B) and the Stroop Color–Word Test Processing speed was measured using the Symbol Coding subtest of the Brief Assessment of Cognition in Schizophrenia (BACS) and the Category Fluency test (Animal Naming). Working memory & attention were gauged with the Spatial Span and Letter–Number Sequencing subtests of the Wechsler Memory Scale–Third Edition (WMS-III) (Wechsler, 1997). Verbal learning was assessed using the Hopkins Verbal Learning Test–Revised (HVLT-R). Results The mean Global Assessment of Functioning (GAF) score was 73.12 (SD = 10.86), reflecting generally preserved functional capacity during remission. GAF scores were positively correlated with executive function (r = 0.34, p = 0.004), whereas correlations with processing speed (r = 0.15, p = 0.24), working memory and attention (r = 0.09, p = 0.46), and verbal learning (r = 0.05, p = 0.68) were not statistically significant. This association remained significant after adjusting for demographic and cognitive covariates, indicating that executive dysfunction was independently related to poorer functional outcomes. Discussion & Conclusions Even during remission, executive dysfunction was independently associated with poorer global functioning in bipolar disorder. These findings highlight that symptomatic remission does not guarantee functional recovery and underscore the importance of assessing and addressing executive deficits during maintenance treatment. Cognitive remediation targeting executive function may help promote recovery beyond symptomatic remission.