Executive Function Among Older Adults With Bipolar Disorder: A GAGE-BD Analysis

OBJECTIVES: Executive function deficits in bipolar disorder (BD) are major contributors to disability in older age BD (OABD). We investigated the difference between OABD and age-equated healthy comparators (HC); and, in the OABD group, the associations of executive function with age, symptom severity, global cognition, and daily functioning. DESIGN: Cross-sectional analysis of executive function in OABD versus HC. SETTING: Analysis of large archival dataset harmonized from 12 international OABD studies. PARTICIPANTS: Older adults (≥50 years) with OABD (n = 614) and HC (n = 192). MEASUREMENTS: Executive function was assessed via Trail Making Test B (TMT-B) completion time; covariates included age, self-reported gender, education, study site, medications (antipsychotics, lithium), and psychomotor speed. RESULTS: Executive function was worse in OABD than in HC, even after controlling for psychomotor speed (p < 0.001). In the OABD group, test completion was associated with less severe manic symptoms (p < 0.001). Worse executive function was associated with older age (p = 0.001), antipsychotic use (p < 0.001), worse global cognition (p < 0.001), and worse daily functioning (p < 0.001). CONCLUSIONS: Executive dysfunction is a prominent feature of OABD, associated with several demographic and clinical characteristics. Future longitudinal studies of executive function and OABD need to assess the individual impact of impairment in executive function on everyday functioning to inform personalized interventions targeting specific patient subgroups.