Metacognition and QOL in BD: Preliminary findings

Ivan TorresErin Michalak

Lakshmi YathamSylvia Mackala

UBC Department of PsychiatryBC Mental Health and Addictions Services

Predicting QOL

• If we understand the determinants of QOL in BD, perhaps we can modify these variables and improve QOL.

Predictors of QOL

• Mood (in particular depression)

• Cognition: Mental processing and knowledge of the external world– Memory, Attention, Executive Function, etc

• Metacognition: Knowledge of internal world, one’s own cognitive functioning or performance

Metacognition: different levels

• Metacognitive Knowledge: General knowledge about one’s cognitive ability

• Metacognitive Experience: Task specific knowledge

• Metacognition of daily functioning: Knowledge in the context of daily life

Research Questions

• How do individuals diagnosed with BD self-rate their everyday cognitive functioning?

• Do these self-ratings predict QOL?

MetacognitionDepression

QOL

Cognition

Measures

• Depression: HAMD• Cognition:

– Learning/Memory: RAVLT trials 1-3

– Executive: Trailmaking Test B

• Self-reported cognitive failures– Cognitive Failures Questionnaire (CFQ; Broadbent

et al., 1982)

• QOL: QoL.BD (Michalak et al., 2010)

Very often

Quite often

Occasion- ally

Very rarely

Never

4 3 2 1 0 Do you find you forget appointments? Do you forget where you put something like a newspaper or a book? Do you daydream when you ought to be listening to something? Do you find you forget people’s names? Do you start doing one thing at home and get distracted into doing something else (unintentionally)? Do you find you can’t quite remember something although it’s “on the tip of your tongue”? Do you read something and find you haven’t been thinking about it and must read it again? Do you find you forget why you went from one part of the house to the other? Do you find you confuse right and left when giving directions? Do you find you forget whether you’ve turned off a light or a fire or locked the door? Do you fail to hear people speaking to you when you are doing something else? Do you leave important letters unanswered for days? Do you find you forget which way to turn on a road you know well but rarely use? Do you fail to see what you want in a supermarket (although it’s there)?

Cognitive Failures Questionnaire

Table 1: Demographics and Characteristics of the Sample Patients (n=63)a Controls (n=40)b Continuous Variable c M SD M SD Age 39.0 10.3 35.3 10.4 Education (years) 15.2 2.2 15.5 2.2 Premorbid IQ 109.1 8.4 108.3 7.5 HAMD 5.7 4.5 - - YMRS 1.5 2.7 - - QoL*** 161.2 29.6 191.6 23.9 CFQ*** 42.6 17.9 25.5 10.2 RVLT .6 1.1 .6 .9 TMT-B 48.3 11.3 46.8 10.5 Note. Premorbid IQ= North American Adult Reading Test FSIQ. HAMD= Hamilton Depression Rating Scale (17). YMRS- Young Mania Rating Scale. QoL= Quality of Life- Bipolar Disorder Questionnaire. CFQ= Cognitive Failures Questionnaire. RVLT= Rey’s Verbal Learning Test mean trials 1-3. TMT-B= Trail Making Test trial B. a Female n= 40 (63.5%). b Female n= 22 (55.0%). c No significant difference on any variables except for QoL and CFQ. *** p<.001

Table 2: Correlations between Quality of Life and depression, cognitive function, and CFQ Patients (n=63) Controls (n=40) Pearson Correlation QoL p QoL p HAMD -.74 .00 - -

CFQ -.53 .00 -.43 .01

RVLT .33 .00 -.06 .70 TMT-B -.25 .03 -.12 .48 Note. QoL= Quality of Life- Bipolar Disorder Questionnaire. CFQ= Cognitive Failures Questionnaire. RVLT= Rey’s Verbal Learning Test mean trials 1-3. TMT-B= Trail Making Test trial B.

Table 3: Hierarchical Regression: Predictors of QoL in patients with BD Patients (n=63) Entry ΔR² p Step 1: HAMD 0.47 <.001

Step 2: Cognition 0.06 <.05

Step 3: CFQ 0.04 <.05 Note. QoL= Quality of Life- Bipolar Disorder Questionnaire. HAMD= Hamilton Depression Rating Scale. CFQ= Cognitive Failures Questionnaire. Cognition = Rey’s Verbal Learning Test mean trials 1-3, Trail Making Test trial B.

Correlation between cognitive failures and QOL

Summary Slide

• Main research finding: In addition to, and independent of mood symptoms and cognitive functioning, perception of daily cognitive functioning may be a predictor of overall quality of life in BD.

• Knowledge Exchange for CREST.BD network members: If self-perceptions of daily cognitive functioning indeed associate with QOL in BD, then these perceptions may serve as targets for change via treatment/intervention.