How Does Dementia Begin to Manifest in Bipolar Disorder? A Description of Prodromal Clinical and Cognitive Changes.
Bibliographic record
Abstract
Abstract BackgroundThis study aims to identify longitudinal cognitive changes that may signal early dementia in bipolar disorder.MethodsParticipants were 114 adults with bipolar disorder, all initially non-demented, who underwent annual neuropsychological assessment up to ten years (47.3 months average follow-up). A small subset (n=12) also had available structural neuroimaging data. Longitudinal features associated with future dementia status were examined with linear mixed-effects models, and yearly differences between incident dementia and controls cases were examined in the six years prior to diagnosis.ResultsTwenty-six participants (22.8%) developed dementia over the follow-up period (‘incident cases’), and the remaining 88 (77.2%) remained dementia-free (‘controls’). Alzheimer’s disease was the most common presumed etiology in the incident cases, and this aligned with findings of smaller hippocampal volumes relative to controls. The incident cases showed clearly declining trajectories in episodic memory, verbal fluency and attention. Story recall and digit symbol substitution showed the earliest decline, four and five years before diagnosis respectively. Digit symbol substitution was most accurate at distinguishing cases from controls: impaired performance (<-1.5 SD) at any time during the follow-up period was associated with 54% sensitivity and 87% specificity of future dementia.ConclusionsProdromal dementia in bipolar disorder can be detected up to five years before onset using the same cognitive tests used in psychiatrically-healthy older adults. Cognition in the natural course of bipolar disorder is generally stable, and impairment or marked decline on measures of memory, fluency or attention may indicate an early neurodegenerative process.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".