Operationalizing Mild Cognitive Impairment in Bipolar Disorder: An Analysis of
the Use of Different Normative Data, Cognitive Measures, and Statistical 
   Lead Investigator:    Daniel Andruchow
   Institution      :     
   E-Mail           :    daniel.andruchow@ucalgary.ca
   Proposal ID      :    1505



   Proposal Description:
   Mild cognitive impairment (MCI) is conceptualized as a pre-dementia state in which cognitive performance is lower than normal but not yet sufficiently impaired to impact functional independence, and many (but not all) individuals with MCI will eventually develop dementia. It has been the target of much research in recent decades, due to strong belief that a better understanding of clinical, cognitive, imaging, and biomarker characteristics within the MCI stage can improve our ability to predict which individuals are likely to further deteriorate to dementia.  Adults with bipolar disorder (BD) have a four-fold increased risk of developing dementia relative to non-psychiatric controls (Diniz et al., 2017 Velosa et al., 2020). The relevance of characterizing the MCI phase in BD is significant because global cognitive deficits are a core feature of the normal BD disease course (Aprahamian et al., 2013, 2014 Forlenza and Aprahamian, 2013) and must be distinguished from those indicative of an early neurodegenerative disease process.  There exist a number of different criteria to diagnose MCI (e.g., DSM-5, ICD-11, NIA-AA), and although they differ in some respects, all include 'objective cognitive impairment' as a core requirement. Specifically how this should be operationalized in individuals with significant pre-existing cognitive difficulties (i.e., BD) is unclear. One necessary component of classifying ?objective cognitive impairment? is with reference to a normative dataset. The use of published norms, collected from the broader population, and internal norms, collected locally, can affect clinicians? abilities to accurately detect and predict cognitive impairment (Callahan, 2020 Wyman-Chick et al., 2018). Moreover, applying different cut-off scores to classify ?impairment,? and varying the number of cognitive measures used to assess patients may also contribute to discrepancies in defining MCI (Callahan et al., 2015 Jak et al., 2009). This project will aim to determ