Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2017-0121
Trends in Psychiatry and Psychotherapy
Original Article

Validity and reliability of the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) in Brazilian bipolar patients

Validade e fidedignidade da Escala de Disfunções Cognitivas no Transtorno Bipolar (COBRA) em pacientes bipolares brasileiros

Flávia M. Lima; Taiane A. Cardoso; Sílvia D. Serafim; Dayane S. Martins; Brisa Solé; Anabel Martínez-Arán; Eduard Vieta; Adriane R. Rosa

http://dx.doi.org/10.1590/2237-6089-2017-0121 Trends Psychiatry Psychother, vol.40, n2, p.170-178, 2018
PDF
SciELO
Downloads: 0
Views: 451

Abstract

Abstract Introduction: In Brazil, there is no valid instrument to measure subjective cognitive dysfunction in bipolar disorder. The present study analyzed the psychometric properties of the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) in Brazilian bipolar patients. We further investigated the relationship between the COBRA, objective cognitive measures, and illness course variables. Methods: The total sample (N=150) included 85 bipolar disorder patients and 65 healthy controls. The psychometric properties of the COBRA (e.g., internal consistency, concurrent validity, discriminative validity, factor analyses, ROC curve, and feasibility) were analyzed. Results: The COBRA showed a one-factor structure with very high internal consistency (Cronbach's alpha=0.890). Concurrent validity was indicated by a strong correlation with the cognitive domain of the FAST (r=0.811, p<0.001). Bipolar patients experienced greater cognitive complaints (mean=14.69; standard deviation [SD]=10.03) than healthy controls (mean=6.78; SD=5.49; p<0.001), suggesting discriminative validity of the instrument. No significant correlations were found between the COBRA and objective cognitive measures. Furthermore, higher COBRA scores were associated with residual depressive (r=0.448; p<0.001) and manic (r=0.376; p<0.001) symptoms, number of depressive episodes (r=0.306; p=0.011), number of total episodes (r=0.256; p=0.038), and suicide attempts (r=0.356; p=0.003). Conclusion: The COBRA is a valid instrument to assess cognitive complaints, and the combined use of subjective-objective cognitive measures enables the correct identification of cognitive dysfunctions in bipolar disorder.

Keywords

Bipolar disorder, cognition, neuropsychological tests, cognitive complaints

Resumo

Resumo Introdução: No Brasil, não existem instrumentos válidos para medir a disfunção cognitiva subjetiva no transtorno bipolar. O presente estudo analisou as propriedades psicométricas da Escala de Disfunções Cognitivas no Transtorno Bipolar (COBRA) em uma amostra brasileira de pacientes bipolares. Adicionalmente, investigamos a relação entre a COBRA, medidas cognitivas objetivas e curso da doença. Métodos: A amostra total (n=150) incluiu 85 pacientes com transtorno bipolar e 65 controles saudáveis. As propriedades psicométricas da COBRA (consistência interna, validade concorrente, validade discriminativa, análise fatorial, curva ROC e fidedignidade) foram analisadas. Resultados: A COBRA apresentou estrutura de um fator com alta consistência interna (alfa de Cronbach=0,890). A validade concorrente ficou demonstrada pela forte correlação com o domínio cognitivo da FAST (r=0,811, p<0,001). Pacientes bipolares tiveram mais queixas cognitivas [média=14,69; desvio padrão (DP)=10,03] que os controles (média=6,78; DP=5,49; p<0,001), sugerindo a validade discriminativa do instrumento. Não houve correlação significativa entre a COBRA e medidas cognitivas objetivas. Além disso, escores mais altos na COBRA estiveram associados com sintomas residuais depressivos (r=0,448; p<0,001) e maníacos (r=0,376; p<0,001), número de episódios depressivos (r=0,306; p=0,011), número de episódios totais (r=0.256; p=0.038) e tentativas de suicídio (r=0,356; p=0,003). Conclusão: A COBRA é um instrumento válido para avaliar queixas cognitivas, e o uso combinado das medidas cognitivas subjetivas-objetivas possibilita a correta identificação das disfunções cognitivas no transtorno bipolar.

Palavras-chave

Transtorno bipolar, cognição, testes neuropsicológicos, queixas cognitivas

References

Torres IJ, Boudreau VG, Yatham LN. Neuropsychological functioning in euthymic bipolar disorder: a meta-analysis. Acta Psychiatr Scand Suppl. 2007;116:17-26.

Bora E, Yucel M, Pantelis C. Cognitive endophenotypes of bipolar disorder: A meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. J Affect Disord. 2009;113:1-20.

Burdick KE, Russo M, Frangou S, Mahon K, Braga RJ, Shanahan M. Empirical evidence for discrete neurocognitive subgroups in bipolar disorder: clinical implications. Psychol Med. 2014;44:3083-96.

Solé B, Jiménez E, Torrent C, Del Mar Bonnin C, Torres I, Reinares M. Cognitive variability in bipolar II disorder: WHO is cognitively impaired and who is preserved. Bipolar Disord. 2016;18:288-99.

Reinares M, Colom F, Rosa AR, Bonnín CM, Franco C, Solé B. The impact of staging bipolar disorder on treatment outcome of family psychoeducation. J Affect Disord. 2010;123:81-6.

Demant KM, Vinberg M, Kessing L V, Miskowiak KW. Assessment of subjective and objective cognitive function in bipolar disorder: Correlations, predictors and the relation to psychosocial function. Psychiatry Res. 2015;229:565-71.

López-Jaramillo C, Lopera-Vásquez J, Gallo A, Ospina-Duque J, Bell V, Torrent C. Effects of recurrence on the cognitive performance of patients with bipolar I disorder: implications for relapse prevention and treatment adherence. Bipolar Disord. 2010;12:557-67.

Martinez-Aran A, Scott J, Colom F, Torrent C, Tabares-Seisdedos R, Daban C. Treatment nonadherence and neurocognitive impairment in bipolar disorder. J Clin Psychiatry. 2009;70:1017-23.

Martinez-Aran A, Vieta E. Cognition as a target in schizophrenia, bipolar disorder and depression. Eur Neuropsychopharmacol. 2015;25:151-7.

Miskowiak KW, Petersen JZ, Ott CV, Knorr U, Kessing LV, Gallagher P. Predictors of the discrepancy between objective and subjective cognition in bipolar disorder: a novel methodology. Acta Psychiatr Scand. 2016;134:511-21.

Rosa AR, Mercadé C, Sánchez-Moreno J, Solé B, Mar Bonnin C Del, Torrent C. Validity and reliability of a rating scale on subjective cognitive deficits in bipolar disorder (COBRA). J Affect Disord. 2013;150:29-36.

Jensen JH, Støttrup MM, Nayberg E, Knorr U, Ullum H, Purdon SE. Optimising screening for cognitive dysfunction in bipolar disorder: Validation and evaluation of objective and subjective tools. J Affect Disord. 2015;187:10-9.

Broadbent DE, Cooper PF, FitzGerald P, Parkes KR. The Cognitive Failures Questionnaire (CFQ) and its correlates. Br J Clin Psychol. 1982;21:1-16.

Chelune GJ, Heaton RK, Lehman RAW. Neuropsychological and personality correlates of patients’ complaints of disability. Advances in clinical neuropsychology. 1986:95-126.

Cuesta MJ, Peralta V, Irigoyen I. Factor analysis of the Frankfurt Complaint Questionnaire in a Spanish sample. Psychopathology. 1996;29:46-53.

McNair D, Kahn RJ. Self-assessment of cognitive deficits. Assessment in geriatric psychopharmacology. 1983:137-43.

Xiao L, Lin X, Wang Q, Lu D, Tang S. Adaptation and validation of the “cognitive complaints in bipolar disorder rating assessment” (COBRA) in Chinese bipolar patients. J Affect Disord. 2015;173:226-31.

Ott CV, Bjertrup AJ, Jensen JH, Ullum H, Sjælland R, Purdon SE. Screening for cognitive dysfunction in unipolar depression: Validation and evaluation of objective and subjective tools. J Affect Disord. 2016;190:607-15.

Toyoshima K, Fujii Y, Mitsui N, Kako Y, Asakura S, Martinez-Aran A. Validity and reliability of the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) in Japanese patients with bipolar disorder. Psychiatry Res. 2017;254:85-9.

Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56-62.

Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978;133:429-35.

Rosa AR, Sánchez-Moreno J, Martínez-Aran A, Salamero M, Torrent C, Reinares M. Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder. Clin Pract Epidemiol Ment Heal. 2007;3:5.

Yatham LN, Torres IJ, Malhi GS, Frangou S, Glahn DC, Bearden CE. The International Society for Bipolar Disorders-Battery for Assessment of Neurocognition (ISBD-BANC). Bipolar Disord. 2010;12:351-63.

Tombaugh TN, Kozak J, Rees L. Normative data stratified by age and education for two measures of verbal fluency: FAS and animal naming. Arch Clin Neuropsychol. 1999;14:167-77.

Reitan RM. Validity of the trail making test as an indication of organic brain damage. Percept Mot Skills. 1958;8:271-6.

Wechsler D. The Wechsler Adult Intelligence Scale-III (WAIS-III) administration and scoring manual. 1997.

Wechler D, Nascimento E. Escala de Inteligencia Wechsler para Adultos-III (WAIS III) - Manual técnico. 2001.

Benedict RHB, Schretlen D, Groninger L, Brandt J, Benedict RHB, Schretlen D. Hopkins Verbal Learning Test - Revised: normative data and analysis of inter-form and test-retest reliability. Clin Neuropsychol. 1998;12:43-55.

Golden CJ. Stroop Colour and Word Test. 1978.

Sanvicente-Vieira B, Kluwe-Schiavon B, Wearick-Silva LE, Piccoli GL, Scherer L, Tonelli HA. Revised Reading the Mind in the Eyes Test (RMET) - Brazilian version. Rev Bras Psiquiatr. 2014;36:60-7.

Wechsler D. Wechsler Abbreviated Scale of Intelligence. 1999.

Wechsler D, Trentini CM, Yates DB, Heck VS. Escala Wechsler Abreviada de Inteligência - WASI: Manual. 2014.

6169bc9ea953954d067e0b22 trends Articles
Links & Downloads
2238-0019 (Electronic)
Trends Psychiatry Psychother ©2024 All rights reserved.

Trends Psychiatry Psychother

Share this page
Page Sections