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Longitudinal relationships between cognition and functioning over 2 years in euthymic patients with bipolar disorder: a cross-lagged panel model approach with the FACE-BD cohort

  • Mickael Ehrminger (a1), Eric Brunet-Gouet (a2), Anne-Sophie Cannavo (a3), Bruno Aouizerate (a4), Irena Cussac (a5), Jean-Michel Azorin (a6), Frank Bellivier (a7), Thierry Bougerol (a8), Philippe Courtet (a9), Caroline Dubertret (a10), Bruno Etain (a11), Jean-Pierre Kahn (a12), Marion Leboyer (a13), Emilie Olié (a14), the FondaMental Advanced Centers of Expertise in Bipolar Disorders (FACE-BD) Collaborators (a15), Christine Passerieux (a2) and Paul Roux (a2)...



Longitudinal studies of the relationship between cognition and functioning in bipolar disorder are scarce, although cognition is thought to be a key determinant of functioning. The causal structure between cognition and psychosocial functioning in bipolar disorder is unknown.


We sought to examine the direction of causality between cognitive performance and functional outcome over 2 years in a large cohort of euthymic patients with bipolar disorder.


The sample consisted of 272 adults diagnosed with bipolar disorder who were euthymic at baseline, 12 and 24 months. All participants were recruited via the FondaMental Advanced Centers of Expertise in Bipolar Disorders. We used a battery of tests, assessing six domains of cognition at baseline and 24 months. Residual depressive symptoms and psychosocial functioning were measured at baseline and 12 and 24 months. The possible causal structure between cognition and psychosocial functioning was investigated with cross-lagged panel models with residual depressive symptoms as a covariate.


The analyses support a causal model in which cognition moderately predicts and is causally primary to functional outcome 1 year later, whereas psychosocial functioning does not predict later cognitive performance. Subthreshold depressive symptoms concurrently affected functioning at each time of measure.


Our results are compatible with an upward causal effect of cognition on functional outcome in euthymic patients with bipolar disorder. Neuropsychological assessment may help specify individual prognoses. Further studies are warranted to confirm this causal link and evaluate cognitive remediation, before or simultaneously with functional remediation, as an intervention to improve functional outcome.

Declaration of interest



Corresponding author

Correspondence: Mickael Ehrminger, Laboratoire HandiRESP, EA4047, UFR des Sciences de la Santé Simone Veil, Université de Versailles Saint-Quentin-En-Yvelines, 50 Rue Berthier, 78000 Versailles, France. Email:


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The FACE-BD Collaborators are listed in the Acknowledgements.



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Longitudinal relationships between cognition and functioning over 2 years in euthymic patients with bipolar disorder: a cross-lagged panel model approach with the FACE-BD cohort

  • Mickael Ehrminger (a1), Eric Brunet-Gouet (a2), Anne-Sophie Cannavo (a3), Bruno Aouizerate (a4), Irena Cussac (a5), Jean-Michel Azorin (a6), Frank Bellivier (a7), Thierry Bougerol (a8), Philippe Courtet (a9), Caroline Dubertret (a10), Bruno Etain (a11), Jean-Pierre Kahn (a12), Marion Leboyer (a13), Emilie Olié (a14), the FondaMental Advanced Centers of Expertise in Bipolar Disorders (FACE-BD) Collaborators (a15), Christine Passerieux (a2) and Paul Roux (a2)...
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