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Validity and reliability of a rating scale on subjective cognitive deficits in bipolar disorder (COBRA)
Authors:Adriane R Rosa  Clara Mercadé  Jose Sánchez-Moreno  Brisa Solé  Caterina Del Mar Bonnin  Carla Torrent  Iria Grande  Gisela Sugranyes  Dina Popovic  Manel Salamero  Flávio Kapczinski  Eduard Vieta  Anabel Martinez-Aran
Institution:1. Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM. Villarroel 170, Barcelona, 08036 Catalonia, Spain;2. Bipolar Disorders Program & INCT for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2350, Porto Alegre, Rio Grande do Sul 90035903, Brazil;3. Department of Child and Adolescent Psychiatry and Psychology, Institut Clínic of Neurosciences, Hospital Clínic Universitari, Barcelona Villarroel, 170, Barcelona 08036, Spain;4. Clinical Psychology. Department, Institute of Neurosciences, Hospital Clinic, IDIBAPS, University of Barcelona. Villarroel 170, Barcelona 08036, Spain;5. Centro Universitário Unilasalle Rua Victor Barreto 2288, Canoas, RS, Brasil
Abstract:

Background

Discrepancies between bipolar patients' reports and neuropsychological testing have been described and replicated. Unfortunately, no valid, specific, user-friendly, brief instrument is available to measure cognitive deficits as reported by these patients. The main aim of this study was to validate a novel instrument named the “cognitive complaints in bipolar disorder rating assessment” (COBRA). Second, we investigated the relationship between the COBRA, objective cognitive measures and illness course variables.

Method

The total sample (N=215) included 91 bipolar disorder patients and 124 healthy controls. The psychometric properties of the COBRA (e.g. internal consistency, concurrent validity, discriminative validity, factorial analyses, ROC curve and feasibility) were analyzed. A complete neuropsychological battery was used as objective cognitive assessment.

Results

The COBRA had one-factor structure with very high internal consistency (Cronbach's alpha=0.913). A high convergent validity was indicated by a strong correlation with the Frankfurt Complaint Questionnaire (ro=0.888, p<0.001). Bipolar patients experienced greater cognitive complaints compared to control group suggesting a discriminative validity of the instrument. Significant correlations were found between the COBRA and some objective cognitive measures. Furthermore, higher COBRA scores were associated with bipolar II subtype, residual depressive symptoms, hypomanic episodes and total episodes.

Limitations

The cross-sectional design of the study, the influence of medication and severity of patients included.

Conclusions

The COBRA showed to be a useful instrument to assess overall cognitive complaints in bipolar disorder with very satisfactory psychometric properties. Cognitive complaints were partially correlated with memory and executive function measures and with issues that may increase the subjective perception of cognitive deficits, such as subthreshold depressive symptoms and number of episodes.
Keywords:Cognitive complaints  Cognitive impairment  Bipolar disorder
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