Subclinical manic symptoms predict social cognitive impairment mediated by deficits in executive functioning in older adults with mood disorders

Introduction Bipolar disorder can impair executive functioning and social cognition which refers to the cognitive processes involved in understanding social cues (this includes theory of mind). However, little is known about the degree to which subclinical manic symptoms can impact social cognition in older adults and the role of executive functioning in this interaction. This cross-sectional study examined if transdiagnostic subclinical manic symptoms in older adults with mood disorders were related to impaired social cognition and if this relationship was mediated by executive functioning. Methods Ninety-five mood disorder patients (43 patients with bipolar disorder, 50 with major depressive disorder, 2 with schizoaffective disorder) ages 55 and above completed a battery of neuropsychological tests, mood and anxiety rating scales, clinical rating scales, functional and medical assessments. Total scores from the Mind in the Eyes task were used to assess social cognition. Executive functioning was assessed using the total correct scores from the Wisconsin Card Sorting Task (WCST). The Young Mania Rating Scale (YMRS), the Generalized Anxiety Disorder 7-item (GAD-7) scale and the Montgomery-Asberg Depression Rating Scale (MADRS) were used to assess mood and anxiety symptoms. Results All participants had subclinical manic symptoms based on the YMRS scores independent of their diagnosis. We used linear regressions to test mediation following the Baron and Kenny (1986) method. We found that greater subclinical manic symptoms (YMRS) were related to reduced executive functioning (path a, p=.043), and lower social cognitive functioning (Mind in the Eyes task), when controlling for depression and anxiety symptoms (path c, p = .002). The association between manic symptoms and social cognition was fully mediated by performance on an executive functioning task (the Wisconsin Card Sorting Task total correct scores, path b, p=.010, path c’ p= .375). Mood diagnosis, depression and anxiety symptoms were not significantly related to performance on social cognitive or executive functioning tasks. Conclusions Executive functioning could explain social cognitive impairment related to subclinical manic symptoms. Our findings shed some light into the neuropsychological features of subclinical manic symptoms in older adults. Funding The Rogers Family Foundation