Objective:

To examine the associations of TNF-α, MIF, and cortisol with cognitive function in patients with bipolar disorder during manic episodes and to characterize their short-term changes.

Approach:

• Study Design: Short-term follow-up study involving 53 patients with bipolar disorder during manic episodes and 53 healthy controls.
• Measurements: Plasma levels of TNF-α, MIF, and cortisol were measured; cognitive function was assessed using the Chinese Brief Cognitive Test.
• Analysis: Group comparisons and biomarker-cognition correlation analyses were performed, controlling for multiple testing.

Key Findings:

• Patients with bipolar disorder had significantly lower cognitive scores across multiple domains, including information processing speed, executive function, sustained attention, and working memory, and higher levels of TNF-α, MIF, and cortisol compared to healthy controls.
• Cognitive scores improved significantly after 8 weeks of treatment, but reductions in TNF-α, MIF, and cortisol did not reach statistical significance.
• Only the negative association between TNF-α and working memory remained significant after adjustment for covariates and multiple comparisons.

Interpretation:

Cognitive impairment in bipolar disorder during manic episodes is associated with elevated inflammatory and neuroendocrine markers, particularly the association of TNF-α with working memory.

Limitations:

• The study's sample size may limit the generalizability of the findings.
• Associations involving MIF or cortisol and executive function are exploratory and require validation in larger studies.

Conclusion:

The findings indicate a link between cognitive impairment and inflammatory/neuroendocrine markers in bipolar disorder, with TNF-α being notably associated with working memory.