Neurocognitive candidate markers across bipolar disorder risk stages in adolescents

We aimed to determine whether reward sensitivity, risk-taking, impulsivity, and emotional conflict resolution are candidate neurocognitive vulnerability markers for bipolar disorder (BD) among adolescents. A total of 111 adolescents (25 euthymic BD-I, 32 high-risk [HR], 24 ultra-high risk [UHR], and 30 healthy controls [HC]) underwent neurocognitive assessment of risk-taking (Modified Balloon Analog Risk Task [M-BART] and Iowa Gambling Task [IGT]), impulsivity (Go/No-Go Task and Barratt Impulsivity Scale-11 [BIS-11]), reward sensitivity (Behavioral Inhibition/Activation [BIS/BAS] Scale and IGT), and emotional conflict resolution (Emotional Stroop Task [EST]). Group comparisons used the Kruskal–Wallis test with a Benjamini–Hochberg false discovery rate (FDR) correction, followed by multinomial logistic regression adjusted for age and sex and receiver operating characteristic (ROC) analysis. EST conflict accuracy was the most consistent discriminator across group comparisons, separating HR, UHR, and BD from HC and further distinguishing BD from both HR and UHR. Lower IGT net scores also differentiated all three clinical groups from HC, whereas a higher M-BART average number of pumps differentiated UHR and BD from HC in the adjusted models. Group differences in EST, IGT, BIS-11, and Go/No-Go task measures survived both FDR and Bonferroni correction, whereas M-BART differences survived FDR correction only. These findings provide preliminary evidence that neurocognitive functioning varied along the continuum from familial risk to full-threshold BD. Non-planning impulsivity, reward sensitivity, and emotional conflict resolution deficits distinguished all three clinical groups from HC, whereas motor and attentional impulsivity, fun-seeking, and response inhibition deficits were more specific to UHR and BD. Increased risk-taking was observed in the UHR group and correlated with concurrent subclinical manic symptoms. EST conflict accuracy discriminated the combined UHR and BD groups from the combined HC and HR groups (AUC = 0.923), although this cut-off was exploratory. Given the modest sample size and cross-sectional design, the neurocognitive alterations identified here should be regarded as candidate vulnerability markers requiring longitudinal validation. Not applicable.