Cognitive impairment in bipolar disorder

Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, Czech Republic.
Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia (Impact Factor: 1.2). 03/2011; 155(1):19-26. DOI: 10.5507/bp.155.2011.003
Source: PubMed


Provide an overview of how bipolar disorder affects cognitive function in patients.
MEDLINE and PsycInfo data bases were searched for articles indexed by the combinations of MESH term or key word "bipolar disorder" with the following terms: "cognition", "memory", "neuropsychology", "neuropsychological tests", "lithium", "anticonvulsants", "antipsychotics", and "schizophrenia". Constraints limiting time period of publications or their language were not applied. Reference lists of publications identified by these procedures were hand-searched for additional relevant citations.
There is evidence of stable and lasting cognitive impairment in all phases of bipolar disorder, including the remission phase, particularly in the following domains: sustained attention, memory and executive functions. But research on the cognitive functions has yielded inconsistent results over recent years. There is a growing need for clarification regarding the magnitude, clinical relevance and confounding variables of cognitive impairment in bipolar patients. The impact of bipolar illness on cognition can be influenced by age of onset, pharmacological treatments, individual response, familial risk factors, and clinical features. In addition to the mood state, cognitive performance in bipolar patients is influenced by seasonality.
Previous optimistic assumptions about the prognosis of bipolar disorder were based on the success of the control of mood symptoms by pharmacotherapy. However, it is now clear that the "remitted" euthymic bipolar patients have distinct impairments of executive function, verbal memory, psychomotor speed, and sustained attention. Mood stabilizers and atypical antipsychotics may reduce cognitive deficits in certain domains and may have a positive effect on quality of life and social functioning.

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    • "Cognitive deficits extensively affect patients with bipolar disorder (BD) independently of disease state and despite clinical improvement (Latalova et al., 2011). Behavioural pharmacology has provided the mainstay of evidence for a role of glutamate in cognition (Robbins and Murphy, 2006). "

    Psychiatry Research 01/2015; 226(1). DOI:10.1016/j.psychres.2014.12.071 · 2.47 Impact Factor
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    • "Chronic lithium intake is associated with a reduced risk of Alzheimer's disease in subjects with bipolar disorder [81]. On the other hand, lithium has been reported to be associated with impairments in learning, memory, and psychomotor performance [82], but this association may be mediated by other factors, such as other medications or symptoms of the affective phase [26]. The authors of another review [83] have concluded that lithium carbonate has only mild negative effects on immediate verbal learning and memory and creativity and a moderate adverse effect on psychomotor performance in euthymic patients with affective disorders. "
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    ABSTRACT: The objective of the present study was to assess the performance of lithium treated euthymic bipolar patients in tests measuring spatial working memory (SWM), planning, and verbal fluency and to delineate the influence of gender on cognitive functioning. Fifty-nine euthymic bipolar patients, treated with lithium carbonate for at least 5 yr, were studied. Patients and controls underwent a neuropsychological assessment. Bipolar patients had significantly worse results than the healthy controls in the spatial memory and planning as well as verbal fluency tests. We detected a gender-related imbalance in the SWM results. Deficits in SWM were observed in male-only comparisons but not in female-only comparisons. The SWM scores were significantly poorer in male patients than in male controls. In female-only comparisons, female patients did not have significantly poorer SWM results in any category than their controls. Bipolar women scored worse in some other tests. The present study points to the different patterns of neuropsychological disturbances in female and male patients and suggests that sex-dependent differences should be taken into account in order to tailor the therapeutic intervention aimed at the improvement of cognitive functions.
    The Scientific World Journal 01/2014; 2014(1):418432. DOI:10.1155/2014/418432 · 1.73 Impact Factor
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    • "Among the factors that potentially influence psychosocial functioning levels and/or subjective QoL, neuropsychological deficits may play a relevant role. Indeed they seem to affect the illness course, treatment outcome and functioning of subjects with different psychiatric disorders [6] [7] [8] [9]. In both non-euthymic and euthymic patients with Bipolar Disorder (BD) several studies found significant associations between impairment on a range of cognitive domains, including executive functions, verbal memory, attention and information processing speed, and diminished psychosocial functioning, as measured by the GAF scale [10] [11] [12] [13]. "
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    ABSTRACT: This study aimed to investigate 1) the relationship between subjective perception of quality of life (QoL) and clinician-rated levels of psychosocial functioning and 2) the relationship of these indicators with neuropsychological performances, in a sample of 117 subjects with mood and anxiety disorders hospitalized for a 4-week psychiatric rehabilitation program. At the beginning of the hospitalization, QoL and clinician-rated functioning were respectively measured by the World Health Organization Quality of Life Assessment-Brief Form (WHOQOL-BREF) and the Global Assessment of Functioning (GAF) scale, and subjects were administered a neuropsychological battery evaluating verbal and visual memory, working memory, attention, visual-constructive ability, language fluency and comprehension. We did not find any association between WHOQOL-BREF and GAF scores and between cognitive impairment and lower QoL or clinician-rated functioning. Our results suggest that 1) the individuals' condition encompasses different dimensions that are not fully captured by using only clinician-rated or self-administered evaluations; 2) the GAF scale seems unable to indicate the cognitive impairments of our subjects and the WHOQOL-BREF does not appear to be influenced by these deficits. Overall, our findings suggest the need of simultaneously use of multiple assessment tools, including objective evaluations of functioning and different measures of QoL, in order to obtain a more complete clinical picture of the patients. This may allow to identify more specific targets of therapeutic interventions and more reliable measures of outcome.
    Comprehensive psychiatry 12/2013; 55(4). DOI:10.1016/j.comppsych.2013.12.007 · 2.25 Impact Factor
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