Robinson LJ, Ferrier IN. Evolution of cognitive impairment in bipolar disorder: a systematic review of cross-sectional evidence. Bipolar Disord 8: 103-116

School of Neurology, Neurobiology & Psychiatry (Psychiatry), University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
Bipolar Disorders (Impact Factor: 4.97). 05/2006; 8(2):103-16. DOI: 10.1111/j.1399-5618.2006.00277.x
Source: PubMed


The notion that sufferers of bipolar disorder achieve complete syndromal and functional recovery between illness episodes has been brought into question by evidence that a large proportion of patients fail to regain premorbid levels of functioning after the resolution of major affective symptoms. A growing body of evidence suggests that bipolar patients exhibit neuropsychological impairment that persists even during the euthymic state, which may be a contributory factor to poor psychosocial outcome. However, the aetiology of such impairment and its relation to progression of illness are not well understood. This review aims to consider evidence from studies investigating both the relationship between cognitive impairment and clinical outcome and studies of neurocognitive function in unaffected first-degree relatives (FDRs) of bipolar sufferers to address issues of the temporal evolution of cognitive impairment in bipolar disorder.
Systematic literature review.
The weight of evidence suggests that greater neuropsychological dysfunction in bipolar disorder is associated with a worse prior course of illness, particularly the number of manic episodes, hospitalizations and length of illness. The most consistent finding was a negative relationship between the number of manic episodes and verbal declarative memory performance. Impairment in unaffected FDRs was reported in verbal declarative memory and some facets of executive function.
Cognitive impairment may be a trait vulnerability factor for bipolar disorder that is present before illness onset and worsens as the illness progresses. Further investigation into the causal relationship between cognitive impairment and illness course is essential.

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Available from: Lucy Jayne Robinson, May 30, 2014
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    • "Persistent neurocognitive deficits (Balanzá-Martínez et al., 2005) likely result from the combination of genetic and environmental risk factors, as well as neurodevelopmental and neuroprogressive processes (Goodwin et al., 2008). Neurocognitive impairment may increase with illness progression (Robinson and Ferrier, 2006; Bourne et al., 2013) and history of psychotic symptoms (Selva et al., 2007; Martínez-Arán et al., 2008; Brissos et al., 2011), but it is also found in healthy first-degree relatives of patients with BD, although at a lesser degree (Arts et al., 2008; Balanzá-Martínez et al., 2008). Subsyndromal depressive symptoms , comorbidites and side effects of medications may compound and further worsen these deficits yet cannot fully explain them (Balanzá-Martínez et al., 2010). "
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    ABSTRACT: Bipolar disorder (BD) and alcohol use disorders (AUDs) are usually comorbid, and both have been associated with significant neurocognitive impairment. Patients with the BD-AUD comorbidity (dual diagnosis) may have more severe neurocognitive deficits than those with a single diagnosis, but there is paucity of research in this area. To explore this hypothesis more thoroughly, we carried out a systematic literature review through January 2015. Eight studies have examined the effect of AUDs on the neurocognitive functioning of BD patients. Most studies found that BD patients with current or past history of comorbid AUDs show more severe impairments, especially in verbal memory and executive cognition, than their non-dual counterparts. Greater neurocognitive dysfunction is another facet of this severe comorbid presentation. Implications for clinical practice and research are discussed. Specifically, the application of holistic approaches, such as clinical staging and systems biology, may open new avenues of discoveries related to the BD-AUD comorbidity.
    Frontiers in Physiology 03/2015; 6. DOI:10.3389/fphys.2015.00108 · 3.53 Impact Factor
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    • "Cognitive deficits have been documented in bipolar I disorder (BD), even during remitted euthymic phases, in the domains of verbal memory, processing speed, sustained attention, working memory and executive function (Dias et al., 2012; Torres et al., 2007) and reportedly influence clinical and functional outcomes in BD (Robinson and Ferrier, 2006). It has been difficult to discern if these cognitive deficits represent enduring subsyndromal symptoms, endophenotype markers, or at least partly result from chronicity of illness or treatment adverse effects (Dias et al., 2012; Torres et al., 2007). "
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    ABSTRACT: In bipolar disorder (BD), lithium and valproate are both reportedly associated with mild cognitive deficits with impaired psychomotor speed and verbal memory ascribed to both while impairments in learning and attention are mainly attributed to valproate. However, there are few direct comparisons of the impact of lithium and valproate on cognitive function in early BD. Using data from the STOP-EM study, we compared neurocognitive functioning in BD patients, who had recently recovered from a first episode of mania, and were on treatment with lithium (n=34) or valproate (n=38), to a comparable sample of healthy controls (HC; n=40), on the domains of processing speed, attention, verbal memory, nonverbal memory, working memory and executive functions. The three groups were comparable on socio-demographic (all p>0.12) and clinical variables (all p>0.08). MANOVA revealed a significant difference between the three groups on overall cognitive functioning (Wilk's lambda=0.644; F= 3.775; p<0.001). On post hoc Tukey test, the valproate group performed poorer on working memory compared to the lithium (p=0.001) and HC groups (p<0.001). There was no significant difference between the lithium and valproate groups on other cognitive domains (all p>0.13). Treatment with valproate and not lithium may be associated with working memory deficits early in the course of BD.
    European Neuropsychopharmacology 09/2014; 25(2). DOI:10.1016/j.euroneuro.2014.09.005 · 4.37 Impact Factor
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    • "There is also growing evidence that illness characteristics (e.g., psychosis and number of times admitted to hospital) are related to cognitive disturbances and impaired psychosocial functioning (Martinez-Aran et al., 2004, 2008; Robinson & Ferrier, 2006). Because cognitive deficits are more or less permanent and may be worsened by the course of the bipolar disorder (Robinson & Ferrier, 2006; Martinez-Aran et al., 2004), it is conceivable that the bipolar disorder has an increasing negative effect on self-care activities in daily life (i.e., ADL) as well as psychosocial functioning; this has been described earlier (Gildengers et al., 2007). It is also conceivable that the effects of impairment due to bipolar disorder might be increased by the effects of normal aging. "
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    ABSTRACT: This study explores which aspects of cognitive functioning may influence the self-care and independence of older patients with a bipolar disorder and whether there is a correlation between characteristics of the disease and self-care. Patients completed a comprehensive neuropsychological battery and filled in a questionnaire on activities of daily living and instrumental activities of daily living. Results indicate that (compared with age-matched norm scores) this group of euthymic patients performed worse on tests of attention, verbal memory, and executive functioning. Tests of attention and executive functioning were related to self-care. Attention and aspects of verbal memory were related to characteristics of the disease. The findings suggest that aspects of attention, memory, and executive functioning are associated with activities of daily living and instrumental activities of daily living.
    Clinical Gerontologist 08/2014; 37(5):419-428. DOI:10.1080/07317115.2014.907589 · 0.94 Impact Factor
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