Pharmacological approaches in bipolar disorders and the impact on cognition: a critical overview (original) (raw)

Bipolar Disorder and Cognitive Dysfunction A Complex Link..pdf

J Nerv Ment Dis , 2017

The aim of this article was to describe the current evidence regarding phenomenon of cognitive functioning and dementia in bipolar disorder (BD). Cochrane Library and PubMed searches were conducted for relevant articles, chapters, and books published before 2016. Search terms used included “bipolar disorder,” “cognitive dysfunction,” and “dementia.” At the end of the selection process, 159 studies were included in our qualitative synthesis. As result, cognitive impairments in BD have been previously considered as infrequent and limited to the affective episodes. Nowadays, there is evidence of stable and lasting cognitive dysfunctions in all phases of BD, including remission phase, particularly in the following domains: attention, memory, and executive functions. The cause of cognitive impairment in BD raises the question if it subtends a neurodevelopmental or a neurodegenerative process. Impaired cognitive functioning associated with BD may contribute significantly to functional disability, in addition to the distorted affective component usually emphasized.

Clinical implications of cognitive function in bipolar disorder

In recent years there has been increased interest in cognitive function in bipolar disorder (BD) as a means of understanding and exploring biological mechanisms relating to predisposition, disease expression and outcome. Despite significant methodological differences between studies we can begin to discern meaningful patterns from existing data. The evidence reviewed suggests that: (a) premorbid cognitive dysfunction is not a dominant feature of BD; in contrast to other severe psychiatric conditions, enhanced cognitive function may be a risk marker for BD; (b) in BD patients with established syndromal disease, trait-related cognitive impairment is reliably seen in the speed of information processing, verbal Learning and memory and response inhibition; (c) cognitive function appears to remain stable post-disease onset in the majority of patients although the risk of dementia in old age is increased; (d) cognitive impairment is a key predictor of functional outcome in BD. These findings underscore the importance of cognition in BD as a marker of neural integrity across all phases of the illness and as a therapeutic target in disability reduction.