Cognitive Impairment in Bipolar: Neurodevelopmental or Neuroprogressive?

Abstract

Background

Bipolar Disorders (BD) are common and complex diseases. Recent findings have provided evidence that impairments in cognition are evident in the various sub-groups of Bipolar Disorder and persist after resolution of acute episodes.

Method

An opinion paper based on a narrative review of the field.

Results

Quantifiable cognitive deficits are clearly found in Bipolar 1 and Bipolar 2 Disorders. These persist after recovery from acute episodes. The aetiopathogenesis of these phenomena is likely to be multifactorial. It seems clear that these cognitive impairments are not in general neurodevelopmental and for most are related to repeated episodes of illness [1]. However, the issues of subgroups with differential profiles of impairment and the trajectory of cognitive change remain to be fully established. The effects of putative treatments (e.g., pharmacological, neurostimulation, cognitive remediation) are at an early stage of evaluation.

Conclusions

Future efforts should focus on further integrating the current and emerging research findings into a coherent model, which generates testable hypotheses and allows treatment effects to be tested.

Disclosure of interest

Employed by King's College London Honorary Consultant SLaM (NHS UK)

Paid lectures and advisory boards for all major pharmaceutical companies with drugs used in affective and related disorders

No share holdings in pharmaceutical companies

Lead Investigator for Embolden Study (AZ), BCI Neuroplasticity study and Aripiprazole Mania Study

Investigator initiated studies from AZ, Eli Lilly, Lundbeck, Wyeth

Grant funding (past and present): NIMH (USA) CIHR (Canada) NARSAD (USA) Stanley Medical Research Institute (USA) MRC (UK) Wellcome Trust (UK) Royal College of Physicians (Edin) BMA (UK) UBC-VGH Foundation (Canada) WEDC (Canada) CCS Depression Research Fund (Canada) MSFHR (Canada) NIHR (UK).