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Review
. 2020 Feb;22(1):13-27.
doi: 10.1111/bdi.12821. Epub 2019 Aug 29.

Current understandings of the trajectory and emerging correlates of cognitive impairment in bipolar disorder: An overview of evidence

Tamsyn E Van Rheenen  1   2 , Kathryn E Lewandowski  3   4 , Isabelle E Bauer  5 , Flavio Kapczinski  6   7 , Kamilla Miskowiak  8   9 , Katherine E Burdick  4   10   11 , Vicent Balanzá-Martínez  12
Affiliations
Review

Current understandings of the trajectory and emerging correlates of cognitive impairment in bipolar disorder: An overview of evidence

Tamsyn E Van Rheenen et al. Bipolar Disord. 2020 Feb.

Abstract

Objectives: Cognitive dysfunction affects a significant proportion of people with bipolar disorder (BD), but the cause, trajectory and correlates of such dysfunction remains unclear. Increased understanding of these factors is required to progress treatment development for this symptom dimension.

Methods: This paper provides a critical overview of the literature concerning the trajectories and emerging correlates of cognitive functioning in BD. It is a narrative review in which we provide a qualitative synthesis of current evidence concerning clinical, molecular, neural and lifestyle correlates of cognitive impairment in BD across the lifespan (in premorbid, prodromal, early onset, post-onset, elderly cohorts).

Results: There is emerging evidence of empirical links between cognitive impairment and an increased inflammatory state, brain structural abnormalities and reduced neuroprotection in BD. However, evidence regarding the progressive nature of cognitive impairment is mixed, since consensus between different cross-sectional data is lacking and does not align to the outcomes of the limited longitudinal studies available. Increased recognition of cognitive heterogeneity in BD may help to explain some inconsistencies in the extant literature.

Conclusions: Large, longitudinally focussed studies of cognition and its covariation alongside biological and lifestyle factors are required to better define cognitive trajectories in BD, and eventually pave the way for the application of a precision medicine approach for individual patients in clinical practice.

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References

REFERENCES

    1. Miskowiak KW, Burdick KE, Martinez-Aran A, et al. Methodological recommendations for cognition trials in bipolar disorder by the International Society for Bipolar Disorders Targeting Cognition Task Force. Bipolar Disord. 2017;19(8):614-626.
    1. Douglas KM, Van Rheenen TE. Current treatment options for cognitive impairment in bipolar disorder: a review. Curr Treat Options Psychiatry. 2016;3:330-355.
    1. Van Rheenen TE, Lewandowski KE, Tan EJ, et al. Characterizing cognitive heterogeneity on the schizophrenia-bipolar disorder spectrum. Psychol Med. 2017;47:1848-1864.
    1. Russo M, Van Rheenen TE, Shanahan M, et al. Neurocognitive subtypes in patients with bipolar disorder and their unaffected siblings. Psychol Med. 2017;47:2892-2905.
    1. Burdick KE, Russo M, Frangou S, et al. Empirical evidence for discrete neurocognitive subgroups in bipolar disorder: clinical implications. Psychol Med. 2014;44(14):3083-3096.

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