Neurocognitive impairment and evidence-based treatment options in Bipolar disorder

Abstract

Background: The current paper briefly summarizes the literature on the neurocognitive deficit and its treatment in BD patients.

Methods: The material was chosen on the basis of previous systematic reviews the author has taken part in.

Results: The data so far suggest that the deficit is qualitatively similar but quantitatively milder in comparison to schizophrenia, it is present already since the first episode, is weakly related to mood symptoms and somewhat stronger to psychotic symptoms, it probably determines much of the disability and treatment is problematic. This deficit is also present during periods of euthymia. The possible adverse effect of psychotropic medication is rather small if any at all and is confounded by the specific clinical symptoms, for which medication is used for their treatment. This is especially true concerning antipsychotics and psychotic symptoms. The origin and the etiopathogenesis of the core neurocognitive impairment remain elusive. The presence of a neurodegenerative and of a neurodevelopmental component has both data in favor and against and they are both the focus of debate.

Conclusions: Treatment of the neurocognitive deficit and restoration of functioning is problematic. The data are limited and treatment options are few and with a weak overall effect. Pharmacological treatments, ECT and rTMS present some hard data, while the literature is inconclusive concerning psychotherapeutic interventions.

Keywords: Bipolar disorder; Cognitive disorder; Cognitive remediation; Functional remediation, treatment; Neurocognitive disorder.

Fig. 1

Long-term evolution of the neurocognitive deficit in BD patients, in comparison to patients with schizophrenia and normal subjects. Overall, in contrast to schizophrenia patients, BD patients exhibit a relatively intact cognitive functioning throughout childhood and adolescence, and the neurocognitive deterioration is observed only after the overt symptom onset (Reproduced after permission from Lewandowski et al. [105])