Objective neuropsychological assessment seems especially warranted in patients with (residual) mood symptoms, BD type II, chronic illness, and/or high IQ for correct identification of cognitive deficits before commencement of treatments targeting cognition.

Objectives Cognitive impairment affects many patients with bipolar disorder (BD), and treatments with replicated pro‐cognitive effects are lacking. This study aimed to assess the effect of Action‐Based Cognitive Remediation (ABCR) vs control treatment on cognitive impairment in patients with BD. Methods Patients with remitted BD with objective cognitive impairment were randomized to 10 weeks of ABCR vs control treatment, and assessed at baseline, after 2 weeks of treatment, at treatment completion and at 6 months follow‐up. The primary outcome was a cognitive composite score. Secondary outcomes were executive function and observer‐rated functional capacity. Tertiary measures included additional neuropsychological tests, performance‐based functional capacity and quality of life. Data were analysed with linear mixed effects models. Results In total, 64 participants were randomized; given three dropouts before the baseline assessments, data were analysed for 61 participants (ABCR: n = 32, control: n = 29). There was no effect on ABCR vs control on the primary cognitive composite score (P‐values ≥.60). At treatment completion, there was a large effect of ABCR vs control on the secondary executive function measure (treatment effect= −0.16, 95% CI [−0.27, −0.05], P ≤ .01, d = 0.65), and on subjective cognitive functioning (treatment effect = −5.38, 95% CI [−8.13, −2.67], P ≤ .001, d = 0.80), which disappeared at follow‐up. There was no treatment‐effect on functioning, and no association between cognitive and functional change. Conclusions There was no effect of ABCR on the cognitive composite score. However, there was an effect on executive function and subjective cognitive functioning suggesting that ABCR may be relevant for patients with executive dysfunction. Trial Registration ClinicalTrials.gov identifier: NCT03295305.

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Objectives: Cognitive impairment occurs in approximately 50% of remitted patients with bipolar disorder (BD). However, there exists no treatment with replicated and robust efficacy on cognition in BD. This is partially due to limited insight into the neuronal underpinnings of cognitive impairment in these patients. This is the first study to investigate neuronal underpinnings of cognitive impairment in a large functional magnetic resonance imaging (fMRI) dataset comparing neural activity patterns between distinct neurocognitive subgroups of partially or fully remitted patients with BD. Methods: Patients (n = 153) and healthy controls (HC) (n = 52) underwent neuropsychological assessment and fMRI, during which they performed a verbal N-back working memory (WM) task. Based on hierarchical cluster analysis of neuropsychological test performance, patients were grouped into one of two neurocognitive subgroups (cognitively impaired, n = 91; cognitively normal compared to HC, n = 62) that were compared on WM-related neural activity. Results: Cognitively impaired patients displayed WM-related hypo-activity in left dorsolateral prefrontal cortex and frontal and parietal regions within a cognitive control network (CCN) as well as hyper-activity in the default mode network (DMN) compared to cognitively normal patients. In contrast, cognitively normal patients only exhibited hypo-activity within a small cluster in the superior frontal gyrus relative to HC.

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