Assessing and addressing cognitive impairment in bipolar disorder: the International Society for Bipolar Disorders Targeting Cognition Task Force recommendations for clinicians

Abstract

This task force paper provides the first consensus-based recommendations for clinicians on whether, when, and how to assess and address cognition, which may aid patients' functional recovery and improve their quality of life.

Cognitive Deficits in Psychotic Disorders: A Lifespan Perspective

“…In first-episode patients, meta-analysis demonstrates smaller, non-significant effect sizes for general cognition, possibly due to a small number of trials with fewer participants than is seen with chronic subjects (Revell et al 2015). Cognitive remediation is getting more attention for use in bipolar disorder (Miskowiak et al 2018), but current results on efficacy are mixed (Demant et al 2015; Bonnin et al 2016). In general, cognitive remediation represents an important avenue of continued research, and more data is needed in ultra-high risk subjects to assess efficacy of remediation on buffering the effects of first-episode psychosis.…”

Thinking about cognitive impairment in bipolar disorder: A clinical perspective

“…Excluding the obvious cognitive impairment seen in acute mood states — both mania and depression — cognitive impairment in bipolar disorder is common but not universal. Best estimates are that 1/3 to 1/2 of patients are minimally to non‐impaired, 1/3 show selective deficits (ie, not in all cognitive domains) with the remainder (somewhat less than 1/3) showing broad‐based cognitive deficits across most if not all domains . Domains that seem most affected are attention, verbal learning and memory, and executive function.…”

“…Best estimates are that 1/3 to 1/2 of patients are minimally to non-impaired, 1/3 show selective deficits (ie, not in all cognitive domains) with the remainder (somewhat less than 1/3) showing broad-based cognitive deficits across most if not all domains. 1 Domains that seem most affected are attention, verbal learning and memory, and executive function. Beyond purely cognitive domains, social cognition (eg, interpretation of social information, such as mentalizing) may also be impaired in some bipolar individuals although less severely in bipolar disorder compared to non-social cognition (opposite to what is seen in schizophrenia).…”

“…Interest in the cognitive impairment seen in euthymic bipolar individuals has exploded over the last few years as evidenced by the number of papers on this topic published in Bipolar Disorders, and by the two recent International Society for Bipolar Disorders (ISBD) task force papers on clinical evaluation and treatment and clinical trial design of cognitive impairment . This increased interest and attention is both welcome, and, frankly, delayed.…”

“…Interest in the cognitive impairment seen in euthymic bipolar individuals has exploded over the last few years as evidenced by the number of papers on this topic published in Bipolar Disorders, and by the two recent International Society for Bipolar Disorders (ISBD) task force papers on clinical evaluation and treatment and clinical trial design of cognitive impairment. 1,2 This increased interest and attention is both welcome, and, frankly, delayed. Our colleagues studying schizophrenia have been focusing on this area of research for many years, assuredly due to the greater overall impairment in schizophrenia and the consistent evidence that cognitive impairment explains a substantial proportion of the functional impairment of schizophrenic individuals.…”