Effect of Action‐Based Cognitive Remediation on cognitive impairment in patients with remitted bipolar disorder: A randomized controlled trial

Abstract

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.

A randomised controlled trial of psychotherapy and cognitive remediation to target cognition in mood disorders

“…There are several possible reasons for limited pro‐cognitive effects of the IPSRT‐CR intervention. Dose of CR : individuals randomised to IPSRT‐CR received a lower dose of CR than in previous positive studies (mean total of 7 h of face‐to‐face and homework practice in the current study vs a minimum of 20 h in Strawbridge et al 13 and an average of 21 h in Ott et al 14 ). The dose of CR was larger (8 h total) in our analysis of treatment completers.…”

“…A small number of individual cognitive test variables either improved significantly in the IPSRT‐CR vs IPSRT group at treatment‐end (RAVLT distractor list recall) or follow‐up (GMLT total learning), or showed an advantage for IPSRT‐CR over IPSRT with a moderate effect size but not statistically significant difference at treatment‐end (Category Fluency, Digit Span Backwards) or follow‐up (Digit Span Forwards). While we are cautious in interpreting these individual findings due to the possibility of Type I error, it is of note that all of the above cognitive measures assess aspects of working memory or executive function, which are domains that have shown sensitivity to CR interventions in BD 13,14 and MDD 15,46 . We have not applied a correction for multiple comparisons since the examination of individual cognitive variables was exploratory.…”

“…Two recent randomised controlled trials (RCTs) in euthymic BD reported improved aspects of cognitive function, particularly executive function, following CR interventions (10–12 weeks in duration). Strawbridge et al 13 reported additional improvement in psychosocial functioning at treatment‐end and 3‐month follow‐up, while Ott et al 14 showed improvement in subjective cognitive function at treatment‐end only. In MDD, recent meta‐analysis reported short‐term, moderate pro‐cognitive effects, and small effects on daily functioning and mood symptoms, but none of these effects were durable 15 .…”

Does cognitive improvement translate into functional changes? Exploring the transfer mechanisms of cognitive remediation therapy for euthymic people with bipolar disorder

“…CIRCuiTS prompts the development and use of strategies to compensate for potential cognitive shortcomings, while a substantial part of therapy time is devoted to how participants can transfer newly acquired Psychological Medicine strategies and cognitive skills to daily-life activities and personal goals (Reeder et al, 2016). Conversely, a recently published randomized trial, assessing the effects of action-based CR on cognition and functioning in remitted patients with BD, did not detect a transfer of post-treatment cognitive changes to improved functioning at follow-up (Ott et al, 2020). This was despite employing strategy use to guide task practicing and bridging techniques to translate cognitive skills into everyday activities.…”

Assessment of the neuronal underpinnings of cognitive impairment in bipolar disorder with a picture encoding paradigm and methodological lessons learnt

“…Baseline neurocognitive and fMRI data were pooled from two studies from our group, The Bipolar Illness Onset (BIO) study (Kessing et al, 2017) and the Prefrontal Target Engagement, as a biomarker model for cognitive improvement -erythropoietin (PRETEC-EPO) and action-based cognitive remediation (PRETEC-ABC), respectively (Ott et al, 2018(Ott et al, , 2020bPetersen et al, 2018) conducted at the Copenhagen Affective disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Rigshospitalet, Denmark. The total sample was N=205 participants (n=153 patients with BD; n=52 healthy controls (HC)).…”