Effects of recurrence on the cognitive performance of patients with bipolar I disorder: implications for relapse prevention and treatment adherence

Abstract

The number of manic episodes predicted poor cognitive performance, suggesting that the recurrence of mania may have a long-term neuropsychological impact. Prospective follow-up studies need to be completed to explore this effect further as better treatment adherence may have a protective effect on neurocognitive function.

Pharmacological treatment and staging in bipolar disorder: evidence from clinical practice

“…Available data show that a higher number of mood episodes is associated with poorer neurocognitive performance, suggesting that the recurrence of mood episodes is associated with cognitive impairments, e.g., in executive function and episodic memory. 28 Tailored treatment approaches could also be used to meet patients' neuropsychological needs, preventing relapses and improving adherence.…”

The bipolar maze: a roadmap through translational psychopathology

“…Cognitive impairment may be considered a measure of allostatic load (36) and may correlate with some neuroinflammatory and oxidative stress markers (37,38). Neurocognitive impairment may reflect a poor course and outcome of the disease, especially concerning the number of manic episodes (39,40), a history of psychosis (41), subthreshold symptoms (42), and comorbidity (43). Although all studies control for the effects of medication, there are very few studies with medication-free patients (44), and the influence of drugs on cognitive performance may be bimodal, with both positive and negative effects (45,46).…”

Challenges and developments in research of the early stages of bipolar disorder

“…Moreover, cognitive improvement (processing speed and executive function) was observed in patients after 1 year of follow-up, particularly in those without a history of substance abuse and who had discontinued antipsychotic treatment. 55 Comparing results from studies of first-episode mania to those of BD cases with multiple episodes, Lopez-Jaramillo et al 60 observed worse cognitive performance (attention, processing speed, and executive function) in euthymic patients who had experienced at least three manic episodes as compared with patients who had only one prior BD episode. Other researchers have also demonstrated that patients who have had multiple episodes are more likely to present with deficits in executive function and verbal memory than those at early stages of BD.…”

“…84 These findings are consistent with previous studies indicating an association between cognitive deficit and BD severity. 62,85 The number of manic episodes is strongly associated with cognitive impairment, 60 87 have also been shown to correlate significantly with cognitive impairment.…”

“…57,59 The mean age of the BD sample is another limitation in some studies. In our review of the literature, it is notable that most first-episode BD studies were conducted in adults 60,61 and very few included children or adolescents. 62,63 The nature of the control groups used in these first-episode studies is also a topic of some debate.…”