Risk of dementia in bipolar disorder and the interplay of lithium: a systematic review and meta‐analyses

Velosa, J.; Delgado, André; Finger, E; Berk, Michael; Kapczinski, Flávio; Cardoso, Taiane de Azevedo

doi:10.1111/acps.13153

Cited by 87 publications

(65 citation statements)

References 67 publications

(117 reference statements)

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“…In addition, a recent study showed that functional impairment is progressive in a subset of patients, characterized primarily by a higher number of relapses, greater neurocognitive impairment, and greater overall severity of depressive symptoms [3], which corroborates previous studies showing that patients who had multiple episodes present with cognitive and functional impairment [4,5]. A recent meta-analysis also showed that the risk of progression to dementia is higher in patients with BD [6]. In addition, the number of mood episodes predicts the development of dementia in BD [6].…”

Section: Introductionsupporting

confidence: 78%

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Biological Pathways Associated with Neuroprogression in Bipolar Disorder

2021

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There is evidence suggesting clinical progression in a subset of patients with bipolar disorder (BD). This progression is associated with worse clinical outcomes and biological changes. Molecular pathways and biological markers of clinical progression have been identified and may explain the progressive changes associated with this disorder. The biological basis for clinical progression in BD is called neuroprogression. We propose that the following intertwined pathways provide the biological basis of neuroprogression: inflammation, oxidative stress, impaired calcium signaling, endoplasmic reticulum and mitochondrial dysfunction, and impaired neuroplasticity and cellular resilience. The nonlinear interaction of these pathways may worsen clinical outcomes, cognition, and functioning. Understanding neuroprogression in BD is crucial for identifying novel therapeutic targets, preventing illness progression, and ultimately promoting better outcomes.

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Section: Introductionsupporting

confidence: 78%

“…A recent meta-analysis also showed that the risk of progression to dementia is higher in patients with BD [6]. In addition, the number of mood episodes predicts the development of dementia in BD [6].…”

Section: Introductionmentioning

confidence: 97%

Biological Pathways Associated with Neuroprogression in Bipolar Disorder

2021

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“…Remarkable neuroprotective and antiviral properties have also been attributed to lithium (Post, 2017;Rybakowski, 2018;Murru et al, 2020;Van Gestel et al, 2019). It slows brain aging (Van Gestel et al, 2019) and reduces the risk of dementia by almost 50% in patients with BD (Velosa et al, 2020). In addition, it could attenuate cognitive and functional decline in patients (without BD) with mild cognitive impairment (Forlenza et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Overview of Lithium´s Use: A Nationwide Survey

Mendiola

Hidalgo‐Mazzei

Vieta

et al. 2020

Preprint

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Background: Lithium is considered the gold standard treatment for bipolar disorder (BD). Its use as a first-line treatment in BD is supported by current clinical guidelines and scientific evidence. However, over the last two decades it has been observed a downward tendency in lithium´s use in several developed countries. Based on a nationwide survey, the objective of this study is to analyze in a large sample of psychiatrists relevant issues of the use of lithium salts in BD.Methods: Data were collected through an anonymous survey sent by email among 500 psychiatrists who belong to a National Society of Psychiatry (Spanish Society of Biological Psychiatry). The survey is a self-administered questionnaire consisting of 21 items on the most key aspects of the use of lithium (indication, dosage, monitoring and information for patients).Results: 212 psychiatrists completed the survey. 70% of psychiatrists prescribe lithium to more than 50% of patients diagnosed with BD. Adverse effects are the main reason not to use lithium salts. Over 75% of the participants consider lithium salts the treatment of choice for the maintenance phase of BD, both in women and men. Most of the participants (> 50%) start lithium after the first affective episode, use conservative plasma concentrations (0.6-0.8 mmol/L) and generally prescribe it twice a day. 57% of psychiatrists who treat patients under 18 do not use lithium in this population. About 70% of the survey respondents use official protocols to inform and monitor patients who are on lithium treatment.Conclusions: From the results of the present study it can be concluded that the use of lithium in Spain is in line with the recommendations of the main international clinical guidelines and current scientific literature. The first reason not to prescribe lithium in our country is the perception of its adverse effects and not the aspects related to its practical use or its effectiveness. Considering that BD is a chronic disease that has a typical onset in adolescence, the reasons for the low rate of prescription of lithium salts in patients under 18 must be thoroughly studied.

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“…8 The heightened risk of OABD to develop dementia is, in this regard, further impetus for characterizing the profile of their executive functioning. 9 Regarding the latter comparison, between the clinical groups, studies found euthymic OABD to have poorer cognitive functioning than euthymic OADEP. 10,11 Beyond these initial findings, however, we still lack indepth understanding of differences in the cognitive profile of the two disorders.…”

mentioning

confidence: 99%

“…This is unfortunate as they share similarities, including cognitive impairment that is marked by executive dysfunctions, the significant disability associated with it, and the increased risk of dementia that they incur. 9,[12][13][14] The comparison between OABD and OADEP may therefore aid in clarifying the cognitive profile of each disorder and thereby advance our theoretical understanding of the disorders and target the cognitive domains that should be the focus of future research (eg, investigating the effects of cognitive training 15 ). Taken together, comparison of OABD with both healthy controls and OADEP was deemed important and included in the current study.…”

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confidence: 99%

Executive functioning of older adults with bipolar disorder

Omer

Braw

Amiaz

et al. 2020

Int J Geriat Psychiatry

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Objectives: Despite their impact on daily functioning, we have limited understanding of the executive functioning of older adults with bipolar disorder (OABD). Even less is known about the possible differences in the executive functioning of OABD and older adults with unipolar depression (OADEP). Methods: After excluding acutely ill patients, the executive functioning of OABD was compared to that of OADEP and healthy controls (n = 22, n = 20, n = 22; respectively). Cognitive insight, a sub-domain of executive functioning, was operationalized as the discrepancy between the participants' self-reported cognitive functioning and appraisals that were made by their care partners. To complement the cognitive profiling, the groups were compared in information processing speed, verbal memory, and visual-spatial memory. Results: OABD were impaired in several cognitive domains compared to healthy controls, most prominently in executive functioning and memory. OABD had poorer executive functioning and visual-spatial memory than OADEP. The findings also tentatively point toward intact cognitive insight among OABD, while OADEP seem to have a heightened level of awareness of their cognitive impairment. Conclusions: OABD have a unique profile of cognitive impairment compared to OADEP. It is characterized by a more severe cognitive impairment, accompanied by relatively intact cognitive insight. The findings may help clarify the cognitive profile of OABD and assist in the development of cognitive rehabilitation programs tailored to their needs. They should, however, be considered preliminary and await further research.

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Risk of dementia in bipolar disorder and the interplay of lithium: a systematic review and meta‐analyses

Cited by 87 publications

References 67 publications

Biological Pathways Associated with Neuroprogression in Bipolar Disorder

Biological Pathways Associated with Neuroprogression in Bipolar Disorder

Overview of Lithium´s Use: A Nationwide Survey

Executive functioning of older adults with bipolar disorder

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