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Bipolar Disord. 2019 Aug 13. doi: 10.1111/bdi.12821. [Epub ahead of print]

Current understandings of the trajectory and emerging correlates of cognitive impairment in bipolar disorder: An overview of evidence.

Author information

1
Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia.
2
Faculty of Health, Arts and Design, School of Health Sciences, Centre for Mental Health, Swinburne University, Melbourne, Australia.
3
Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA.
4
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
5
Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA.
6
Department of Psychiatry and Behavioral Neurosciences, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada.
7
Department of Psychiatry, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.
8
Neurocognition and Emotion in Affective Disorders Group, Copenhagen Affective Disorder Research Centre, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
9
Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
10
Brigham and Women's Hospital, Boston, MA, USA.
11
James J Peters VA Medical Center, Bronx, NY, USA.
12
Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain.

Abstract

OBJECTIVES:

Cognitive dysfunction affects a significant proportion of people with bipolar disorder (BD), but the cause, trajectory and correlates of such dysfunction remains unclear. Increased understanding of these factors is required to progress treatment development for this symptom dimension.

METHODS:

This paper provides a critical overview of the literature concerning the trajectories and emerging correlates of cognitive functioning in BD. It is a narrative review in which we provide a qualitative synthesis of current evidence concerning clinical, molecular, neural and lifestyle correlates of cognitive impairment in BD across the lifespan (in premorbid, prodromal, early onset, post-onset, elderly cohorts).

RESULTS:

There is emerging evidence of empirical links between cognitive impairment and an increased inflammatory state, brain structural abnormalities and reduced neuroprotection in BD. However, evidence regarding the progressive nature of cognitive impairment is mixed, since consensus between different cross-sectional data is lacking and does not align to the outcomes of the limited longitudinal studies available. Increased recognition of cognitive heterogeneity in BD may help to explain some inconsistencies in the extant literature.

CONCLUSIONS:

Large, longitudinally focussed studies of cognition and its covariation alongside biological and lifestyle factors are required to better define cognitive trajectories in BD, and eventually pave the way for the application of a precision medicine approach for individual patients in clinical practice.

PMID:
31408230
DOI:
10.1111/bdi.12821

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