Neurocognitive Functioning in Bipolar Disorder: A Comprehensive Review of Recent Data
The neurocognitive function of BD patients has been the focus of debate for decades. It was unclear whether the observed neurocognitive deficit is because of some kind of iatrogenic or alcohol and/or drug abuse effects, whether it reflects temporary funct
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Neurocognitive Functioning in Bipolar Disorder: A Comprehensive Review of Recent Data
The neurocognitive function of BD patients has been the focus of debate for decades. It was unclear whether the observed neurocognitive deficit is because of some kind of iatrogenic or alcohol and/or drug abuse effects, whether it reflects temporary functional changes as a result of mood changes or on the contrary it is the product of degenerative structural brain changes or of some kind of structural changes of a neurodevelopmental origin, or it derives from the same enduring functional brain alterations that cause mood dysregulation. The latest research data suggest that the neurocognitive impairment is an enduring component of BD and represents a core primary characteristic of the illness, rather than being secondary to the mood state or medication. A recent study reported that 84 % of the schizophrenia patients, 58.3 % of psychotic major depression patients and 57.7 % of psychotic BD patients were cognitively impaired (1 SD below healthy controls in at least two domains) (Reichenberg et al. 2009). Traditionally, BD patients were considered to have higher IQ in comparison to the general population and to be more creative (e.g. artists, scientists etc.) (Andreasen 1987, 2008; Andreasen and Glick 1988; Jamison 1995, 1989). However, recent research revealed the presence of a significant and broad neurocognitive impairment, which seems to be present even before the first manifestation of mood symptoms; it persists across the different phases and even worsens during the course of the illness (Arts et al. 2008; Bora et al. 2009a, 2011; Kurtz and Gerraty 2009; MannWrobel et al. 2011; Robinson et al. 2006). A general impression is that verbal ability is relatively preserved (Mann-Wrobel et al. 2011). The neurocognitive impairment in BD is less pronounced in comparison to schizophrenia, even after controlling for confounding variables, like clinical symptoms, education and social class (Dickerson et al. 2004; Schretlen et al. 2007). Maybe 40 % of BD patients are impaired in one neurocognitive domain, one-third or more are impaired in at least two neurocognitive domains and 22 % are impaired in three or more domains (Gualtieri and Morgan 2008; Martino et al. 2008). This deficit is rather stable and relatively independent from mood changes, probably reflecting trait features of BD (Clark and Goodwin 2004; Quraishi and Frangou 2002; Malhi et al. 2004; Thompson et al. 2005). © Springer-Verlag Berlin Heidelberg 2015 K.N. Fountoulakis, Bipolar Disorder: An Evidence-Based Guide to Manic Depression, DOI 10.1007/978-3-642-37216-2_4
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Neurocognitive Functioning in Bipolar Disorder
A number of confounding factors have been identified, including gender, age and education. An additional important confounding variable when comparing the different phases of the illness is that although some of the acutely ill patients might be medication-free during testing, this is not the case with patients in remission. Thus, medication status consti
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