A recent study published online in the Annals of General Psychiatry reiterates the fact that cognitive impairment exists in patients with bipolar disorders.
Bipolar disorder is a difficult-to-treat mental disorder. The patient experiences episodes of severe high and or severe low variations in mood. The periods of 'high' are referred to as mania, while the periods of low are called 'depression'. The patient may also experience psychotic symptoms like delusions and hallucinations.
‘Cognitive impairment may have negative implications in the functional outcome of patients with bipolar disorder.’
AdvertisementSeveral drugs are used in the treatment of acute episodes of bipolar disorders, or in stabilizing the condition and preventing recurrences. Among these are lithium, anti-seizure medications like carbamazepine, valproic acid and lamotrigine, and antipsychotic drugs like aripiprazole, olanzapine and risperidone.
Though the above drugs help to treat mood swings, there is one aspect in patients of bipolar disorder that has not received much importance - impairment of cognitive functions. Cognitive functions refer to brain functions like attention, memory and executive functions. These are necessary for normal functioning of a person.
A study was conducted to study impaired cognition in patients with bipolar disorder in various states, manic, depressive, mixed, as well as in periods between episodes when the patients were apparently normal. The study, conducted over three years in Romania, covered 137 patients with bipolar disorder and also included 62 normal individuals for comparison. Standard tests were used to evaluate cognitive functions in these individuals.
The study found that patients with bipolar disorder had cognitive impairment. This was also true for patients who were apparently normal between episodes, though their performance was better than those who were suffering from the episodes.
The researchers found that patients in the manic phase experienced more impairments in verbal and working memory, executive function/reasoning and problem-solving tasks. Working memory helps a person to remain concentrated on a particular task. Thus, patients with maniac episodes of bipolar disorder have difficulty with concentration. It is possible that medications that are prescribed to these patients may have contributed to the cognitive impairment.
Patients with episodes of depression had lower scores in different cognitive functions, that is, verbal fluency and psychomotor speed tests.
Patients with mixed episodes had problems with cognitive functions related to working memory, executive function/reasoning, problem-solving, attention, and speed of information processing.
The study also found that age of onset of bipolar disorder was associated with severity of cognitive impairments. Lower scores were noted with verbal memory test in patients with manic episodes and verbal fluency test in patients with depressive episodes when the disease started at an early age. Cognitive impairment was also related to the duration of the illness and the number of hospitalizations associated with it.
Thus, assessment of cognitive defects in patients with bipolar disorder should be an important aspect of its treatment. Adequate occupational training should be imparted to the affected individuals so that they can be independent despite their disabilities.
References:1. Vrabie M, Marinescu V, Talaşman A, Tăutu O, Drima E and Micluţia I. Cognitive impairment in manic bipolar patients: important, understated, significant aspects. Annals of General Psychiatry 2015, 14:41, doi:10.1186/s12991-015-0080-0