The effects of lithium on cognition: an updated review
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Adverse cognitive effects associated with lithium are often implicated as contributing to vocational and social impairment, as well as medication noncompliance. As impaired cognitive functioning caused by lithium has clear clinical implications, it is important to determine whether evidence for or against impaired cognitive functioning exists in the literature.
An attempt is made to synthesize findings from previous studies, which assess a variety of cognitive domains, to determine whether conclusions can be drawn regarding lithium-associated cognitive impairment. The "reversibility" of neuropsychological impairment following lithium discontinuation and whether lithium administration has negative cumulative effects on cognition were also reviewed.
Key word searches on "Medline" and "Psych Info" were completed for clinical articles that investigated the neuropsychological effects of lithium in clinical and normal populations between 1968 and 2000.
Despite methodological flaws, poor replicability and the subtle cognitive effects of lithium, five consistent findings emerged from the review; impairment on tasks of psychomotor speed, impaired functioning in the majority of studies examining verbal memory, no impairment on tasks of visuo-spatial constructional ability or attention/ concentration, and no negative cumulative effect.
Many patients administered lithium carbonate complained of mental slowness. Lithium carbonate also appeared to have definite, yet subtle, negative effects on psychomotor speed. Studies reviewed also showed a trend toward impaired verbal memory. Recommendations with respect to future research, methodological and statistical problems, and additional clinical implications are presented.
KeywordsLithium Memory Cognition Bipolar
- Andrews DG, Schweitzer I, Marshall N (1990) The comparative cognitive side effects of lithium, carbamazepine, and combined lithium-carbamazepine in patients treated for affective disorders. Hum Psychopharmacol 5:41–45Google Scholar
- Baastrup PC (1964) The use of lithium in manic-depressive psychosis. Compr Psychiatry 5:396Google Scholar
- Benes F, Kwok E, Vincent S, Todtenkopf M (1998) A reduction of nonpyramidal cells in sector CA2 of schizophrenics and manic depressives. Biol Psychiatry 44:88–97Google Scholar
- Christodoulou GN, Kokkevi A, Lykouras EP, Stefanis CN, Papadimitrious GN (1981) Effects of lithium on memory. Am J Psychiatry 138:847–848Google Scholar
- Demers RG, Heninger GR (1971) Visual-motor performance during lithium treatment—a preliminary report. J Clin Pharmacol 11:274–279Google Scholar
- Erdfelder E, Faul F, Buchner A (1996) GPOWER: a general power analysis program. Behav Res Methods Instrum Comput 28:1–11Google Scholar
- Goldberg J, Burdick K (2001) Cognitive side effects of anticonvulsants. J Clin Psychiatry 14:27–33Google Scholar
- Goldberg J, Harrow M (1999) Bipolar disorders: clinical course and outcome. American Psychiatric Press, WashingtonGoogle Scholar
- Hartigan GP (1963) The use of lithium salts in affective disorders. Br J Psychiatry 109:810Google Scholar
- Jauhar P, McClure I, Hillary C, Watson A (1993) Psychomotor performance of patients on maintenance lithium therapy. Hum Psychopharmacol 8:141–143Google Scholar
- Karniol IG, Dalton J, Lader MH (1978) Acute and chronic effects of lithium chloride on physiological and psychological measures in normals Psychopharmacology 57:289–294Google Scholar
- Lenzer I, Eastwood D, Street P (1989) Reinterpreting memory complaints through neuropsychological assessment. Clin Gerontol 8:57–60Google Scholar
- Loo H, Bonnel J, Etevenon P, Benyacoub J, Slowen P (1981) Intellectual efficiency in manic-depressive patients treated with lithium: a control study. Acta Psychiatr Scand 64:423–430Google Scholar
- Lund Y, Nissen M, Rafaelsen OJ (1982) Long-term lithium treatment and psychological functions. Acta Psychiatr Scandin 65:233–244Google Scholar
- Marusarz TZ, Wolpert EA, Koh SD (1981) Memory processing with lithium carbonate. J Clin Psychiatry 42:190–192Google Scholar
- Rajkowska G (1999) Morphometric methods for studying the prefrontal cortex in suicide victims and psychiatric patients. Ann N Y Acad Sci 836:253–268Google Scholar
- Rapp S, Thomas R (1979) Lithium and memory loss. Can J Psychiatry 24:784Google Scholar
- Reitan RM, Wolfson D (1993) The Halstead-Reitan neuropsychological test battery, 2nd edn. Neuropsychology Press, Tucson, pp 229–801Google Scholar