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Cognitive Impairment in Patients with Bipolar Disorder: Impact of Pharmacological Treatment

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Abstract

Bipolar disorder is an illness characterised by periods of elated and depressed mood. These mood episodes are associated with changes in cognitive function and there is evidence to suggest that cognitive dysfunction persists during euthymia. The extent to which this is a function of the illness or a result of treatment is less clear. In this narrative review, we explore the impact of commonly used medications for bipolar disorder on cognitive function. Specific impairments in executive function and verbal memory have been noted in bipolar disorder. The impact of pharmacological treatments upon cognitive function is mixed with a number of studies reporting conflicting results. Interpretation of the data is further complicated by the variety of cognitive tests employed, study design, the relatively small numbers of patients included and confounding by indication. Overall, there is some evidence that while lithium improves some cognitive domains, it impedes others. Antipsychotics may be deleterious to cognition, although this may relate to the patient population in which they are prescribed. Sodium valproate is also associated with worse cognitive outcomes, while the impact of other antiepileptics is unclear. Overall the quality of evidence is poor and is derived from a relatively small number of studies that often do not account for the significant heterogeneity of the disorder or common comorbidities. The use of consistent methodologies and measures of cognition across studies, as well as in naturalistic settings, would enable more certain conclusions to be drawn.

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Authors and Affiliations

  1. Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK

    Ni Xu & Kate E. A. Saunders

  2. John Radcliffe Hospital, University of Oxford Medical School, Oxford, UK

    Benjamin Huggon

  3. Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, OX3 7JX, UK

    Kate E. A. Saunders

Authors
  1. Ni Xu
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  2. Benjamin Huggon
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  3. Kate E. A. Saunders
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Correspondence to Ni Xu.

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Funding

KEAS is supported by the National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health and Social Care. NX is a Rhodes Scholar.

Conflict of interest

Ni Xu, Benjamin Huggon and Kate E.A. Saunders have no conflicts of interest to report.

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Xu, N., Huggon, B. & Saunders, K.E.A. Cognitive Impairment in Patients with Bipolar Disorder: Impact of Pharmacological Treatment. CNS Drugs 34, 29–46 (2020). https://doi.org/10.1007/s40263-019-00688-2

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