Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia.
Faculty of Health, Arts and Design, School of Health Sciences, Centre for Mental Health, Swinburne University, Melbourne, Australia.
Bipolar Disord. 2020 Feb;22(1):13-27. doi: 10.1111/bdi.12821. Epub 2019 Aug 29.
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.
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).
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.
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.
认知功能障碍影响了相当一部分双相情感障碍（BD）患者，但这种功能障碍的原因、轨迹和相关性仍不清楚。需要更多地了解这些因素，才能推进针对这一症状维度的治疗发展。
本文对 BD 认知功能的轨迹和新兴相关性的文献进行了批判性综述。这是一篇叙述性综述，我们对当前有关 BD 认知障碍的临床、分子、神经和生活方式相关性的证据进行了定性综合，这些相关性贯穿于整个生命周期（在病前、前驱期、早期发病、发病后、老年队列）。
有越来越多的证据表明，认知障碍与 BD 中的炎症状态增加、大脑结构异常和神经保护减少之间存在实证联系。然而，关于认知障碍进行性本质的证据是混杂的，因为不同横断面数据之间缺乏共识，并且与有限的纵向研究结果不一致。在 BD 中对认知异质性的认识增加，可能有助于解释现有文献中的一些不一致。
需要进行大型的、纵向聚焦的认知及其与生物学和生活方式因素的相关性研究，以更好地确定 BD 中的认知轨迹，并最终为临床实践中为个体患者应用精准医学方法铺平道路。
