Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
Dialogues Clin Neurosci. 2022 Jun 1;23(1):29-38. doi: 10.1080/19585969.2022.2042164. eCollection 2021.
This narrative review of systematic reviews and meta-analyses aims at compiling available evidence in various aspects of neurocognitive functioning in Bipolar Disorder (BD). We conducted a MEDLINE literature search and identified 38 relevant systematic reviews and metaanalyses. Current evidence suggests that BD is associated with cognitive impairment across multiple domains and during all clinical states. However, there is a considerable cognitive heterogeneity within BD, which cannot be explained by clinical subtypes, and the pattern of neurocognitive impairment in BD overlaps with other psychiatric conditions such as major depression and schizophrenia. Residual depressive symptoms, poor clinical course and higher number of manic episodes may negatively impact cognitive performance, which is a major predictor of general functioning in BD. Evidence from available prospective studies does not support the notion of progressive cognitive decline in BD while some evidence exists to suggest patients may show some improvements in cognitive functioning following the first manic episode. Furthermore, a subset of patients may show premorbid cognitive abnormalities that could signal an early neurodevelopmental aetiology. Preliminary findings from small studies identify potential pro-cognitive effects of Cognitive Remediation, erythropoietin, intranasal insulin, lurasidone, mifepristone, repetitive Transcranial Magnetic Stimulation and transcranial Direct Current Stimulation in BD. Longitudinal studies in high-risk individuals can provide a better understanding of the development and progression of neurocognitive impairment in BD. Largescale randomised control trials are needed to compare the pro-cognitive efficacy of various pharmacological and non-pharmacological interventions in different cognitive subgroups of patients at different stages of BD.
这篇系统性综述和荟萃分析的叙述性综述旨在汇编双相情感障碍（BD）在神经认知功能各个方面的现有证据。我们进行了 MEDLINE 文献检索，确定了 38 篇相关的系统性综述和荟萃分析。目前的证据表明，BD 与多个领域和所有临床状态下的认知障碍有关。然而，BD 存在相当大的认知异质性，不能用临床亚型来解释，BD 的神经认知障碍模式与其他精神疾病如重度抑郁症和精神分裂症重叠。残留的抑郁症状、较差的临床病程和较多的躁狂发作可能会对认知表现产生负面影响，认知表现是 BD 一般功能的主要预测因素。来自现有前瞻性研究的证据不支持 BD 认知衰退的概念，而一些证据表明，患者在首次躁狂发作后可能会在认知功能方面有所改善。此外，一部分患者可能表现出认知前异常，这可能提示存在早期神经发育病因。一些小型研究的初步结果表明，认知矫正、促红细胞生成素、鼻内胰岛素、鲁拉西酮、米非司酮、重复经颅磁刺激和经颅直流电刺激在 BD 中有潜在的认知益处。高危人群的纵向研究可以更好地了解 BD 中神经认知障碍的发展和进展。需要大规模的随机对照试验来比较不同认知亚组患者在 BD 不同阶段的各种药物和非药物干预措施的认知益处。
