Sabtiari Talitha Najmillah, Myrtle Samuel, Orfanos Stelios, Young Allan H, Strawbridge Rebecca
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
South London and Maudsley NHS Foundation Trust, UK.
J Psychopharmacol. 2025 Oct;39(10):1135-1153. doi: 10.1177/02698811251371139. Epub 2025 Oct 17.
Lithium, a mainstay treatment for bipolar disorders, has shown promise in treating cognitive impairments. However, concerns about cognition-related side effects persist.
We aimed to synthesise the evidence on how lithium affects cognition by comparing cognitive performance before and after starting lithium treatment.
A systematic search was conducted to identify studies examining lithium's effects on cognition. The review considered studies with adult human participants that reported quantitative cognitive outcomes using within-subject comparisons between lithium-absent and lithium-present conditions.
Thirty-two articles describing 30 studies were included (727 participants, approximately 54% female, mean age ± 50 years old). The studies exhibited significant heterogeneity within cognitive domains, including global cognition (15 studies), memory (19 studies), processing and psychomotor speed (8 studies), attention (9 studies), verbal fluency (4 studies) and executive function (6 studies). The included studies comprised 16 randomised controlled trials (RCTs) and 14 non-RCTs, with study populations ranging from individuals with affective disorders (13 studies) to neurocognitive disorders (11 studies) and healthy individuals (6 studies). Some studies reported cognitive enhancements, particularly in individuals with affective disorders, while others documented declines or mixed results.
Definitive conclusions regarding lithium's isolated cognitive effects remain elusive, particularly considering the influence of factors such as affective state, population and methodological heterogeneity among studies. Further research is needed to conclusively determine the raw cognitive impacts of lithium therapy, requiring larger RCTs across distinct populations. Prioritising the resolution of main symptoms should remain the primary therapeutic goal of lithium treatment.
锂盐是双相情感障碍的主要治疗药物，在治疗认知障碍方面显示出前景。然而，对与认知相关的副作用的担忧依然存在。
我们旨在通过比较开始锂盐治疗前后的认知表现，综合关于锂盐如何影响认知的证据。
进行系统检索以识别研究锂盐对认知影响的研究。该综述纳入了有成年人类参与者的研究，这些研究通过在无锂和有锂状态下的个体内比较报告了定量认知结果。
纳入了32篇描述30项研究的文章（727名参与者，约54%为女性，平均年龄±50岁）。这些研究在认知领域内表现出显著的异质性，包括整体认知（15项研究）、记忆（19项研究）、加工和心理运动速度（8项研究）、注意力（9项研究）、语言流畅性（4项研究）和执行功能（6项研究）。纳入的研究包括16项随机对照试验（RCT）和14项非RCT，研究人群从情感障碍患者（13项研究）到神经认知障碍患者（11项研究）和健康个体（6项研究）。一些研究报告了认知增强，特别是在情感障碍患者中，而其他研究记录了认知下降或混合结果。
关于锂盐单独的认知影响的明确结论仍然难以捉摸，特别是考虑到情感状态、人群和研究方法异质性等因素的影响。需要进一步研究以最终确定锂盐治疗对认知的原始影响，这需要在不同人群中进行更大规模的RCT。优先解决主要症状应仍然是锂盐治疗的主要治疗目标。
