Bipolar Cognitive Impairment
Bipolar disorder and cognitive impairment. Two very different things, but could they possibly be intertwined?
The Centers for Disease Control and Prevention defines cognitive impairment as “when a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life.”
They estimate that cognitive impairment affects over 16 million Americans – that is twice the amount of people living in New York City.
Does this sound like you? Let’s take a closer look.
What Is Cognitive Impairment?
Age is the greatest risk factor for developing cognitive impairment; in fact, the most well-known cause of cognitive impairment is Alzheimer’s disease, which is an affliction that is most common among the elderly – affecting 5.1 million Americans. Add the fact that the Baby Boomer generation is passing the age of 65, and you’ve got a lot of people suffering from cognitive impairment.
However, the elderly are not the only patient population that suffers from cognitive impairment.
Other risk factors may include:
- Family history
- Brain injury
- Exposure to pesticides
- Education level
- Chronic conditions such as heart disease and stroke, Parkinson’s disease, and diabetes
Additionally, there are some reversible forms of cognitive impairment, such as impairment that is caused by depression, nutritional deficiencies, and medication side effects.
Cognitive impairment can range from mild to severe. Mild cognitive impairment allows for the person to live a normal life with noticeable changes in cognitive function. Severe cognitive impairment can cause the person to lose understanding of the spoken and written word, causing them to be unable to live independently.
What Are the Symptoms of Cognitive Impairment?
Symptoms of cognitive impairment may include:
- Memory loss
- Difficulty planning and carrying out tasks
- Repeating questions or the same story, over and over
- Vision problems
- Not recognizing familiar faces or places
- Changes in mood or behavior
- Issues with judgment
Bipolar Disorder and Cognitive Impairment – Is There a Link?
According to Psychiatric Times, “There is growing evidence that individuals with bipolar affective disorder have cognitive impairments, even during periods of symptom remission.”
The cognitive impairments appear to be less pronounced than people who have schizophrenia and neurological conditions, such as Alzheimer’s, but there does seem to be a measurable decline in psychosocial functioning.
Psych Central notes that not everyone with bipolar disorder has cognitive impairment. The exact implications of cognitive impairment amongst people suffering from bipolar disorder are not known, but estimates suggest anywhere from 15 percent to 60 percent.
There appears to be a higher correlation of cognitive impairment in patients who have more manic episodes, as well as those with bipolar I as opposed to bipolar II.
The Research On Bipolar Cognitive Impairment
In a 2015 study published in Annals of General Psychiatry, 137 bipolar patients enrolled; all patients were free of psychotic symptoms upon enrolling in the study. Included in the study were also 62 patients without psychiatric disorder. All patients underwent cognitive battery testing.
According to the researchers, “Bipolar patients showed cognitive deficits regardless of the phase of illness. Subjects experiencing a manic episode displayed higher deficits in verbal and working memory, executive function/reasoning, and problem solving. Severe course of illness also showed significant contribution in terms of cognitive impairment.”
The results were not shocking to the researchers – but why does bipolar disorder seem to have this effect on cognition?
Bipolar Disorder and Cognitive Impairment – Is There a Link?
The Theories About Bipolar Cognitive Impairment
One theory is the use of the psychotropic medications that are necessary to treat bipolar disorder. For example, lithium is often prescribed to bipolar patients. A qualitative study concluded that lithium “had a negative effect on memory and speed of information processing.”
However, memory test scores appeared to remain stable over a six-year time span, which indicates further testing needs to be performed.
Other anticholinergic antidepressant medications used to treat bipolar disorder may have adverse cognitive affects, though – but there are few large-scale studies to support this conclusion.
Another theory is that cognitive impairment worsens as the acuity of bipolar disorder worsens – whether this is due to treatment noncompliance, treatment resistant symptoms, or other lifestyle choices.
Dr. Russ Federman of Psychology Today poses the question, “A salient question is whether the manifestations of cognitive deficit symptoms are mood-phase-specific or do they represent some degree of impairment that persists and is independent of cycles of mania, hypomania and depression.”
Risk Factors for Cognitive Problems with Bipolar Disorder
Problems with memory and problem-solving are generally mild among people with bipolar disorder, but they are widespread: studies have shown that up to 75 percent of patients score considerably lower in tests of long-term memory, attention and thought-processing.
While any bipolar patient can feel these psychiatric effects, certain behaviors and medical history seem to compound cognitive difficulty:
- Substance abuse. Recreational drugs, particularly alcohol, can have a direct and powerful impact on bipolar symptoms and are known to interfere with memory, thought processing and attention in those with bipolar disorder.
- Recurrent mania. Some studies have shown that manic episodes may have a greater impact on cognitive function than depressive episodes.
- Number of relapses. The frequency of manic and depressive episodes, along with the number of hospitalizations that have resulted, appears to affect cognitive problems.
- Medication use. Psychotropic medications, like lithium, and some antidepressants can have a negative impact on memory and information processing.
- Illness duration. The longer a patient has been living with bipolar disorder, the worse the cognitive impairment seems to be.
Even relatively mild cognitive dysfunction can be a big problem for people with bipolar disorder, because it tends to initiate a damaging cycle. For instance, problems with thought processing can result in poor insight, which can sway the patient from their treatment plan, resulting in a manic episode.
The more bipolar manic episodes, the worse the cognitive issues, and the cycle repeats.
Treatment for Memory, Attention and Concentration Problems
As is the case for many mental illnesses, early treatment is important to limit the long-term cognitive damage of bipolar disorder. Luckily, you can attack the threats to your psyche with several approaches:
Experts recommend psychoeducation to learn how to spot the warning signs of manic episodes, and learn coping skills to control the mania when it hits. Additionally, cognitive behavioural therapy can be a good replacement or supplement to antidepressant medication: while some antidepressants can bring dangerous side effects, there is little chance that CBT will harm the mind, personality or quality of life.
Evidence suggests that the mania in bipolar disorder could be related to a chemical problem in the brain, which means that it can be treated with the appropriate medications for bipolar disorder. Research continues to show that certain other antipsychotics that show promise, and reveal those that might cause more cognitive dysfunction.
This is the process of relearning cognitive skills that have been lost, and it makes use of four different types of training: developing awareness of the problem, process training, strategy training and functional activities training. The aim is to resolve the problem, and compensate for the symptoms when resolution isn’t possible.
Treatment for cognitive problems in bipolar disorder isn’t easy, especially when the subjective and objective effects don’t match up. Some patients may not notice their cognitive dysfunction, and in other cases, complaints of cognitive symptoms don’t point to a treatable cognitive problem.
Fortunately, a flexible treatment plan that involves regular assessment will go far to stop cognitive decline and even reverse the effects on memory and concentration.
The Bottom Line…
If you think that you are suffering from cognitive impairment related to bipolar disorder, there is evidence that this is likely.
Researchers are not sure what is causing this impairment – the disease process itself, or the medications that you are prescribed.
That being said, the medications you are taking are prescribed for your safety so please discuss any concerns you may have with your physician.