Neurocognitive functioning in bipolar disorder: What we know and what we don't.

IF 8.3 2区 医学 Q1 Medicine Dialogues in Clinical Neuroscience Pub Date : 2022-06-01 eCollection Date: 2021-01-01 DOI:10.1080/19585969.2022.2042164
Kamyar Keramatian, Ivan J Torres, Lakshmi N Yatham
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引用次数: 13

Abstract

Introduction: This narrative review of systematic reviews and meta-analyses aims at compiling available evidence in various aspects of neurocognitive functioning in Bipolar Disorder (BD). Methods: We conducted a MEDLINE literature search and identified 38 relevant systematic reviews and metaanalyses. Results: 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. Discussion: 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.

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双相情感障碍的神经认知功能:我们知道什么,我们不知道什么。
简介:本文对系统综述和荟萃分析进行综述,旨在收集双相情感障碍(BD)神经认知功能各方面的现有证据。方法:我们进行了MEDLINE文献检索,并确定了38个相关的系统综述和荟萃分析。结果:目前的证据表明双相障碍在多个领域和所有临床状态下都与认知障碍有关。然而,双相障碍内部存在相当大的认知异质性,这无法用临床亚型来解释,并且双相障碍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有重叠。残留的抑郁症状、不良的临床病程和较多的躁狂发作次数可能会对认知表现产生负面影响,而认知表现是双相障碍一般功能的主要预测因素。现有前瞻性研究的证据不支持双相障碍认知能力进行性下降的概念,但一些证据表明患者在第一次躁狂发作后可能会出现一些认知功能的改善。此外,一部分患者可能表现出发病前认知异常,这可能是早期神经发育病因的信号。小型研究的初步结果确定认知修复、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刺激对BD的潜在促认知作用。高危人群的纵向研究可以更好地了解双相障碍神经认知功能障碍的发生和进展,需要大规模的随机对照试验来比较各种药物和非药物干预对不同阶段双相障碍患者不同认知亚组的促进认知效果。
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来源期刊
Dialogues in Clinical Neuroscience
Dialogues in Clinical Neuroscience Medicine-Psychiatry and Mental Health
CiteScore
19.30
自引率
1.20%
发文量
1
期刊介绍: Dialogues in Clinical Neuroscience (DCNS) endeavors to bridge the gap between clinical neuropsychiatry and the neurosciences by offering state-of-the-art information and original insights into pertinent clinical, biological, and therapeutic aspects. As an open access journal, DCNS ensures accessibility to its content for all interested parties. Each issue is curated to include expert reviews, original articles, and brief reports, carefully selected to offer a comprehensive understanding of the evolving landscape in clinical neuroscience. Join us in advancing knowledge and fostering dialogue in this dynamic field.
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