Abstract
Cognitive deficits in executive function and memory among individuals with bipolar disorder (BD) are well-documented; however, only recently have efforts begun to address whether such cognitive deficits can be ameliorated through cognitive training. This pilot study examined the effects of a top–down, cognitive reasoning training program in adults with BD on both brain and cognitive measures. Twenty-seven participants (11 males, 16 females), aged 21–70 years old, completed the study. Participants completed neurocognitive testing and functional magnetic resonance imaging (fMRI) before and after training, consisting of 8 h (2 h/week) of training in small groups. The training delivered information processing strategies that were implemented and applicable to a variety of daily living contexts. Results indicated that participants showed significant gains in the primary outcome measure of complex abstraction, also referred to as gist reasoning, as well as in untrained domains of executive function and memory. We found a significant increase in resting cerebral blood flow (CBF) in left inferior frontal gyrus after cognitive training. We also found that resting CBF in the right frontal middle gyrus correlated positively with performance on the measure of complex abstraction. This feasibility study provides promising evidence that short-term reasoning training can enhance cognitive performance and brain health in adults with BD. These data motivate further efforts to explore adjuvant therapeutics to improve cognitive performance and underlying brain systems in bipolar, as well as other psychiatric disorders. Clinicaltrials.gov Identifier: NCT02843282, http://www.clinicaltrials.gov/ct2/show/NCT02843282
Highlights
Bipolar disorder (BD), a mental illness with recurring episodes of mania and depression, can have far-reaching detrimental effects on the everyday function and living of those with the diagnosis
When the participant was not a patient of the collaborating psychiatrist, written approval was obtained from the treating psychiatrist confirming the following: participant was between ages 21 and 70; participant had a diagnosis of BDI or BDII; participant was in a euthymic, rather than manic or depressive, state; participant had been stable on medications for at least 3 months; and participant was believed to be appropriate for the study
Immediate memory recall improved on Test of Strategic Learning (TOSL) memory for details (p = 0.002)
Summary
Bipolar disorder (BD), a mental illness with recurring episodes of mania and depression, can have far-reaching detrimental effects on the everyday function and living of those with the diagnosis. A meta-analysis of cognitive deficits in adult euthymic patients with BD (i.e., neither depressed nor manic) consistently found deficits in executive function and verbal learning, with variance in deficits across other areas of Reasoning Training in Bipolar Disorder cognition, such as memory, abstraction, set-shifting, sustained attention, and inhibition (Robinson and Ferrier, 2006). Whereas cognitive and brain abnormalities in both symptomatic and asymptomatic individuals with BD are well-documented, available clinical interventions continue to be limited to pharmacological and/or psychological counseling regimens to manage symptoms. These approaches will continue to be a vital aspect of BD treatment; additive benefits may be derived from protocols that directly address the common cognitive sequelae
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