Cognitive Impairment in Bipolar Disorder

Abstract

Cognitive impairment is recognized as a common aspect of bipolar disorder (BD), persisting beyond acute episodes and extending into euthymic periods. Verbal learning, memory, and executive functions exhibit the most pronounced impairments among the affected cognitive domains. Patients with BD also demonstrate social cognitive deficits. However, all patients with BD do not exhibit similar cognitive features. Recent data-driven studies emphasize the heterogeneity of cognitive impairment in BD, identifying 3 distinct subgroups: preserved cognition, selective impairment in specific domains, and global cognitive deficits. This classification highlights the variability in cognitive functioning among individuals with the disorder. The presence of cognitive deficits in healthy relatives of bipolar disorder patients, in individuals at high risk for BD, and in the firstepisode of BD patients suggest a potential neurodevelopmental component. Conversely, studies associating cognitive decline with factors such as illness duration, the number of manic episodes, and age of onset underscore a possible neuroprogressive aspect. There is no consensus on whether BD is a neurodevelopmental or a neuroprogressive disease. Longitudinal studies are needed to clarify the trajectory of cognitive impairment. Although cognitive deficits in BD resemble those observed in schizophrenia, they tend to be less severe, pointing to a transdiagnostic dimension of impairment. Cognitive deficits negatively impact the clinical course, functional outcomes, and quality of life. Future research should focus on the cognitive subgroups, the trajectory of cognitive impairment, personalized treatment strategies, and cognitive rehabilitation.

Cite this article as: Uzman Özbek S, Bora E. Cognitive impairment in bipolar disorder. Neuropsychiatr Invest. 2025, 63, 0007, doi:10.5152/NeuropsychiatricInvest.2025.25007.