Cognitive remediation for bipolar patients with objective cognitive impairment: a naturalistic study

J Veeh; J Kopf; S Kittel-Schneider; J Deckert; A Reif

doi:10.1186/s40345-017-0079-3

Cognitive remediation for bipolar patients with objective cognitive impairment: a naturalistic study

Int J Bipolar Disord. 2017 Dec;5(1):8. doi: 10.1186/s40345-017-0079-3. Epub 2017 Apr 13.

Authors

J Veeh¹, J Kopf², S Kittel-Schneider², J Deckert³, A Reif²

Affiliations

¹ Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University, Heinrich-Hoffmann-Straße 10, 60528, Frankfurt, Germany. julia.veeh@kgu.de.
² Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University, Heinrich-Hoffmann-Straße 10, 60528, Frankfurt, Germany.
³ Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, 97080, Würzburg, Germany.

Abstract

Background: Many bipolar patients (BP) are affected by cognitive impairments and reduced psychosocial function even after complete remission. In the present naturalistic study, we developed a tailored cognitive remediation program (CR) to evaluate the effect on objective and subjective neuropsychological performance, psychosocial functioning and quality of life.

Methods: The CR program used a cognitive training software combined with group sessions to educate cognitive skills. 102 BP were screened by a neuropsychological test battery. Of those, 39 BP showed distinct cognitive impairments and 26 patients of them participated in the CR program for 12 weeks and then were retested. A matched control group consisting of 10 BP was measured at baseline and follow-up after three months (treatment as usual).

Results: Within the training group, a significant improvement of cognitive performance after CR was observed in working memory (p = .043), problem solving (p = .031) and divided attention (trend, p = .065). The control group did not improve in any test measure. In addition, we detected a significant reduction of sub-depressive symptoms (p = .011) after the CR program. However, there was no change in psychosocial functioning and quality of life. Subjective cognitive complaints were not associated with objective test performance.

Limitations: As we included exclusively BP with objectively assessed neurocognitive deficits, recruitment was difficult and subsequently we had a small sample size and were not able to implement a randomized group design.

Conclusions: Our results suggest that BP with objective cognitive impairments could benefit from CR potentially with regard to executive functioning. Furthermore, there is preliminary evidence that CR could have a positive effect on subthreshold residual symptoms. However, to fully identify the possible implications of CR in bipolar disorder, larger randomized-controlled trials are needed in this new field of research.

Keywords: Bipolar disorder; Cognitive deficits; Cognitive remediation.