Cognitive deficits can be severe or subtle, but studies report as many as a third of people with bipolar I have cognitive problems that disrupt their lives. These signs of deficits in brain power may be temporary or ongoing and may be helped with certain treatments. Here are some facts to consider:
Research catching up
Researchers and psychiatrists are coming to appreciate that memory lapses and other neurocognitive problems—disorganization, groping for words, difficulty learning new information—can co-exist with the more obvious mood and behavioral symptoms that characterize bipolar. The area where the differences were seen helps control “executive function” — activities such as problem-solving, working memory, and reasoning.
A big office
The brain is organized like a big office with specific departments assigned to complex tasks such as attention, verbal memory, decision-making, spatial memory, motor speed and skill, and logical reasoning. The frontal lobes of the brain contain circuitry that acts like an executive secretary—information comes in, the secretary notes it, organizes it, and sends out messages to the brain’s various departments to get things done.
In every phase of bipolar (depression, mania and remission), studies report marked deficits in verbal memory and what’s known as “frontal executive tasks,” says Joseph Goldberg, MD, a psychiatrist at the Mount Sinai School of Medicine in New York City. He notes that many aspects of intellectual functioning carry on just fine in people with bipolar; the glitches seem limited to specific areas: verbal memory, executive organization, “processing speed” and attention.
The file clerk
The hippocampus serves as a kind of file clerk for recording new memories and sending them on to permanent storage. Bipolar disorder has been associated with shrinkage of the hippocampus, which may explain difficulties in acquiring and accessing various kinds of data.
Bipolar brain fog
Bipolar brain fog has been described as scattered attention, the inability to focus on a task or conversation, tune out distractions, and, ultimately, filter information into working memory, says Frederick Goodwin, MD, a leading clinical researcher on bipolar disorder at George Washington University. Attention, he says, is the gateway to learning, memory and the other higher cognitive processes.
One aspect to consider is whether any cognitive impairment is directly linked to a mood episode—mania or depression phase—or if it’s independent of this. It’s known that either depression or mood elevation can have a negative impact upon memory, focus and thinking. For example, many would agree that when they’re acutely depressed, their cognition seems faulty. And while in a manic state, thoughts can be so rapid that it’s difficult to stay attentive.
Ruling out overlaps
It’s necessary to rule out the presence of neurologically-based diagnoses such as Attention Deficit Disorder. If you do already know that you carry both diagnoses of ADD and Bipolar Disorder, then you’re faced with the complex task of figuring out what deficits come from what disorder as well as what degree of overlap may exist between the two.
The next issue to consider is whether any symptoms of cognitive deficit could be related to the medications you are prescribed. As different people react to medications differently, it’s not always an easy task. It’s also important to remember that taking antipsychotic medication on a daily basis does not mean that cognitive deficit symptoms are inevitable.
There are neuropsychological tests that are proving helpful in identifying problems that can make everyday functioning difficult. Some tests measure planning skills and how quickly and accurately someone responds to stimuli, while other tests are devised to catch misfires in attention and memory. Undergoing a thorough neuropsychological assessment may help correctly diagnose whether you do have any persistent areas of deficit related to your bipolar disorder.
A 2010 Canadian study that appeared in the Journal of Clinical Psychiatry found that focus, recall, and several aspects of executive functioning were impeded even at the onset of the first manic episode. The fact that neurocognitive impairments remain after symptoms subside makes scientists think that these disturbances are a core and consistent feature of the illness.
via bpHope – bp Magazine Community