Long-term course of cognitive functioning in bipolar disorder: A ten-year follow-up study

Bipolar Disord. 2024 Mar;26(2):136-147. doi: 10.1111/bdi.13364. Epub 2023 Jun 25.


Introduction: Cognitive impairments are common in bipolar disorder (BD), but the long-term course remains understudied. Longitudinal data on cognitive functioning from the start of the first treatment could help clarify pathophysiological processes that shape the illness outcome. We here aim to investigate the 10-year cognitive course in BD compared to healthy controls (HC) and the effects of clinical symptoms on cognitive trajectories.

Methods: Fifty-six BD participants recruited within their first year of treatment and 108 HC completed clinical and cognitive assessments at baseline and 10-year follow-up. We derived eight cognitive domain scores and a cognitive composite score, which were further investigated using linear mixed model analyses. Correlation analyses were used to assess associations between the composite score and depressive, manic and psychotic symptoms.

Results: BD participants performed poorer than HCs in all domains except mental speed and verbal fluency. Verbal learning and memory, verbal fluency and the composite score improved over time in both BD participants and HC, while short-term memory, mental speed, psychomotor speed and working memory were stable. We found no significant correlations between cognition and symptom level at either time point in BD participants.

Conclusions: We found evidence of long-term cognitive stability or improvement in BD participants from first treatment to 10-year follow-up. Though the BD group was impaired in all domains except mental speed and verbal fluency, the change in cognitive functioning was parallel to that of HCs. These findings are not consistent with the notion of neuroprogression in BD.

Keywords: bipolar disorder; cognition; cognitive function; long-term effects; longitudinal studies.

MeSH terms

  • Bipolar Disorder* / diagnosis
  • Cognition
  • Follow-Up Studies
  • Humans
  • Neuropsychological Tests
  • Psychotic Disorders* / psychology