Neuropsychological Profile and Working Memory in Bipolar Disorder

According to the World Health Organization (WHO), the bipolar disorder is one of the ten costliest and most incapacitating diseases in the world. Management of this pathology usually involves a psychiatric follow-up at a pace adapted to the thymic state, and the initiating of a mood-stabilizing treatment. However, what will become of patients with bipolar disorder remains unsatisfying. Psychosocial impacts, increased by often present physical and psychological comorbidities are important (Bonnin et al., 2010) and can be incapacitating: socioprofessional deintegration, social withdrawal, family-related repercussions, low socioeconomic status, lesser quality of life. A functional impairment is found in acute decompensation phases, but also in intercritical periods where different factors might be involved: thymic or cognitive residual symptomatology, as episode consequences, presence of comorbidities...Actually, in this stage of the disease, 30% of bipolar patients present cognitive impairments, that neuropsychological testing can objectify (Gualtieri and Morgan, 2008). Almost 2 thirds present subjective cognitive complaints (Martinez-Aran et al., 2005) that are negatively correlated with quality of life. Among these impairments, harm to working memory is reported in several studies (Bora et al., 2009; Robinson et al., 2006), and seems to play a leading role in functional impairment. Managing cognitive impairments seems an important issue to improve patient functioning, quality of life and disorder stability. However, cognitive remediation techniques, largely developed for patients with schizophrenia, remain limited in bipolar disorder, in spite of the great impact of cognitive impairments in this disorder. This objective of this article was an update on bipolar patient neuropsychological profile in an intercritical period, while putting forward working memory critical role in functional impairment. We will also discuss current therapeutic advances allowing to manage these impairments and improve patient functioning.