Neurocognitive Functioning in Bipolar Disorder

Neuropsychological processes may have direct bearing on the emotional dysregulation and functional impairments characteristic of bipolar disorder. Neuropsychological deficits that have been identified in adults and children with bipolar disorder include impairments in executive functions, declarative memory, attentional processes, and possibly working memory. Structural and functional magnetic resonance imaging and magnetic resonance spectroscopy studies of adults and children with bipolar disorder also indicate abnormalities in regions thought to underlie these neuropsychological deficits, including the basal ganglia, amygdala, and dorsolateral, orbitofrontal, and anterior cingulate cortices. Study of this area is made challenging by the heterogeneity of bipolar disorder, the heterogeneity of neuropsychological deficits among groups of patients with different clinical characteristics, the lack of specificity of neurocognitive deficits for bipolar disorder, and difficulty ascertaining whether deficits are inherent in the disorder, predate the disorder, or are influenced by mood state, course, treatment, and comorbidity with other disorders. In this review, we integrate the literature on neuropsychological functioning and neuroimaging in both children and adults with bipolar disorder, propose a nascent integrative model of cognitive function in bipolar disorder, and make suggestions for future studies and model development..