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Cognitive enhancement in bipolar disorder: current evidence and methodological considerations 

Cognitive enhancement in bipolar disorder: current evidence and methodological considerations
Chapter:
Cognitive enhancement in bipolar disorder: current evidence and methodological considerations
Author(s):

Kamilla W. Miskowiak

and Lars V. Kessing

DOI:
10.1093/med/9780198748625.003.0026
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date: 22 August 2019

Cognitive dysfunction is an emerging treatment target in bipolar disorder (BD). Numerous trials have assessed the efficacy of novel pharmacological and psychological treatments on cognition. Overall, the results are disappointing, possibly due to methodological challenges. A key issue is the lack of consensus on whether and how to screen for cognitive impairment and on how to assess efficacy. We suggest that screening for cognitive impairment is critical and should involve objective neuropsychological tests. We also recommend that the primary outcome is a composite of neuropsychological tests with socio-occupational function as co-primary or secondary outcome. Trials should include fully or partially remitted patients, ensure that concomitant medication is kept stable and that statistical methods include mixed models or similar ways to take account of missing values. Future treatment development should implement a ‘circuit-based’ neuroimaging biomarker model to examine neural target engagement. Interventions targeting multiple treatment modalities may also be beneficial.

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