The effects of cognitive remediation on cognitive abilities and real-world functioning among people with bipolar disorder: A systematic review

Marcella Bellani, B. Biagianti, Niccolò Zovetti, Maria Gloria Rossetti, Cinzia Bressi, Cinzia Perlini, P. Brambilla

Research output: Contribution to journalArticle

Abstract

Background: Bipolar disorder (BD) is characterized by cognitive impairments that are known to predict psychosocial functioning and quality of life. While cognitive remediation (CR) was originally developed to directly target cognitive symptoms in traumatic brain injury and psychotic illnesses, the efficacy of CR in BD has begun to emerge only in the last decade. Functional Remediation (FR) is an integrated intervention that has been developed to restore psychosocial functioning by means of ecological neurocognitive techniques that involve psychoeducation about cognitive dysfunctions and their impact on the general functioning. Because of the heterogeneity of treatment targets and mechanisms of actions, here we aim to illustrate the effects induced by existing CR/FR approaches in BD. Methods: In this systematic review, we evaluated cognitive and functional outcomes after CR/FR in studies conducted in BD. Results: Eleven studies met inclusion criteria: 3 RCTs that compared CR/FR to one or more control condition (n = 354), 5 secondary analyses that further examined data from these trials, 2 single-arm studies, and 1 naturalistic study. While features such as the use of computerized training tools and a group-based format recurred across studies, CR/FR paradigms targeting different cognitive and functional domains showed specificity of training focus to outcomes. Effect sizes were in the medium-large range, suggesting that patients with BD respond to treatment at or above the level reported in psychotic patients. Integrated approaches that combined cognitive exercises with group-based experiences were associated with both cognitive and functional improvements. Conclusions: In this review, we found support for the use of CR/FR paradigms in patients with BD with evidence of cognitive and functional improvements. The scarcity of currently published RCTs as well as of data examining mechanisms of action and neural correlates limits the generalizability of our findings.

Original languageEnglish
Pages (from-to)691-697
Number of pages7
JournalJournal of Affective Disorders
Volume257
DOIs
Publication statusPublished - Oct 1 2019

Fingerprint

Aptitude
Bipolar Disorder
Neurobehavioral Manifestations
Cognitive Remediation
Quality of Life
Exercise
Therapeutics

Keywords

  • Affective disorder
  • Bipolar disorder
  • Cognitive remediation
  • Functional remediation

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

The effects of cognitive remediation on cognitive abilities and real-world functioning among people with bipolar disorder : A systematic review. / Bellani, Marcella; Biagianti, B.; Zovetti, Niccolò; Rossetti, Maria Gloria; Bressi, Cinzia; Perlini, Cinzia; Brambilla, P.

In: Journal of Affective Disorders, Vol. 257, 01.10.2019, p. 691-697.

Research output: Contribution to journalArticle

@article{10304cae3cab4b97a57d0c563ec9b9d1,
title = "The effects of cognitive remediation on cognitive abilities and real-world functioning among people with bipolar disorder: A systematic review",
abstract = "Background: Bipolar disorder (BD) is characterized by cognitive impairments that are known to predict psychosocial functioning and quality of life. While cognitive remediation (CR) was originally developed to directly target cognitive symptoms in traumatic brain injury and psychotic illnesses, the efficacy of CR in BD has begun to emerge only in the last decade. Functional Remediation (FR) is an integrated intervention that has been developed to restore psychosocial functioning by means of ecological neurocognitive techniques that involve psychoeducation about cognitive dysfunctions and their impact on the general functioning. Because of the heterogeneity of treatment targets and mechanisms of actions, here we aim to illustrate the effects induced by existing CR/FR approaches in BD. Methods: In this systematic review, we evaluated cognitive and functional outcomes after CR/FR in studies conducted in BD. Results: Eleven studies met inclusion criteria: 3 RCTs that compared CR/FR to one or more control condition (n = 354), 5 secondary analyses that further examined data from these trials, 2 single-arm studies, and 1 naturalistic study. While features such as the use of computerized training tools and a group-based format recurred across studies, CR/FR paradigms targeting different cognitive and functional domains showed specificity of training focus to outcomes. Effect sizes were in the medium-large range, suggesting that patients with BD respond to treatment at or above the level reported in psychotic patients. Integrated approaches that combined cognitive exercises with group-based experiences were associated with both cognitive and functional improvements. Conclusions: In this review, we found support for the use of CR/FR paradigms in patients with BD with evidence of cognitive and functional improvements. The scarcity of currently published RCTs as well as of data examining mechanisms of action and neural correlates limits the generalizability of our findings.",
keywords = "Affective disorder, Bipolar disorder, Cognitive remediation, Functional remediation",
author = "Marcella Bellani and B. Biagianti and Niccol{\`o} Zovetti and Rossetti, {Maria Gloria} and Cinzia Bressi and Cinzia Perlini and P. Brambilla",
year = "2019",
month = "10",
day = "1",
doi = "10.1016/j.jad.2019.07.059",
language = "English",
volume = "257",
pages = "691--697",
journal = "Journal of Affective Disorders",
issn = "0165-0327",
publisher = "Elsevier",

}

TY - JOUR

T1 - The effects of cognitive remediation on cognitive abilities and real-world functioning among people with bipolar disorder

T2 - A systematic review

AU - Bellani, Marcella

AU - Biagianti, B.

AU - Zovetti, Niccolò

AU - Rossetti, Maria Gloria

AU - Bressi, Cinzia

AU - Perlini, Cinzia

AU - Brambilla, P.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Background: Bipolar disorder (BD) is characterized by cognitive impairments that are known to predict psychosocial functioning and quality of life. While cognitive remediation (CR) was originally developed to directly target cognitive symptoms in traumatic brain injury and psychotic illnesses, the efficacy of CR in BD has begun to emerge only in the last decade. Functional Remediation (FR) is an integrated intervention that has been developed to restore psychosocial functioning by means of ecological neurocognitive techniques that involve psychoeducation about cognitive dysfunctions and their impact on the general functioning. Because of the heterogeneity of treatment targets and mechanisms of actions, here we aim to illustrate the effects induced by existing CR/FR approaches in BD. Methods: In this systematic review, we evaluated cognitive and functional outcomes after CR/FR in studies conducted in BD. Results: Eleven studies met inclusion criteria: 3 RCTs that compared CR/FR to one or more control condition (n = 354), 5 secondary analyses that further examined data from these trials, 2 single-arm studies, and 1 naturalistic study. While features such as the use of computerized training tools and a group-based format recurred across studies, CR/FR paradigms targeting different cognitive and functional domains showed specificity of training focus to outcomes. Effect sizes were in the medium-large range, suggesting that patients with BD respond to treatment at or above the level reported in psychotic patients. Integrated approaches that combined cognitive exercises with group-based experiences were associated with both cognitive and functional improvements. Conclusions: In this review, we found support for the use of CR/FR paradigms in patients with BD with evidence of cognitive and functional improvements. The scarcity of currently published RCTs as well as of data examining mechanisms of action and neural correlates limits the generalizability of our findings.

AB - Background: Bipolar disorder (BD) is characterized by cognitive impairments that are known to predict psychosocial functioning and quality of life. While cognitive remediation (CR) was originally developed to directly target cognitive symptoms in traumatic brain injury and psychotic illnesses, the efficacy of CR in BD has begun to emerge only in the last decade. Functional Remediation (FR) is an integrated intervention that has been developed to restore psychosocial functioning by means of ecological neurocognitive techniques that involve psychoeducation about cognitive dysfunctions and their impact on the general functioning. Because of the heterogeneity of treatment targets and mechanisms of actions, here we aim to illustrate the effects induced by existing CR/FR approaches in BD. Methods: In this systematic review, we evaluated cognitive and functional outcomes after CR/FR in studies conducted in BD. Results: Eleven studies met inclusion criteria: 3 RCTs that compared CR/FR to one or more control condition (n = 354), 5 secondary analyses that further examined data from these trials, 2 single-arm studies, and 1 naturalistic study. While features such as the use of computerized training tools and a group-based format recurred across studies, CR/FR paradigms targeting different cognitive and functional domains showed specificity of training focus to outcomes. Effect sizes were in the medium-large range, suggesting that patients with BD respond to treatment at or above the level reported in psychotic patients. Integrated approaches that combined cognitive exercises with group-based experiences were associated with both cognitive and functional improvements. Conclusions: In this review, we found support for the use of CR/FR paradigms in patients with BD with evidence of cognitive and functional improvements. The scarcity of currently published RCTs as well as of data examining mechanisms of action and neural correlates limits the generalizability of our findings.

KW - Affective disorder

KW - Bipolar disorder

KW - Cognitive remediation

KW - Functional remediation

UR - http://www.scopus.com/inward/record.url?scp=85069959536&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85069959536&partnerID=8YFLogxK

U2 - 10.1016/j.jad.2019.07.059

DO - 10.1016/j.jad.2019.07.059

M3 - Article

AN - SCOPUS:85069959536

VL - 257

SP - 691

EP - 697

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

SN - 0165-0327

ER -