Prophylactic lithium treatment and cognitive performance in patients with a long history of bipolar illness: no simple answers in complex disease-treatment interplayReportar como inadecuado

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International Journal of Bipolar Disorders

, 2:16

First Online: 24 December 2014Received: 03 September 2014Accepted: 15 November 2014


Cognitive impairment in patients with bipolar disorder BD is not restricted to symptomatic phases. It is also present in euthymia. There is evidence of differences in the brain’s structure between bipolar patients and healthy individuals, as well as changes over time in patients. Lithium constitutes the gold standard in long-term prophylactic treatment. Appropriate therapy that prevents new episodes improves the disease’s course and reduces the frequency of harmful outcomes. Interestingly, preclinical data suggest that lithium has a additional neuroprotective effect. There is limited data on its related effects in humans and even less on its long-term application. In this multi-center cross-sectional study from the International Group for the Study of Lithium-treated Patients IGSLi, we compared three groups: bipolar patients without long-term lithium treatment non-Li group; <3 months cumulative lithium exposure, ≥24 months ago, bipolar patients with long-term lithium treatment Li group, ongoing treatment ≥24 months, and healthy subjects controls. Strict inclusion and exclusion criteria were defined; the inclusion criteria for patients were diagnosis of BD types I or II, duration of illness ≥10 years, ≥5 episodes in patient’s history and a euthymic mood state. Neurocognitive functioning was assessed using the Wechsler Adult Intelligence Scale-Revised WAIS-R, the California Verbal Learning Test CVLT, and a visual backward masking VBM task. A total of 142 subjects were included, 31 in the non-Li and 58 in the Li group, as well as 53 healthy controls. Treated patients with long-standing BD and controls did not differ significantly in overall cognitive functioning and verbal learning, recall, and recognition; regardless of whether lithium had been part of the treatment. Patients, however, demonstrated poorer early visual information processing than healthy controls, with the lithium-treated patients performing worse than those without. Our data suggest that bipolar patients with a long illness history and effective prophylactic treatment do not reveal significantly impaired general cognitive functioning or verbal learning and memory. However, they are worse at processing early visual information. Accompanying volumetric and spectroscopic data suggest cell loss in patients not treated with lithium that may be counterbalanced by long-term lithium treatment.

KeywordsLithium Bipolar disorder Cognition Electronic supplementary materialThe online version of this article doi:10.1186-s40345-014-0016-7 contains supplementary material, which is available to authorized users.

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Autor: Andrea Pfennig - Martin Alda - Trevor Young - Glenda MacQueen - Janusz Rybakowski - Aleksandra Suwalska - Christian Simhand


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