A randomized double-blind controlled trial recently published in the Journal of Clinical Psychiatry showed that cognitive remediation (CR) improves cognitive function in patients with bipolar disorder. The study looked at 75 patients with a DSM-IV diagnosis of bipolar disorder with a history of psychosis. Patients were randomized to a 70-hour computer-based CR program or a dose-matched computer control. Cognition, the primary outcome, and clinical and community functioning, the secondary outcomes, were assessed at baseline, midway through treatment, posttreatment, and at a follow-up after 6 months of no study contact. CR is a behavioral intervention targeting the cognitive symptom dimension to improve cognitive functioning. The computer-based CR program used in the study was PositScience.
At baseline, the CR and control groups did not differ on any characteristics, cognitive scores, chlorpromazine equivalents or lithium dose, total number of medications prescribed, or proportion of patients on any given class of medication. Study investigators found a medium to large effects of CR at posttreatment in several cognitive domains, including: processing speed (d =0.42; P ≤ 0.10), visual learning and memory (d =0.92; P < 0.05), and composite (d =0.80; P < 0.05). At 6-month follow-up, superiority of CR over the control group was seen for processing speed (d =0.65; P < 0.05), composite (d =0.83; P < 0.05), and a trend for verbal learning and memory (d=0.67; P ≤ 0.10). CR was not associated with change in community functioning, the secondary endpoint. Overall, cognitive remediation produced significant improvements over an active control in several cognitive domains and the cognitive composite.
>> Lewandowski KE, Sperry SH, Cohen BM, et al. Treatment to Enhance Cognition in Bipolar Disorder (TREC-BD): Efficacy of a Randomized Controlled Trial of Cognitive Remediation Versus Active Control. J Clin Psychiatry. 2017;ePub ahead of print