Randomised controlled cognition trials in remitted patients with mood disorders published between 2015 and 2021: A systematic review by the International Society for Bipolar Disorders Targeting Cognition Task Force.

Kathryn E Lewandowski, Katherine E Burdick, Lars V Kessing, Lakshmi N Yatham, Tamsyn E Van Rheenen, Ivan J Torres, Tomiki Sumiyoshi, Paul Stokes, Ayal Schaffer, Scot E Purdon, Richard J Porter, Roger S McIntyre, Anabel Martinez-Aran, Carlos López-Jaramillo, Eduard Vieta, Beny Lafer, Gregor Hasler, Peter Gallagher, Katie Douglas, Annemieke Dols, Andre F Carvalho, Christopher R Bowie, Caterina Del Mar Bonnin, Mette B Jensen, Ida Seeberg, Kamilla W Miskowiak, Vicent Balanzá-Martínez, Allan H Young

Journal: Bipolar disorders 2022;24(4):354-374

PMID: 35174594

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Abstract

BACKGROUND

Cognitive impairments are an emerging treatment target in mood disorders, but currently there are no evidence-based pro-cognitive treatments indicated for patients in remission. With this systematic review of randomised controlled trials (RCTs), the International Society for Bipolar Disorders (ISBD) Targeting Cognition Task force provides an update of the most promising treatments and methodological recommendations.

METHODS

The review included RCTs of candidate pro-cognitive interventions in fully or partially remitted patients with major depressive disorder or bipolar disorder. We followed the procedures of the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) 2020 statement. Searches were conducted on PubMed/MEDLINE, PsycInfo, EMBASE and Cochrane Library from January 2015, when two prior systematic reviews were conducted, until February 2021. Two independent authors reviewed the studies with the Revised Cochrane Collaboration's Risk of Bias tool for Randomised trials.

RESULTS

We identified 16 RCTs (N = 859) investigating cognitive remediation (CR; k = 6; N = 311), direct current or repetitive magnetic stimulation (k = 3; N = 127), or pharmacological interventions (k = 7; N = 421). CR showed most consistent cognitive benefits, with two trials showing improvements on primary outcomes. Neuromodulatory interventions revealed no clear efficacy. Among pharmacological interventions, modafinil and lurasidone showed early positive results. Sources of bias included small samples, lack of pre-screening for objective cognitive impairment, no primary outcome and no information on allocation sequence masking.

CONCLUSIONS

Evidence for pro-cognitive treatments in mood disorders is emerging. Recommendations are to increase sample sizes, pre-screen for impairment in targeted domain(s), select one primary outcome, aid transfer to real-world functioning, investigate multimodal interventions and include neuroimaging.

Address: Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.; Department of Psychology, University of Copenhagen, Copenhagen, Denmark.; Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain.; Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.; Department of Psychology, Queen's University, Kingston, Canada.; IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment), Deakin University, Geelong, Vic., Australia.; Department of Old Age Psychiatry, GGZ in Geest, Amsterdam UMC, Location VUmc, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.; Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK.; Psychiatry Research Unit, University of Fribourg, Fribourg, Switzerland.; Bipolar Disorder Research Program, Institute of Psychiatry, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.; McLean Hospital, Schizophrenia and Bipolar Disorder Program, Belmont, Massachusetts, USA.; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.; Research Group in Psychiatry, Department of Psychiatry, Universidad de Antioquia, Medellín, Colombia.; Mood Disorders Psychopharmacology Unit, Brain and Cognition Discovery Foundation, University of Toronto, Toronto, Canada.; Department of Psychiatry, University of Alberta, Edmonton, Canada.; Department of Psychiatry, University of Toronto.; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.; Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.; Department of Psychiatry, University of British Columbia, Vancouver, Canada.; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Carlton, Australia.; Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University, Australia.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.

DOI: 10.1111/bdi.13193

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MeSH Terms: Bipolar Disorder, Cognition, Cognitive Dysfunction, Humans, Lurasidone Hydrochloride, Mood Disorders