Efficacy of cognitive and functional remediation in bipolar disorder: a meta-analysis of randomized controlled trials

Abstract

Introduction: A significant percentage of people with bipolar disorder (BD) exhibit conspicuous deficits in everyday functioning, even when appropriately treated and after symptomatic recovery is achieved. Given that cognitive impairment is one of the strongest correlates of socio-occupational outcomes and quality of life in BD, cognitive remediation (CR) has been proposed in recent years as a promising treatment that could help bridge the gap between symptomatic and full functional recovery. The aim of this study was to explore the efficacy of CR in improving executive deficits and functional outcomes in BD patients.Method: PubMed, PsycINFO, and CENTRAL were searched from inception to August 2022. Only randomized controlled trials exploring the effects of CR on cognition or functional adjustment in adult BD patients were eligible. Change-score effect sizes (Hedges’ g) were obtained and combined by means of meta-analytic procedures (PROSPERO, CRD42022306504). Results: Nine studies reporting the results of six independent trials (n = 544) were included. Meta-analytic findings revealed small durable improvements in working memory (g = 0.34; 95% CI = 0.12 to 0.56) and planning (g = 0.30; 95% CI = 0.03 to 0.56). However, no significant effects of CR were observed on functional outcomes at treatment completion or at follow-up assessment. Conclusion: Though CR may produce a modest improvement in some aspects of executive functioning, it has not proven to exert any effect on the functional outcomes of BD patients. The best evidence available does not support the inclusion of CR as recommendation in treatment guidelines.