CREST.BD Cognition & Bipolar Disorder Slides

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CREST.BDBipolar Wellness Center Webinars
Connect. Learn. Engage.

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Bipolar Wellness Center Webinars
Connect. Learn. Engage.CREST.BD
Cognition

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Connect. Learn. Engage.CREST.BDCREST.BD
Featuring: Dr. Ivan Torres
CREST.BD Member and
Clinical Associate Professor,
Department of Psychiatry,
University of British Columbia
Cognition

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Defining cognition
Cognition and BD
Why cognition is important to your QoL
Tools and resources
Webinar focus

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Defining cognition
Refers to thinking skills, eg., the ability to pay
attention, remember, process information, solve
problems and plan1
We’re all born with different cognitive capabilities
Cognitive skills can change over time, e.g.:
• worsen with illness, injury or age
• also be strengthened or improved
1
Medalia, A., Revheim, N. (2002). Dealing with Cognitive Dysfunction Associated with Psychiatric Disabilities. New York
State Office of Mental Health.

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Cognition and BD
BD can be associated with decreases in learning, verbal memory,
planning, decision-making and/or ability to focus attention2
Or, may not be associated with any cognitive problems at all3
Cognitive problems most obvious during mood episodes,
especially severe depression or mania4
• can continue even when not experiencing mood symptoms
Primary symptom of BD, not just related to mood symptoms1
1
Medalia, A., Revheim, N. (2002). Dealing with Cognitive Dysfunction Associated with Psychiatric Disabilities. New York State Office of Mental
Health.
2
Sole, B., Bonnin, C.M., Torrent, C et al. (2012). Neurocognitive impairment across the bipolar spectrum. CNC Neurosciences & Therapeutics, 18:
194-200.
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Osuji, I.J., Cullum, C.M. (2005). Cognition in BD Psychiatr Clin North Am, 28(2): 427-41
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Torres, I.J., Malhi, G.S. (2010). Neurocognitive in BD. Chapter 8 in Yatham LN & Maj M (eds), BD: clinical and neurobiological foundations, 2010,
John Wiley & Sons: 71.

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Age
Recreational drugs, alcohol or substance misuse
Medications
Sleep problems
Cognition and BD
Factors contributing to cognition in BD:

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Why is cognition important to QoL?
Cognitive skills are necessary for success in many QoL areas, e.g.:
independent living and everyday functioning
work and education
leisure activities
maintaining social relationships and roles
Research has linked cognitive function to QoL in people with BD5
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Mackala, S.A., Torres, I.J., Kozicky, J., Michalak, E.E., Yatham, L.N. (2014). Cognitive performance and QoL early in the
course of BD. J Affect Disord. 2014 Jul 2, 168C: 119-124.

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How you can take action
Pay attention to cognitive changes or problems
Track changes in memory, attention, alertness and thinking
Be vigilant for cognitive changes with different medications or
mood phases1
Engage others, such as a family member or healthcare
professionals to help track changes
1

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How you can take action
Report any changes to your doctor and healthcare team
Empowers you to work with your healthcare team to
explore medication changes that could help
Be open with your healthcare team about recreational
substance use, other medications you’re taking or
changes in the way you’re taking them

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Cognitive rehabilitation strategies
Refers to activities that help restore cognition to a healthy state
Includes managing cognitive problems via 3 different methods1
1. Remediation techniques
2. Compensatory strategies
3. Adaptive approaches
An assessment by a healthcare professional can help you decide
which unique approach may be most helpful
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Remediation techniques
Research on remediation techniques is in its infancy, but shows
promise for cognitive training in people with mood disorders, including
some (but not all) people with BD6
While you may improve your results on the specific tasks you practice,
it’s still uncertain how helpful this will be to your overall functioning7
Remediation techniques:
• focus on improving thinking with drills and exercises (may involve
computers, paper and pencil, or group activities)
• don’t offer a quick fix: progress takes time and effort
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Bowie, C.R., Gupta, M., Holshausen, K. (2013). Cognitive remediation therapy for mood disorders: rationale, early
evidence, and future directions. Canadian Journal of Psychiatry, 58: 319-325.
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Owen, A., Hampshire, A., Grahn, J.A., Stenton, R., Dajani, S., Burns, A.S., Howard, R., Ballard, C.G. (2010). Putting Brain
Training to the Test. Nature, 465(7299):775-55.

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Compensatory strategies
helping identify different
ways to accomplish goals by
‘compensating’ for cognitive
challenges
cognitive strengths can be
used to override cognitive
weaknesses
e.g., can learn mnemonics (or
‘memory aids’) to help you
remember things
Focus on:

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Adaptive approaches
Focus on:
changes to your
environment
e.g., recording devices
to help you keep track of
important information,
or reminders

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Final Tips
Keep communication and activities simple, direct, short
Keep activities to one thing at a time; avoid
multi-tasking
Rest; fatigue can make cognitive problems worse
Limit distractions
Balance activities so that you have a blend of physical,
mental and social activities to keep your interest up and
prevent fatigue
Keep activities and tasks structured and organized

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Tools and Resources

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Resources
CogniFit
This online cognitive training program provides tools to measure cognitive
skills, and build on these skills through entertaining games and tracking one’s
progress. Caveat: The efficacy of these resources has yet not been evaluated in people with BD
https://www.cognifit.com/

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Resources
Lumosity
This is a similar online cognitive training website, using interactive games to
“train memory and attention” through a “personalized training program.”
Caveat: The efficacy of these resources has yet not been evaluated in people with BD
www.lumosity.com

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Resources
Dealing with Cognitive Dysfunction Associated with Psychiatric Disabilities
A handbook for families and friends of individuals with psychiatric disorders,
written by Alice Medalia, Ph.D.and Nadine Revheim, Ph.D.
https://www.omh.ny.gov/omhweb/cogdys_manual/CogDysHndbk.htm

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For more information and resources,
visit our Bipolar Wellness Center at:
http://www.bdwellness.com/
To assess your quality of life,
visit our QoL tool at:
http://www.bdqol.com/

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Acknowledgments

CREST.BD Cognition & Bipolar Disorder Slides

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CREST.BD Cognition & Bipolar Disorder Slides