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Domain-specific cognitive function in euthymic bipolar disorder: a systematic review and meta-analysis.

Samuel Swidzinski¹, Dimosthenis Tsapekos¹, Pricilla Swidzinska¹

¹Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.

Psychological Medicine

|November 5, 2025

Summary

Euthymic bipolar disorder (BD) is linked to significant cognitive impairments across multiple domains, including memory and executive function. These deficits impact daily functioning and suggest targets for future therapeutic interventions.

Keywords:

bipolar disorder cognitive functioning euthymia meta-analysis systematic review

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Area of Science:

Neuroscience
Psychiatry
Cognitive Psychology

Background:

Euthymic bipolar disorder (BD) is characterized by cognitive impairments affecting general and specific domains.
These cognitive deficits are associated with poorer occupational and social functioning in individuals with BD.

Purpose of the Study:

To systematically review and meta-analyze cognitive functioning in euthymic bipolar disorder (BD).
To identify specific cognitive domains affected in euthymic BD and explore potential influencing factors.

Main Methods:

A comprehensive literature search was conducted across Embase, Medline, and PsycInfo databases up to June 2024.
Meta-analysis and meta-regressions were employed to analyze cognitive data, including premorbid IQ, demographic, and clinical variables.
Study quality, heterogeneity, and publication bias were assessed using established statistical methods and procedures.

Main Results:

The meta-analysis included 75 studies with 4,404 individuals with BD and 4,037 healthy controls (HC).
Significant cognitive impairments were observed in BD across general functioning, verbal memory, executive function, visuo-spatial memory, attention/processing speed, and working memory.
While demographic and clinical factors showed limited association, higher education correlated with less verbal memory impairment.

Conclusions:

Euthymic bipolar disorder (BD) is associated with widespread cognitive deficits, highlighting key areas for intervention development.
Unexplained variance in cognitive performance necessitates further research with larger datasets and individual-level data analysis.