Pharmacological Treatment and Cognition in Bipolar I Disorder: Evidence From a Prospective Study in India

Bipolar I disorder is frequently accompanied by persistent cognitive dysfunction, but the extent to which routine pharmacological treatment influences subjective and objective cognition remains unclear. We sought to examine short-term changes in cognitive functioning among euthymic bipolar I disorder patients receiving routine pharmacotherapy.

In this prospective observational study, adults with bipolar I disorder in euthymia (Young Mania Rating Scale ≤10; Hamilton Depression Rating Scale ≤7) underwent cognitive assessment using the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) and the Montreal Cognitive Assessment (MoCA) at baseline and again after 3 to 4 months. Medication regimens, dose stability, adherence, and clinical variables were recorded. Paired tests evaluated within-subject cognitive change; categorical shifts were examined using the McNemar test. Limitations related to study design were explicitly evaluated.

Fifty-one participants were enrolled (median age 39 years), and 50 completed follow-up. COBRA scores improved from 7.48±7.13 to 4.04±5.94 (mean change -3.44; P <0.001), and MoCA scores increased from 23.90±4.89 to 25.84±4.40 (mean change +1.94; P <0.001). The proportion with normal cognition increased from 42% to 78% on MoCA, while COBRA-defined impairment decreased from 20% to 6%. Improvements were observed across medication classes, and no regimen demonstrated consistent superiority.

Routine pharmacological treatment was associated with short-term cognitive improvement, but the findings are preliminary and not causal.