Pathophysiological relationships between cognitive deficit in bipolar affective disorder and metabolic syndrome

Abstract

Introduction and objectives

Bipolar disorder (BD) has been related to various cognitive dysfunctions as well as to a high prevalence of metabolic syndrome (MS), which seems to influence the cognitive performance of patients with BD. Therefore, different hypotheses have been generated to try to explain the pathophysiological relationship between cognitive deficit in BD and MS. The objective was to review the current literature regarding the possible pathophysiological explanation of the relationship between BD and MS and its effect on cognitive performance of patients with BD.

Methods

A bibliographic search was carried out using MEDLINE, ClinicalKey, EMBASE, Literatura Latino-Americana y del Caribe en Ciencias de la Salud [Latin American and Caribbean Literature in Health Sciences] (LILACS), APA PsycNet, Scopus and Scielo databases, and the Pan-American Medical Electronic Library; using the following search terms: “bipolar disorder”[MeSH Terms] OR “bipolar disorder”[All Fields] OR “mood disorders”[All Fields] AND “cognitive deficit”[MeSH Terms] OR “cognitive deficit”[All Fields] OR “cognitive dysfunction”[All Fields] OR “cognitive impairment”[All Fields] OR “cognitive decline”[All Fields] AND “metabolic syndrome” [MeSH Terms] OR “metabolic abnormalities”[All Fields] OR “metabolic effects”[All Fields] OR “obesity” [All Fields] OR “abdominal obesity” [All Fields] OR “overweight” [All Fields] OR “diabetes” [All Fields] OR “hypertension” [All Fields] AND “antipsychotics” [MeSH Terms] OR “antipsychotics”[All Fields] AND “antidepressants” [MeSH Terms] OR “antidepressants”[All Fields] AND “mood stabilizers” [MeSH Terms] OR “mood stabilizers”[All Fields]. Filters: free full text, full text, from 2001 to 2022. A total of 80 articles in Spanish and English, of any type of design, were selected. Selection and reading were carried out by all the authors.

Results and conclusions

The various pathophysiological hypotheses proposed, inflammatory, endocrine, drug, environmental and social, suggest that a series of changes at the macro and microcellular level are correlated in patients with BD and MS with a negative effect on cognition of patients both globally and in specific domains, mainly executive function, memory, attention, and perceptual motor skills. Research processes should be continued to explore the various hypotheses that support the relationship between BD, MS and cognition.

Resumen

Introducción y objetivos

El trastorno bipolar (TB) se ha relacionado con diversas disfunciones cognitivas y una alta prevalencia de síndrome metabólico (SM), el cual parece influir en el desempeño cognitivo de los pacientes con TB, por lo que se han generado diferentes hipótesis para tratar de explicar la relación fisiopatológica entre el déficit cognitivo en el TB y el SM. El objetivo es revisar la literatura en busca de las posibles explicaciones fisiopatológicas de la relación entre TB y SM y su efecto en el desempeño cognitivo de los pacientes con TB.

Métodos

Se realizó una búsqueda bibliográfica utilizando las bases de datos MEDLINE, ClinicalKey, EMBASE, Literatura Latino-Americana y del Caribe en Ciencias de la Salud (LILACS), APA PsycNet, Scopus y Scielo, y la librería electrónica Médica Panamericana; se utilizaron los siguientes términos de búsqueda: “bipolar disorder”[MeSH Terms] OR “bipolar disorder”[All Fields] OR “mood disorders”[All Fields] AND “cognitive deficit”[MeSH Terms] OR “cognitive deficit”[All Fields] OR “cognitive dysfunction”[All Fields] OR “cognitive impairment”[All Fields] OR “cognitive decline”[All Fields] AND “metabolic syndrome” [MeSH Terms] OR “metabolic abnormalities”[All Fields] OR “metabolic effects”[All Fields] OR “obesity” [All Fields] OR “abdominal obesity” [All Fields] OR “overweight” [All Fields] OR “diabetes” [All Fields] OR “hypertension” [All Fields] AND “antipsychotics” [MeSH Terms] OR “antipsychotics”[All Fields] AND “antidepressants” [MeSH Terms] OR “antidepressants”[All Fields] AND “mood stabilizers” [MeSH Terms] OR “mood stabilizers”[All Fields] Filters: Free full text, Full text, from 2001-2022. Se seleccionaron en total 80 artículos en español y en inglés, de cualquier tipo de diseño. Todos los autores efectuaron la selección y la lectura.

Resultados y conclusiones

Las diversas hipótesis fisiopatológicas descritas (inflamatoria, endocrina, medicamentosa, ambiental y social) plantean que una serie de cambios macrocelulares y microcelulares se correlacionan en los pacientes con TB y SM con un efecto negativo en la cognición de los pacientes, tanto general como en dominios específicos, principalmente función ejecutiva, memoria, atención y habilidades perceptuales motoras. Deben continuarse los procesos de investigación que permitan explorar las diversas hipótesis que sustentan la relación entre TB, SM y cognición.