Aside from the obvious mood difficulties that are inherent to individuals suffering from Bipolar Disorder (see Understanding Bipolar Disorder), memory, attention, and executive functioning can also be compromised. Attention is “the ability to selectively and flexibly process some information in the environment at the expense of other information.” Executive Functioning is a “broad term that refers to a collection of higher-level cognitive processes, including planning, working memory, strategy development, inhibitory control and cognitive flexibility” (Goldberg et al. 2008). In regards to memory, studies have demonstrated that working memory is most affected in those struggling with Bipolar Disorder (Douglas et al. 2015).
The above-mentioned cognitive impairments are more pronounced when an individual is in a manic or depressed state but can remain present when the individual is in a euthymic state (stable mood state). There is a positive correlation between the number/severity of episodes and increased cognitive deficits. In other words, the more severe and chronic the symptoms, the more likely an individual will struggle with attention, memory, and executive functioning difficulties. In addition, 50% of clients with bipolar disorder also have an underlying anxiety disorder that can negatively affect cognitive functioning. Medications used to treat anxiety and stabilize mood can also affect cognition.
What can I Do about it? (Goldberg et al. 2008)
- Impaired Attention
- Continue to summarize conversations and redirect back to the topic at hand
- Build redundancies into daily life (i.e. have significant structure so that one can almost be on autopilot)
- Impaired memory
- Write down past experiences/lessons following an extreme mood state (then review these lessons/experiences when another extreme mood state is experienced and judgment is impaired)
- Write out daily lists of what needs to be accomplished; review this list daily, at the same time, every day
- Take notes whenever there is doubt that information will not be retained
- Executive Functioning
- Set specific long-term and short term-goals and review them on a regular basis
- Delay response in decision-making (to avoid acting out of impulsivity) by waiting 24 hours by before making a major decision and by referring back to your personal goals
- Use calendars, alarms, schedules, etc. to improve organization
Cognitive remediation may also be an option to improve memory, attention and executive functioning. Cognitive remediation involves targeting the predetermined areas of cognitive deficits and working on specifically tailored exercises, frequently completed using a computer software program, to improve function in these areas. Preliminary research indicates promising findings for treating cognitive dysfunction in individuals with Bipolar Disorder. (Veeh et al. 2017)
Impaired memory, attention, and executive functioning can range from being mildly frustrating to being significant enough to impact mood, relationships, and career or functioning at school. When learning to manage Bipolar Disorder, emphasis is usually placed on developing coping skills and finding the right combination of medications to stabilize mood. Once the mood is stable, however, changes in cognitive abilities are seldom addressed, which can put an individual at higher risk for relapse if cognitive difficulties are a trigger. Therefore, it is important to offer techniques and coping skills to individuals who continue to demonstrate or verbalize cognitive frustrations.
Douglas R et al. Cognitive Impairment in First Episode Mania: A Systematic Review of the Evidence in the Acute and Remission Phases of the Illness. International Journal of Bipolar Disorder. 2015 3:9
Goldberg F, Burdick, K. Cognitive Dysfunction in Bipolar Disorder: A Guide for Clinicians. Washington DC: American Psychiatric Publishing, Inc. 2008
Veeh J, Kopf J, Kittel-Schneider S, Deckert J, Reif A. Cognitive remediation for bipolar patients with objective cognitive impairment: a naturalistic study. International Journal of Bipolar Disorder. 2017;5(1):8. Epub 2017 Apr 13
Mbali na matatizo ya hisia ambayo ni ya asili kwa watu wanaosumbuliwa na ugonjwa wa bipolar (tazama Kuelewa ugonjwa wa bipolar), kumbukumbu, umakini, na utendaji wa mtendaji pia unaweza kuathiriwa. Uwezo wa kuchagua na kubadilika kwa habari fulani katika mazingira kwa gharama ya habari nyingine: Utendaji wa Utekelezaji ni neno pana linalomaanisha mkusanyiko wa michakato ya utambuzi wa kiwango cha juu, ikiwa ni pamoja na mipango, kumbukumbu ya kazi, maendeleo ya mkakati, udhibiti wa kuzuia na kubadilika kwa utambuzi. 2008) na Kwa habari ya kumbukumbu, utafiti umeonyesha kwamba kumbukumbu ya kazi huathiriwa zaidi kwa wale wanaopambana na Ugonjwa wa Bipolar (Douglas et al. 2015) na Uharibifu wa utambuzi unaotajwa hapo juu ni dhahiri zaidi wakati mtu yuko katika hali ya manic au depressive lakini anaweza kubaki wakati mtu yuko katika hali ya euthymic (hali ya hali ya hali ya hewa). Kuna uhusiano mzuri kati ya idadi ya matukio na kuongezeka kwa upungufu wa utambuzi. Kwa maneno mengine, kadiri dalili zinavyozidi kuwa kali na sugu, ndivyo mtu anavyozidi kuwa na matatizo ya kukaza fikira, kukumbuka, na kufanya kazi. Kwa kuongezea, asilimia 50 ya wateja wenye ugonjwa wa bipolar pia wana shida ya wasiwasi ambayo inaweza kuathiri vibaya utendaji wa utambuzi. Dawa zinazotumiwa kutibu wasiwasi na kudumisha hali ya moyo zinaweza pia kuathiri uwezo wa kutambua mambo. Ninaweza Kufanya Nini Kuhusu Jambo Hilo? (Goldberg et al. "Mtazamo wa ""Uwezo wa kujadili"" - Kuongeza na kuharakisha mazungumzo na kurudisha tena kwenye mada ya karibu - Kujenga redundancy katika maisha ya kila siku." "Kumbuka: ""Kumbuka mambo yaliyopita baada ya hali ya hali ya juu (na kisha angalia masomo haya wakati hali nyingine ya hali ya juu inapatikana na uamuzi umeharibiwa) "" - ""Kuchora orodha ya kila siku ya kile kinachohitaji kutimizwa; angalia orodha hii kila siku, wakati huo huo, kila siku - ""Kuchukua maelezo wakati wowote kuna shaka kwamba habari haitakuwa kuhifadhiwa - ""Kufanya kazi ya Utekelezaji - Kuweka maalum ya muda mrefu na muda mfupi-lengo na kuikagua mara kwa mara - ""Kuchelewesha majibu katika maamuzi (kuepuka kutenda nje ya impulsivity) kwa masaa 24 kabla ya kufanya uamuzi mkubwa." Ili kuboresha shirika, matibabu ya utambuzi yanaweza pia kuwa chaguo la kuboresha kumbukumbu, umakini na utendaji wa mtendaji. Matibabu ya utambuzi (Cognitive remediation) ni hatua ya kuelekeza maeneo yaliyowekwa mapema ya upungufu wa utambuzi na kufanya mazoezi maalum, mara nyingi kukamilika kwa kutumia programu ya programu ya kompyuta, ili kuboresha kazi katika maeneo haya. Utafiti wa awali unaonyesha matokeo yenye kuahidi kwa ajili ya kutibu matatizo ya utambuzi kwa watu walio na Ugonjwa wa Bipolar. (Veeh et al. Uharibifu wa kumbukumbu, umakini, na utendaji wa mtendaji unaweza kuanzia kuwa wa kukatisha tamaa kidogo hadi kuwa muhimu vya kutosha kuathiri hali ya moyo, mahusiano, na kazi au utendaji shuleni. Wakati wa kujifunza kusimamia ugonjwa wa bipolar, msisitizo kwa kawaida huwekwa juu ya kukuza ujuzi wa kukabiliana na kupata mchanganyiko sahihi wa dawa ili kudumisha hali ya moyo. Hata hivyo, mara tu hali ya moyo inapokuwa imara, mabadiliko katika uwezo wa utambuzi mara chache huzungumziwa, ambayo inaweza kumweka mtu katika hatari kubwa ya kurudi nyuma ikiwa ugumu wa utambuzi ni kichocheo. Kwa hiyo, ni muhimu kutoa mbinu na ujuzi wa kukabiliana na watu ambao kuendelea kuonyesha au verbalize kukatishwa tamaa utambuzi. Douglas R na wenzake. Uharibifu wa utambuzi katika Mania ya Kipindi cha Kwanza: Mapitio ya Mfumo wa Ushahidi katika Awamu za Akut na Remission za Ugonjwa. Jarida la Kimataifa la Matatizo ya Bipolar. Goldberg, F. Burdick, K. K. Dysfunction ya utambuzi katika ugonjwa wa bipolar: Mwongozo kwa Wataalamu wa Kliniki. "Wachapishaji wa Psychiatric ya Marekani, Inc., 2008: Veeh J., Kohlf J., Kittel-Schneider S., Decker J., Reif A., ""Uponyaji wa Kuzoea kwa Wagonjwa wa Bipolar na Uharibifu wa Kuzoea wa Lengo: Utafiti wa Asili.""" Jarida la Kimataifa la Matatizo ya Bipolar. 2017 (5 (1)):8. Epub 2017 Aprili 13