Sustained cognitive and functional effects of pro-cognitive interventions for bipolar disorder: A systematic review of randomised controlled trials.

Michail Kalfas; Anna Tr&#xf6;ger; Elliot Hampsey; Rebecca Strawbridge; Kamilla W Miskowiak; Sameer Jauhar; Allan H Young; Dimosthenis Tsapekos

doi:10.1016/j.jad.2026.122390

PubMed · 42607892

Sustained cognitive and functional effects of pro-cognitive interventions for bipolar disorder: A systematic review of randomised controlled trials.

Michail Kalfas·Anna Tröger·Elliot Hampsey·Rebecca Strawbridge·Kamilla W Miskowiak·Sameer Jauhar·Allan H Young·Dimosthenis Tsapekos

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Abstract

A substantial proportion of individuals with bipolar disorder (BD) experience considerable cognitive deficits. Existing systematic reviews have evaluated the efficacy of pro-cognitive interventions in BD, but have not established whether any cognitive benefits translate into functional improvements, with evidence for sustained functional effects remaining limited. A systematic search was conducted on MEDLINE, EMBASE, PsycINFO and Cochrane Library from inception until 21 May 2026. Eligible studies were randomised controlled trials (RCTs) in BD reporting cognitive or functional outcomes at three or more months following a pro-cognitive intervention, or examining the translation of cognitive benefits into improvements in functional outcomes at any timepoint. Seven unique RCTs plus three secondary analyses of these trials (n = 615) met the inclusion criteria. Approximately 13% (7/55) of RCTs identified in the search of pro-cognitive interventions in adult BD assessed cognitive or functional outcomes at least 3 months after treatment end. Of the seven unique RCTs, most evaluated cognitive remediation (CR; k = 4). The average follow-up length was 4 months (range: 3-6 months). Three of the four RCTs examining CR reported cognitive benefits at 3 to 6 months, whereas only one CR RCT found consistent functional effects at 3 months. Evidence on the translation of cognitive benefits to functional improvements is scarce and inconsistent. Most trials examining pro-cognitive interventions do not examine whether potential benefits are sustained or whether they translate into improvements in real-world functioning. CR appears to be a promising intervention for achieving durable cognitive gains in BD, although evidence for sustained effects of other interventions is limited.

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Humans Bipolar Disorder Cognitive Dysfunction Cognitive Enhancement Cognitive Remediation Cognitive Training Randomized Controlled Trials as Topic Bipolar disorder Cognitive functioning Cognitive transfer Pro-cognitive interventions Psychosocial functioning Systematic review Journal Article Systematic Review

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Michail Kalfas, Anna Tröger, Elliot Hampsey, Rebecca Strawbridge, Kamilla W Miskowiak, Sameer Jauhar, Allan H Young, Dimosthenis Tsapekos. 2026-08-17. Sustained cognitive and functional effects of pro-cognitive interventions for bipolar disorder: A systematic review of randomised controlled trials.. https://doi.org/10.1016/j.jad.2026.122390

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Journal Article; Systematic Review resource Bipolar Disorder subject Cognitive Dysfunction subject Cognitive Enhancement subject Cognitive Remediation subject Cognitive Training subject Cognitive functioning subject Cognitive transfer subject Humans subject Journal Article subject Systematic reviews study

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