Asks for Information on Specific Treatments for Cognitive Deficits
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Q:  Asks for Information on Specific Treatments for Cognitive Deficits

Dear Dr. Phelps, 

I am a 44 year old female diagnosed wth BP.  My initial dagnosis was when I was thirty but I didn't receive treatment until I was forty.  I am fairly certain I  developed pre pubescent based on my childhood memories an my nieces diagnosis at 13.  I have been identified as  having a high IQ but I have started to demonstrate severe cognitive deficits.  From my research I have found that the type of cognitive deficiencies are normal for BP even in euthymic bipolar patients. 

I take 20 mg of Lamictal daily but most data suggests that no additional deficit in cognitive function has been attributed to this medication at that dosage.  The dysfunction appears to be progressively increasing and has begun to affect my daily functioning.  I am a trainer at my job and my verbal and word retrieval dysfunction is interfering with my ability to affectively transfer knowledge to my trainees.  Also, my husband has become more and more frustrated with my  response delay to questions and slowed thought processing.    I can not find any information on treatment nor suggestions on how to improve functioning either using medication (which I must admit I shy away from fearing a the  treatment will mess up the positive effect of the Lamictal in controlling the moods) or some other form of retraining to alleviate some of the symptoms.  I am afraid I am destined to become a Gomer and it terrifies me.  If you could please make a suggestion as to where I might find some information on specific treatments for cognitive deficits I would truly  appreciate it. 

Thank you for your time and consideration.



Dear Allison --

An interesting case series was just published on this question, to which I will refer you in a moment. 

However, first things first: if you're still having symptoms, I think most mood experts would agree that the first step is to get those symptoms under control, then reevaluate your cognitive function.  In the process you will of course want to make sure that your thyroid function has been assessed and found to be not only normal, but perhaps nearer the "hyperthyroid" end of the normal range. 

From my experience, I would be particularly interested in how you are sleeping.  If you have difficulty falling asleep or staying asleep, that might be a good sign, ironically.  If so, if you took steps to normalize your sleep pattern, that might have a significant impact on your daytime concentration and memory.  At least there is good reason to hope so; and that is a treatment step you would probably want to take anyway. 

Likewise, if you're still having "cycling", suggesting that the bipolar process is not completely under control, then additional steps to decrease cycling -- hopefully to 0 -- might also lead to improvement in cognitive function.  I think most mood experts would agree that these steps are worth taking first before thinking about this next idea. 

Dr. Tam Kelly, a psychiatrist in Fort Collins, Colorado, would probably answer your question by referring you to a paper he just published: Is donepezil useful for improving cognitive dysfunction in bipolar disorder?  As you can see from the summary , two thirds of the 58 patients he treated with this approach showed improvement.  He did see some worsening of symptoms in some cases, suggesting that this approach warrants caution. 

Good luck with the process --

Dr. Phelps

Published August, 2008


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