Insights, challenges and new frontiers for cognitive function in bipolar disorder

Cognitive impairment in various domains—including attention, memory and executive function—is a common feature of bipolar disorder (BD) that persists beyond mood episodes and greatly impacts daily functioning, prognosis and treatment outcomes. Yet, the mechanisms and clinical implications of this cognitive impairment remain insufficiently understood. In this narrative Review, we synthesize cutting-edge findings from multidisciplinary research on cognitive function in people with BD that provide the foundation for a paradigm shift in recognizing cognitive impairment as an independent treatment target in BD. Furthermore, we discuss cognition as a moderator of illness trajectory in BD, with implications extending beyond BD to other psychiatric disorders, highlighting the transdiagnostic relevance for improving cognition across psychiatric disorders. Finally, we provide recommendations for clinicians to screen for cognitive impairments and suggest perspectives for strategies to target cognition and improve cognitive functioning in BD.