I recently got a call from an aging family member who has suffered with bipolar disorder, untreated for most of his life. He explained to me about the police cars that had “surrounded” his home and were “monitoring” him, but really were trying to harm him because they were involved in a “conspiracy with the gangsters who live down the street.”
I sighed. This was just another in a long line of these kinds of episodes, and I was pretty sure it would resolve on its own with my relative hunkering down in his house for a while until he was sure the police had gone away.
But then I decided to go see him as soon as I could, because he just turned 80 and I began to wonder if I should be worried that in addition to his bipolar disorder he might not be showing some signs of dementia. I wasn’t sure about the overlap between bipolar and dementia. We know from studies that people with bipolar disorder often have cognitive problems – memory, executive function, and other thinking problems. But does this put them at higher risk for memory problems in old age?
Many people who experience a serious mood episode with psychosis often have cognitive impairments that continue long after they recover from the mood episode. The actual percentages vary from study to study, but approximately 50% of those with mania and 15% of those with major depression experience mood episodes with psychotic features, so recovery from cognitive impairment is a serious concern for those with bipolar disorder.
A study published in the American Journal of Psychiatry entitled “Two-Year Syndromal and Functional Recovery in 219 Cases of First-Episode Major Affective Disorder With Psychotic Features,” found that while most patients recovered from symptoms soon after hospitalization, only about one third with psychotic affective disorders recovered functionality by 24 months.
Medication is effective in treating acute bipolar mood episodes. Medication and psychoeducation are both effective in reducing recurrences in euthymic periods (when symptoms are not present). Unfortunately, neither treatment option has much effect on restoring cognitive facilities or one’s ability to function as they did prior to the episode. But there may be hope on the horizon.