Kognitive Störungen bei bipolaren Patienten

Zusammenfassung

Bipolare Patienten leiden auch im episodenfreien Intervall unter deutlichen kognitiven Beeinträchtigungen. Sehr wahrscheinlich sind die kognitiven Störungen auch Ursache der erheblichen beruflichen Schwierigkeiten, über die bis zu 68% aller Betroffenen klagen. Insbesondere Aufmerksamkeit, verbales Gedächtnis, Arbeitsgedächtnis und Exekutivfunktionen scheinen bei bipolar Erkrankten beeinträchtigt zu sein. Vor allem Defizite im Gedächtnis sowie in den Exekutivfunktionen scheinen mit dem psychosozialen Funktionsniveau assoziiert zu sein. Insbesondere die Länge der Krankheitsdauer, die Anzahl maniformer Episoden, subsyndromale Symptome und einige biologische Marker, z. B. ein erhöhtem Homocysteinspiegel, sind mit kognitiven Störungen assoziiert. Medikamente scheinen die Kognition nicht maßgeblich zu beeinträchtigen, hier ist noch weitere Forschung nötig.

Die rechtzeitige und suffiziente akut und rückfallprophylaktische Behandlung bleibt die wirkungsvollste Therapie bei der Prävention und Behandlung kognitiver Störungen bei bipolaren Patienten. Nach einer akuten Phase sollten auf mögliche kognitive Störungen im Rahmen der Wiedereingliederung besonders Rücksicht genommen werden (z. B. Hamburger Modell). In einigen Fällen mit erheblichen Einbußen kann eine medizinische Rehabilitation indiziert sein.

Summary

Patients with bipolar disorder suffer also during euthymic periods form cognitive impairments. Cognitive impairments are most probably the number one reason for occupational impairment and working difficulties. About 68% of all bipolar patients complain about such problems. The cognitive domains most often affected are attention, verbal memory, working memory and executive functioning. Memory deficits and impairment in executive functioning go hand in hand with worse psychosocial functioning. Length of illness duration, number of prior episodes (specifically manic episodes) and subsyndromal symptoms as well as some biological markers like for instance elevated homocysteine blood levels are associated with cognitive functioning in bipolar disorder. Compared to illness activity, medication seems not to negatively affect cognition in bipolar disorder, although further research is still warranted.

The early and sufficient acute and relapse preventing treatment which should include psychoeducation, remains the most efficient treatment and prevention strategy for cognitive deficits in bipolar disorder. After remission from an acute phase, cognitive impairments need to be considered during the vocational reintegration process (e. g. Hamburger Modell). In some cases with severe impairments also the use of vocational and medical rehabilitation can be indicated.

Schlüsselwörter

Bipolare Störungen - Kognition - kognitive Defizite

Keywords

Bipolar disorders - cognition - cognitive impairment

• Literatur

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