NMDA receptor-modulating treatments for cognitive deficits in patients with bipolar disorder: A narrative review

IF 3.7 2区医学 Q1 PSYCHIATRY

General hospital psychiatry Pub Date : 2025-08-26 DOI:10.1016/j.genhosppsych.2025.08.013

Rahim Badrfam , Atefeh Zandifar

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引用次数: 0

Abstract

Objective

Cognitive impairment is a significant aspect of bipolar disorder, affecting both emotional and non-emotional domains, leading to ongoing challenges and poorer outcomes. Efforts to enhance cognitive functioning in these patients have intensified, yet effective treatments remain elusive. Existing bipolar disorder treatments often do not improve and can even worsen cognitive function. Recent studies have highlighted the link between the glutamatergic system and cognitive impairment, particularly through the activation of the N-methyl-d-aspartate receptor (NMDAR). This has sparked interest in NMDAR modulators as potential therapeutic agents. Currently, only a few have been approved for clinical use, and clinical studies are limited in scope. This review examines research on NMDAR modulation aimed at enhancing cognitive function in individuals with bipolar disorder, highlighting promising findings from animal studies and initial clinical trials.

Methods

A PubMed and Google Scholar search adhering to PRISMA guidelines was conducted for articles on NMDAR antagonists for the treatment of cognitive deficits in patients with bipolar disorder.

Results

Memantine as an add-on therapy has been linked to improvements in cognitive issues, enhancing memory after traumatic brain injury (TBI), boosting cognitive functioning in treatment-resistant bipolar disorder (BD), and elevating cognitive status in patients with depression before electroconvulsive therapy (ECT) in patients with bipolar disorders. Ketamine infusions have also improved processing speed and verbal learning in bipolar disorder patients.

Conclusion

Evidence suggests that NMDA receptor-modulating agents play a significant role in improving cognitive function in patients with bipolar disorder. Researchers should consider recently identified NMDA receptor antagonists for potential benefits. It is also important to conduct longer and multicenter studies to address the persistent cognitive impairments, such as impairment in attention, executive function, and verbal memory, that patients with bipolar disorder experience throughout their illness, while also assessing the safety of these treatments.

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双相情感障碍患者认知缺陷的NMDA受体调节治疗：叙述性回顾

目的认知障碍是双相情感障碍的一个重要方面，影响情感和非情感领域，导致持续的挑战和较差的结果。增强这些患者认知功能的努力已经加强，但有效的治疗方法仍然难以捉摸。现有的双相情感障碍治疗通常不能改善甚至恶化认知功能。最近的研究强调了谷氨酸系统与认知障碍之间的联系，特别是通过n -甲基-d-天冬氨酸受体（NMDAR）的激活。这引起了人们对NMDAR调节剂作为潜在治疗剂的兴趣。目前，只有少数被批准用于临床，临床研究的范围有限。本文综述了旨在增强双相情感障碍患者认知功能的NMDAR调节研究，重点介绍了动物研究和初步临床试验的有希望的发现。方法根据PRISMA指南，对NMDAR拮抗剂治疗双相情感障碍患者认知缺陷的相关文章进行PubMed和谷歌Scholar检索。结果双相情感障碍作为一种附加治疗与认知问题的改善、创伤性脑损伤（TBI）后记忆的增强、难治性双相情感障碍（BD）患者认知功能的增强以及双相情感障碍患者电休克治疗（ECT）前抑郁症患者认知状态的提高有关。氯胺酮输注也提高了双相情感障碍患者的处理速度和语言学习能力。结论NMDA受体调节剂对双相情感障碍患者认知功能的改善有重要作用。研究人员应该考虑最近发现的NMDA受体拮抗剂的潜在益处。同样重要的是，开展更长时间和多中心的研究，以解决双相情感障碍患者在整个疾病过程中经历的持续性认知障碍，如注意力、执行功能和言语记忆的障碍，同时评估这些治疗的安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

General hospital psychiatry 医学-精神病学

CiteScore

9.60

自引率

2.90%

发文量

125

审稿时长

20 days

期刊介绍： General Hospital Psychiatry explores the many linkages among psychiatry, medicine, and primary care. In emphasizing a biopsychosocial approach to illness and health, the journal provides a forum for professionals with clinical, academic, and research interests in psychiatry''s role in the mainstream of medicine.