Predicting Response to Pro-Cognitive Interventions in Mood Disorders: A Systematic Review by the International Society for Bipolar Disorders Targeting Cognition Task Force.
Dimosthenis Tsapekos, Michail Kalfas, Johanna M Schandorff, Caterina Del Mar Bonnin, Christopher R Bowie, Vicent Balanzá-Martínez, Katherine E Burdick, Andre F Carvalho, Annemieke Dols, Katie Douglas, Peter Gallagher, Gregor Hasler, Lars V Kessing, Hanne L Kjærstad, Beny Lafer, Kathryn E Lewandowski, Carlos López-Jaramillo, Anabel Martinez-Aran, Roger S McIntyre, Richard J Porter, Scot E Purdon, Ayal Schaffer, Paul R A Stokes, Tomiki Sumiyoshi, Ivan J Torres, Tamsyn E Van Rheenen, Lakshmi N Yatham, Jeff Zarp, Allan H Young, Eduard Vieta, Kamilla W Miskowiak
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引用次数: 0
Abstract
Introduction: Major depressive disorder (MDD) and bipolar disorder (BD) are often associated with persistent cognitive deficits that impair psychosocial functioning. While pro-cognitive interventions show promise, trial findings are inconsistent, potentially due to baseline factors influencing treatment response. This systematic review summarizes evidence on pre-treatment characteristics associated with cognitive improvement and offers methodological recommendations.
Methods: A systematic search was conducted in PubMed/MEDLINE, EMBASE, PsycINFO, and Cochrane Library from inception to February 28, 2025. Eligible studies included primary or secondary analyses of randomized controlled trials (RCTs) investigating predictors of cognitive response to pro-cognitive interventions in MDD and/or BD. Two researchers independently conducted study selection and risk of bias assessments. Findings were synthesized qualitatively.
Results: Forty studies (N = 3864) were identified, covering pharmacological treatments (k = 20; N = 2299), psychological therapies (k = 16; N = 1165), brain stimulation (k = 2; N = 168), and physical activity (k = 2; N = 232). Poorer baseline cognitive performance was the most consistent predictor of greater cognitive improvement, though the direction of the effect was not entirely uniform across all studies. Baseline depression severity showed no significant association with cognitive outcomes. Age, education, sex, IQ, diagnosis, and medication status were similarly non-predictive. Risk of bias was high in 77% of studies, mainly due to deviations from specified outcomes, poor randomization processes, and inconsistent handling of missing data. Considerable heterogeneity in interventions, outcome measures, and sample characteristics limited replicability and precluded meta-analysis.
Conclusion: Poorer baseline cognition emerged as the most reliable predictor of greater cognitive improvement across interventions. More rigorous, well-powered studies are needed to replicate these findings and identify robust predictors to guide personalized pro-cognitive treatment approaches in mood disorders.
期刊介绍：
Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers.
Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.
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