What Are The Causes Of Cognitive Impairment With Bipolar Disorder?

Posted on Tue, 17 Apr 2012

Question: my problem is I'm trying to diagnose a severe cognitive impairment, that I have always had to some extent, (potentially due to a hypoxia injury at birth,) but has grown 10 fold after a severe and lasting psychotic break in XXXXXXX of 2005. Basically, in short, I lost the ability to simply think, remember, problem solve etc. in the matter of a week, while actively psychotic. The psychosis lasted about 4 months, and since then I have struggled to get some of my cognitive abilities back...but sadly I was bed bound for almost those 4 years after the incident. I made some impressive improvements, was actively volunteering, etc. and could even do some reading and remembered what I read. But after a recent, Feb 2011, traumatic incident in a hospital, I spiraled into a delirious state, and am much lower cognitively than I was even just prior. I have read all kinds of things on the "good" medical web sites, and one said delirium can lead to also, permanent cognitive problems. Now I am scared because I'm 35 and funcitoning at such a low brain level...what will I be like in 10 years? even 1 year? Other symptoms include extreme mental fog, extreme lethargy...and a feeling like my brain has been "fried." I simply cannot remember anything long term, except foggy bits here and there. There are other symptoms as well. I got evaluated several times by neurologists and psychiatrists, and I passed the neuro tests, MRI in 09 was normal, and I'm looking here, for, a realistic idea of what you may think could happen to me with cognition over time. I have a schizoaffective diagnosis, also been told I'm bipolar. I can assure you I haven't had any positive psychosis in almost 3 years.

Answered by Dr. Sunil.N (9 hours later)

Hi ,

Thanks for your query.

After studying your history in detail the cognitive impairment is likely due to the Schizoaffective disorder and /or the Bipolar disorder.

Let me explain to you my observations.

The causes for the cognitive impairment are :
A. Organic brain disorders like Psychosis , Bipolar disorders , Delirium etc.
B. Infections.
C. Hypoxial brain injury during birth.
D.Tumors.
E.Vascular disorders like stroke.

Cognitive impairment can happen because of the Hypoxial injury to the brain but the impairement is moderate to severe and it is not just limited to cognition,even movements ,speech all faculty are affected and it doesn't change with time.So Hypoxial injury as you cited as the intiation cause is unlikely.

It is evident from your history( psychosis and its improvement) that likely cause of cognitive impairment is because of the One of the organic brain disorder like Schizoaffective disorder and /or Bipolar disorder. Because it is limited to few faculty like thought process and task performance and its improvement only to get worse during the episode of Delirium, which is global(complete) loss or limitations of all the faculty of the brain including loss of consciousness.

Organic brain disorders are known to occur because of the imbalance in the neurotransmitters in the brain which are neither be detected in test nor in scans and the test and MRI scans usually normal. But in the other conditions that i mentioned earlier can be detected in test and scans.
Its not necessary to have psychotic episodes all thought out the year, they may disappear completely or can recur during acute exacerbation.

If not treated properly, the cognition can worsens over time though there is no method to predict what will happen in terms of worsening of the conditions, a gradual deterioration is expected.

Hope I have answered your query. If you have any follow up queries I will be available to answer them.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sunil.N (1 hour later)

that makes a lot of sense to me, and that is what I have been told, except I did not know about the motor and speech problems...could you please tell me what I can expect for prognosis, as I am being treated, and have not had psychosis or real mania in a long time, especially the psychosis. s without trying to make me feel better, or "sugar coat," not that you would, is it possible to continue to make improvements? There ARE days like right now, or moments, when I can think noticeably better, but this seems to wax and wain. Finally I did read that a delirium can cause permanent brain damage..is this true, and given that I have gotten better since the episode, the delirium but not as good as before, do I have some chance at getting better over time? P.s. I also exercise and eat well, most of the time. thanks!

Follow up: Dr. Sunil.N (3 hours later)

last question sir, I will pay you, I'm sorry I didn't see the button, but if it's just an imbalance of neurotransmitters, how is that an organic problem?

Also, I have read studies of psychosis eating away at grey matter in the brain, in some cases a whopping 25%..but i've also been told, "the jury is out" regarding this structural damage hypothesis..

thanks very much this is really helping me calm a bit, and hope for the best!
XXXXXXX

Answered by Dr. Sunil.N (4 hours later)

Hi XXXXXXX ,

Thanks for follow up query.

First, I thank you for identifying my mistake . Yes, "Imbalance of the Neurotransmitters is an Functional brain disorder not an Organic brain disorder."

People with schizoaffective disorder have a greater chance of going back to their previous level of function when compared to people with most other psychotic disorders. However, long-term treatment is often needed, and results can vary among individuals. Constant monitoring and regular follow ups with your doctor are needed.

Psychosis can happen due to organic causes (like tumors, infections,strike etc) OR due to Functional causes (Depression,Bipolar disorder). Since in your case the organic causes are ruled out that doesn't apply here.

Delirium can cause permanent brain damage in few cases, since you have recovered. You need not worry.

Summarizing the above discussions- Schizoaffective disorders have good prognosis than the other psychotic conditions, but the long term treatment is required.

Hope this helps you.

Wish you good health.

Regards

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar