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The Archives of Psychiatry

ISSN: 2995-8776

Review Article Open Access
Volume 4 | Issue 1 | DOI: https://doi.org/10.33696/Psychiatry.4.038

Cognitive Impairment in Bipolar Disorder: Neurobiological Mechanisms and Integrated Treatment Strategies. A PRISMA-ScR–Guided Scoping Review

Michel Bourin1,*
  • 1Neurobiology of Anxiety and Mood Disorders, Nantes University, 98 rue Joseph Blanchart, 44100 Nantes, France
+ Affiliations - Affiliations

Corresponding Author

Michel Bourin, michel.bourin@univ-nantes.fr

Received Date: March 14, 2026

Accepted Date: June 30, 2026

Citation:

Bourin M. Cognitive Impairment in Bipolar Disorder: Neurobiological Mechanisms and Integrated Treatment Strategies. A PRISMA-ScR–Guided Scoping Review. Arch Psychiatry. 2026;4(1):29–35.


Copyright: © 2026 Bourin M. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background: Cognitive impairment is now widely recognized as a core; persistent feature of bipolar disorder (BD) that persists even after mood symptoms subside and is strongly associated with lasting disability and decreased quality of life. Growing evidence implicates interacting neurobiological mechanisms, including neuroinflammation, mitochondrial dysfunction, blood–brain barrier (BBB) disruption, and gut–brain axis alterations.

Objective: This scoping review aimed to map and synthesize evidence on the nature and trajectory of cognitive impairment in BD, BD-specific neurobiological mechanisms underlying cognitive dysfunction, and emerging and integrated treatment strategies targeting cognition.

Methods: We performed a scoping review following PRISMA-ScR guidelines, searching PubMed, Scopus, and Web of Science for studies published between January 2015 and January 2025. Only peer-reviewed studies that investigated cognitive outcomes in adults diagnosed with bipolar I or II disorder were included. The evidence was integrated using both narrative and thematic methods.

Results: A total of seventy-eight studies were included. Challenges with executive function, attention, memory, processing speed, and social cognition persisted even when mood remained stable. Key mechanisms included inflammatory activation, mood-state-dependent mitochondrial dysfunction, increased BBB permeability, microbiome dysbiosis, and fronto-limbic network alterations. Integrated interventions combining cognitive remediation, neuromodulation, metabolic and anti-inflammatory strategies showed the greatest promise, though evidence remains heterogeneous.

Conclusion: Cognitive impairment represents a central therapeutic target in BD. This scoping review highlights converging neurobiological pathways and supports a multimodal, personalized treatment framework. Future trials should prioritize cognition as a primary outcome and integrate biomarker-guided strategies.

Keywords

Bipolar disorder, Cognitive impairment, Neuroinflammation, Mitochondria , Blood–brain barrier, Gut-brain axis, Cognitive remediation, Neuromodulation

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