Cognitive training helped patients with bipolar disorder

Cognitive training helped patients with bipolar disorder

This was proven in a study by Danish researchers. The results will be used in efforts to develop new forms of cognitive training to help people affected by mood disorders. Kamilla Miskowiak, professor at the University of Copenhagen and head of the research project, believes that the findings could also have implications for design of a novel drug.

To a large extent, our brains are like our muscles. We need to exercise them by challenging them, otherwise they grow weak, and their level of function and ability to perform decline.
This knowledge plays a key role in many scientific attempts to develop novel, cognitive therapies such as brain training programmes to make life easier for people with psychological disorders.

There are many problems associated with mental illness, and the ability to remember, plan and concentrate, in particular, is one that brain researchers hope to alleviate using various types of cognitive training.
And with good reason: to a great extent, these cognitive problems are the reason why people with bipolar disorder, depression, schizophrenia and a range of other mental illnesses find it difficult to cope with their working and private lives, despite their very best intentions.

As yet, there are no effective treatments – neither cognitive nor medicinal – for the side effects of mental illness.

However, a study conducted by Danish researchers from Rigshospitalet, University of Copenhagen, and the Mental Health Services in the Capital Region of Denmark shows some indication that targeted cognitive therapy may have good potential.
The study was led by Kamilla Miskowiak, a Lundbeck Foundation Fellow and professor of neuropsychiatry at the University of Copenhagen.

The study, using fMRI brain scans, was recently published in a scientific article in the international research journal Neuropsychopharmacology.
This article sheds light on aspects that have never before been demonstrated in a scientific study:

Firstly, within as little as a couple of weeks, psychological intervention aimed at cognitive difficulties in people with bipolar disorder was able to stimulate brain activity in a region largely known for controlling human cognitive function.
Secondly, this activity proved to be a sure marker for subsequent improvement of the patient’s ability to plan.

This improvement appeared after ten weeks. Obviously, it would have been best if the effect had lasted – but it didn’t.
When the participants were tested again, six months after the initial intervention, the positive effect could no longer be detected. In other words, the patients had the same cognitive impairments as before the trial.

Nevertheless, Professor Miskowiak considers the trial promising in a number of respects:

‘The region of the brain where we measured the change was the very front of the frontal lobe. This region is the conductor of our cognitive functions, so to speak. It’s important for our ability to plan, impulse control and mental flexibility – and we already know that a range of psychological problems are linked to low activity levels in the frontal lobe.’

It is a well-known fact that the human brain can be strengthened by training it. However, as Professor Miskowiak explains, science faces a difficult challenge when the aim of the training is to improve poor cognitive function in people struggling with mental illness:

‘Because which regions of the brain should this kind of treatment target? We’re not entirely sure, and we need some biomarkers in this area. It does seem that the measurements we’ve now performed could represent a biomarker. And, in my opinion, this is another important finding of the study.’


Drug Testing

In addition to using this knowledge to develop new cognitive training methods for people affected by mood disorders, Professor Miskowiak and her colleagues want to investigate whether the discovery of this potential new biomarker could be useful for design of a drug.

The idea is to try to use the discovery to investigate whether substances suspected of being able to counteract cognitive difficulties associated with mental illness really do have these properties.

There is an urgent need for novel and effective drugs in this field. However, as Professor Miskowiak explains, the pharmaceutical industry has largely withdrawn from this development field because the risk of failure – and thus of suffering substantial financial loss – is huge:

‘Using fMRI to test whether a drug increases activity in a person’s frontal lobe should give the pharmaceutical industry a good indication of whether it’s worth pursuing. Tests could be performed after a drug has passed animal trials and received permission from the authorities for testing on humans in small-scale trials.

‘This would give the pharmaceutical industry a good basis for halting a trial if the substance doesn’t seem to be able to stimulate activity in this particular region of the brain that’s key to human cognitive function. Or for continuing and testing the drug in large-scale trials with humans, if it should prove to work as intended,’ says Professor Miskowiak.


About Professor Kamilla Miskowiaks’ research, when she became a Lundbeckfonden Fellow in 2016 (2 min.) 

Read more about Professor Kamilla Miskowiaks’ research in neuroscience



The Scanner Gave Answers

Kamilla Miskowiak and her colleagues conducted their study using brain scans from a functional MRI scanner (fMRI).
This scanner measures brain activity by recording changes in blood flow – for example, in the frontal lobe, the region of the brain in the Danish research team’s spotlight.

A total of 45 patients with bipolar disorder participated in the study, and they were relatively symptom-free during the course of the scientific work.

Lots were drawn and the 45 participants were divided into two groups. All were initially given a cognitive test.

‘Group 1’ then took part in a version of an intensive cognitive training programme, ABCR, which aims to strengthen the ability to remember, plan and concentrate. ‘Group 2’ was offered a different programme. They took part in group therapy and met at regular intervals over a period of ten weeks to share their experiences of living with bipolar disorder.

All participants had two fMRI scans: one before the trial began and one after the trial had been running for two weeks.
The scans after two weeks showed that activity in the frontal lobes of the participants in Group 1 had already increased, but that this was not the case for Group 2.

After ten weeks, all of the trial subjects were asked to solve a range of assignments to see whether the trial had improved their level of cognitive function. The results showed that, over the course of the trial, Group 1 had considerably improved their ability to plan compared to Group 2.


The Research Team:

  • The members of the research team behind the scientific article in Neuropsychopharmacology are Caroline V Ott, Julian Macoveanu, Christopher R Bowie, Patrick M Fisher, Gitte M Knudsen, Lars V Kessing and Kamilla Miskowiak.
  • Read the article in Neuropsychopharmacology


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