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Insights, challenges and new frontiers for cognitive function in bipolar disorder

Nature Mental Health (2026)Cite this article

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Abstract

Cognitive impairment in various domains—including attention, memory and executive function—is a common feature of bipolar disorder (BD) that persists beyond mood episodes and greatly impacts daily functioning, prognosis and treatment outcomes. Yet, the mechanisms and clinical implications of this cognitive impairment remain insufficiently understood. In this narrative Review, we synthesize cutting-edge findings from multidisciplinary research on cognitive function in people with BD that provide the foundation for a paradigm shift in recognizing cognitive impairment as an independent treatment target in BD. Furthermore, we discuss cognition as a moderator of illness trajectory in BD, with implications extending beyond BD to other psychiatric disorders, highlighting the transdiagnostic relevance for improving cognition across psychiatric disorders. Finally, we provide recommendations for clinicians to screen for cognitive impairments and suggest perspectives for strategies to target cognition and improve cognitive functioning in BD.

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Fig. 1: Proposed temporal course of cognitive impairment in bipolar disorder.
Fig. 2: Proposed mechanisms underlying cognitive impairment in bipolar disorder.

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Acknowledgements

E.V. acknowledges support from the Spanish Ministry of Science and Innovation (PI21/00787) integrated into the Plan Nacional de I+D+I and co-financed by the Instituto de Salud Carlos III –Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2021-SGR-01358), CERCA Programme, Generalitat de Catalunya; La Marató-TV3 Foundation grant 202234-30; the European Union Horizon 2020 research and innovation program (H2020-EU.3.1.1 – Understanding health, well-being and disease, H2020-EU.3.1.3 – Treating and managing disease), grant 945151 HORIZON.2.1.1 – Health throughout the Life Course, grant 101057454, and EIT Health (EDIT-B project).

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Author notes

  1. These authors contributed equally: Kamilla Woznica Miskowiak, Hanne Lie Kjærstad.

  2. These authors jointly supervised this work: Eduard Vieta, Lakshmi N. Yatham.

Authors and Affiliations

  1. Neurocognition and Emotion Across Disorders of the Brain (NEAD) Centre, Psychiatric Centre Copenhagen, Frederiksberg Hospital, Frederiksberg, Denmark

    Kamilla Woznica Miskowiak & Hanne Lie Kjærstad

  2. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Kamilla Woznica Miskowiak

  3. Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain

    Eduard Vieta

  4. Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada

    Lakshmi N. Yatham

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Contributions

L.N.Y., E.V. and K.W.M. were responsible for conceptualization of the Review. K.W.M., H.L.K., E.V. and L.N.Y. were responsible for the methodology and investigation. H.L.K. and K.W.M. wrote the original draft. E.V. and L.N.Y. reviewed and edited the work.

Corresponding author

Correspondence to Kamilla Woznica Miskowiak.

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Competing interests

K.W.M. has received honoraria from Angelini, Lundbeck and Gideon Richter in the past three years. H.L.K. has received honoraria from Neurotorium. E.V. has received grants and served as consultant, advisor or CME speaker for the following entities: AB-Biotics, AbbVie, Angelini, Biogen, Biohaven, Boehringer-Ingelheim, Celon Pharma, Compass, Dainippon Sumitomo Pharma, Ethypharm, Ferrer, Gedeon Richter, GH Research, Glaxo-Smith Kline, Idorsia, Janssen, Lundbeck, Medincell, Novartis, Orion Corporation, Organon, Otsuka, Rovi, Sage, Sanofi-Aventis, Sunovion, Takeda and Viatris, outside the submitted work. L.N.Y. reports consultant/speaker fees from AbbVie, Alkermes, Intracellular Therapies, LivaNova, Merck, Neurotorium, Newron, Otsuka, Sanofi, Sumitomo Pharma, Sunovion and Xenon, and grants from AbbVie, CIHR and Sumitomo Pharma, outside the submitted work, over the last three years.

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Nature Mental Health thanks Kangguang Lin, Paul Roux and Marsal Sanches for their contribution to the peer review of this work.

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Miskowiak, K.W., Kjærstad, H.L., Vieta, E. et al. Insights, challenges and new frontiers for cognitive function in bipolar disorder. Nat. Mental Health (2026). https://doi.org/10.1038/s44220-026-00615-7

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