Lifestyle-based interventions targeting neurocognition in bipolar disorders - a systematic review of randomized controlled trials.
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INTRODUCTION: A substantial proportion of individuals with bipolar disorder (BD) show some degree of cognitive impairment. Emerging evidence suggests that lifestyle-based interventions (LBIs) can improve clinical outcomes in BD, although few studies have assessed their efficacy on cognition. AIM: To evaluate the methodological quality and efficacy of randomized controlled trials (RCTs) comprising LBIs for improving cognition in people with BD. METHODS: A systematic search following PRISMA guidelines. PubMed, Embase, Scopus, Web of Science, PsycINFO and ClinicalTrials.gov were searched from inception until February 1st, 2024. RCTs examining the effects of LBIs on cognition, assessed by validated neuropsychological tests, in individuals with BD (of any age, mood or comorbidity) were eligible. Risk of bias and methodological quality were assessed with the Cochrane RoB 2 tool and the PEDro scale, respectively. Results were narratively synthesized. RESULTS: Seven RCTs ( = 275) were included, each targeting one lifestyle domain. Six assessed nutraceuticals (e.g., vitamins B1/B6, DHA, NAC, citicoline, creatine) and one evaluated a mind-body intervention (Tai Chi/Qigong). Two RCTs reported pro-cognitive effects of nutraceuticals: citicoline was associated with improvements in declarative memory and verbal learning, and creatine with improved verbal fluency. Mean intervention duration was 12 weeks. Cognition was a primary outcome in three RCTs. Overall, methodological quality was high, and risk of bias was low. CONCLUSION: Specific nutraceuticals may offer pro-cognitive effects for BD. However, the evidence is limited by the small number of included studies and substantial heterogeneity in populations, interventions, and cognitive assessments. Future studies should examine whole-diet, physical activity/exercise and multimodal LBIs.
