Good Cognitive Remediation Studies Are Hard To Find–Unless You’re Danish

So you may recall from my mentioning in previous posts – and I most certainly hope you do not – that my ECT treatments combined with my bipolar disorder (BD) have left me, well – how do I say this nicely? – not the sharpest tool in the shed.

I really didn’t know that having bipolar itself put you at risk for cognitive impairment until several doctors I knew started hinting around, trying not to hurt my feelings.  When I did research for my oh-so-innovatively titled  piece Bipolar Disorder and Cognitive Impairment, it became quite clear that pretty much everyone around me knew about this but me.

In terms of ECT, you really don’t need to search hard to realize that undergoing three seizures a week for a couple months is going to leave you a few cards shy of a full deck, at least for a while. But just having BD itself?

Although, in hindsight, I really should have known something was up when I gave up getting my news from the New York Times and started to get it instead from the Daily Show with John Stewart. Reading long texts, or ones where I had to follow an  argument, had become challenging, which I would say is ironic for an English major, except that I majored in poetry, where short is king.

In fact, now that I think on it, switching John Stewart for the Times is really a metaphor for it all, now, isn’t it?

So the question is, of course, what to do now?

One approach – totally gauche–is repeatedly telling people I graduated from an Ivy League college with honors–in English literature. This does not fix the impairments, of course, although it creates the aura about me that I could read and interpret at the drop of hat, should any of these people I just met so ask.

Btu I clearly needed an alternative. So, just to keep PT Barnum happy in his grave and to prove a sucker is born every minute, I was lured by the advertising of Lumosity: “Improve your brain performance and live a better life.” For real.

I mean, heck, if I could not just play games, but also improve my life, as this company promised – let me at it!

First chink the armor: I had to pay for the privilege. And it wasn’t that cheap.  (More recently an Israeli company with the same idea, Cognifit, has rolled out the red carpet – but it didn’t promise me it could improve my life, so I’m sticking with Lumosity. It’s a no-brainer.)

So, okay, for about four weeks I’ve been on the computer or iPhone matching faces with their chosen snacks, putting the right colored trains in their proper homes, shooting birds that quickly disappear, playing memory, and feeding computer pellets to computerized koi.

I haven’t noticed anyone remarking on my new-found insight, intelligence and wit (and I surely haven’t noticed the better life part–perhaps I need to feed some more koi?), and even though I’ve gotten really good at getting those trains in their homes, I don’t think my IQ points have shot up, so I was interested to find that there might just be a back-up plan.

(photo by rosipaw at flickr.com)Really, you won’t come across many options.  And the research I did find didn’t exactly “have me at hello,” in that the following opening (by Kucyi et al in 2010, randomly picked for its classic lack of optimism) is typical of articles on cognitive impairment in BD:

“Neurocognitive dysfunction associated with bipolar disorder (bd) is pervasive, persistent across illness phases, and is demonstrated to predispose and portend psychosocial impairment. Moreover, no approved therapies for various phases of BD have been shown to reliably improve any dimension of neurocognitive performance.”

Well, there you have it, right?  Time to shutter the doors and go home, minus 30+ IQ points.

But just recently I ran into a study–one that appears to be among the very first–on the topic of remediation for cognitive impairment specifically in bipolar disorder. Entitled, “Effects of cognitive remediation on cognitive dysfunction in partially or fully remitted patients with bipolar disorder: study protocol for a randomized controlled trial,” it was using cognitive remediation, which I thought was anything that worked to fill in the space between your ears, but apparently this has its own acronym (CR) and is “a new psychological treatment, which aims to improve cognitive function and coping skills.” (I found that definition a rather wordy way of saying exactly nothing–but, as anyone who has read any scholarly paper knows, even if nothing has been said, there are still studies quoted to back it up.  That turned out to be a lifesaver in this case, as Wykes et al 2007 studied CR on schizophrenics, and finally got me a definition: CR is, apparently, . . . “an umbrella term for a number of different interventions defined by their procedural characteristics such as use of a therapist, use of a computer and the method of training.”)

Still fuzzy?  Sorry–it seems it’s best you’re going to get.

And fuzzy as it may be, CR  has improved cognitive and occupational function in those with schizophrenia and depression.  With both of those studies having been published in 2007, I’m beginning to wonder if people just forgot about bipolar–or if something about it makes it particularly sticky to study.

But, better late than never, researchers are finally now gearing up to study whether CR helps those with bipolar, too–and to find out if it could even, perhaps, get them back to work, improve their coping strategies, and give them overall better quality of life.

At the bottom of the study protocol is a call for volunteers.

My thoughts? How do I get into this study–fast?  This is just what I need–free, expert remediation to deal with my cognitive, um, issues. AND–a better quality of life, too?  How fast can I sign up?

I really thought I was a pretty good candidate.

  • You had to be 18-50 years.  Room to spare.
  • They’re taking both genders.  Good. I’m one of the genders.
  • You couldn’t be healthy.  I’ve got BD in spades.  They’d love me.
  • You had to have “Subjective complaints of moderate to severe cognitive problems.” Oh, please.  Today I played charades with my un-amused doctor as I–in quick succession–forgot the words for (by the way–I was an English major, recall?) antibiotic, fungus, blood test, and the name of a mood-tracking app. I think he was thrilled when my session was up.
  • You couldn’t be schizophrenic.  Nailed again. I mean–am I MADE for this study, or what?
  • Oh, and you couldn’t currently be having ECT.  As far as I’m concerned, if I never even have to hear the words ECT again I’m a lucky lady.

Really–can you imagine a more perfect candidate?

So I emailed the first author on the study, Kirsa M. Demant, not really thinking about the origin of her name, which seemed, well, generic enough to me.  She, polite as could be, got back to me within 24 hours.

In short–I was rejected.  Some people have no vision.

Even calling herself Kirsa, she said she was so pleased to hear that I had heard of the study in the U.S. that her communique required lots of exclamation points to express her emotion. But, happy as she was with my news, it couldn’t buy me a spot in her study–there was a definite lack of flexibility when it came to that.

“Unfortunately,” she wrote, “you must live in Denmark in order to participate.”

Why, you may ask?  Well, she gave her reasons:

“The treatment is a weekly group-based setting carried out at our clinic, so that would involve quite a bit of commuting on your part…”

Hmmm. . .Really? We couldn’t work around this?

She continued,

“Also, the cognitive training is delivered in Danish, so you must speak the language.”

Mere details. No vision at all.

And then she tells me that not only will she not take me, but, basically, there’s nowhere in the world where I could participate in such a study.

“I wish I could refer to similar studies in your area,” she writes, “but so far the effects of cognitive remediation in bipolar disorder has only been investigated in Spain and Denmark.”

Apparently in the US we don’t mind leaving our BD patients short a few marbles.

So, in short, much as I’d love to linger, I really must be off.

There are computerized koi to be fed.

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