Cognitive Impairment: A Frequently Overlooked Symptom of Bipolar Disorder

Cognitive Impairment: A Frequently Overlooked Symptom of Bipolar Disorder | >> Click to Read!When people hear “bipolar disorder” they generally think of mood fluctuations and the symptoms that go along with depression, hypomania and mania. All of that is more than plenty for a person and loved ones to endure. But there’s another symptom that many battle during those mood fluctuations, and every single day in between. Cognitive Impairment. Not only can it make life frustrating and difficult, it can get in the way of both enjoyable activities and meaningful work. It can be isolating and, in my experience, lead to feelings of failure.

A Doctor’s Description

Russ Federman Ph.D. accurately describes it in a Psychology Today article“difficulties with linguistic working memory (word retrieval), difficulties with planning, prioritizing and organizing of behavior (executive functioning), problems with retention of what’s been read or listened to, as well as the experience of mildly dulled or slowed thought processes.”

How It Affects My Everyday Life

I often feel like I’m running into the same brick wall over and over again. I feel like I’m trying SO hard and going nowhere. Everything takes me at least twice as long to complete as it does someone who doesn’t have a mental illness. My husband sometimes takes over tasks because he can’t bare to watch me waste so much time on things of such an ordinary nature.

What’s most frustrating is when I attempt to do something I love and am passionate about. Something that requires thought, organization and planning. Like blogging. My past life experiences reinforce my feelings of knowing I’m capable. It’s like I have this huge boulder blocking my way. And I’m no match for it, yet I continue trying to figure out ways around it, over it and under it. From time-to-time it causes me to get down on myself. I ask if I’m kidding myself for thinking I can accomplish anything at all. Then, the worst feeling of all comes over me – failure. And failure’s not a feeling I cope well with. But I feel a bit better after becoming aware of the studies referenced directly below.

Studies show that individuals with bipolar disorder maintain their IQ levels once their illness begins.

One of my biggest fantasies in life is to simply be organized. I go through spurts when I “lose my words,” what the doctor calls “word retrieval.” My memory is awful. I currently have 19 Facebook friend requests from people who I obviously know – we have over 20 mutual friends, but I cannot remember them to save my life. I wonder how many people I walk right by when I’m out in public simply because I’ve forgotten what they look like or who they are all together. I’m sure this only adds to the typical introvert misconception of me being a snob or a b*@!h. Is it really a misconception though? 😉


Despite normal, or even above normal cognition prior to the first episode of mania, there’s a decline in cognitive capacity that’s steepest after the first episode of mania.

Researchers agree that cognitive impairment is present during symptom remission, with deficits intensifying during mood episodes. Both depression and mania negatively impact memory, focus, thinking and planning. However, the level of impairment varies from person-to-person and numerous studies show impairment to be more intense in individuals who’ve had a higher acuity in bipolar symptoms.

According to an article in the American Journal of Therapeutics, currently there are no FDA–approved medications specifically designated for the management of cognitive deficits in bipolar disorder. Though some have been tested, with mixed results. “Non-pharmacological interventions, such as cognitive remediation and non-invasive brain stimulation techniques, seem promising, but their role has not yet been properly explored among bipolar patients.”

But new research is always being completed. For example, researchers at Karolinska Institute, and the Sahlgrenska Academy at Gothenburg University in Sweden have identified a gene variant linked to specific psychotic symptoms and cognitive impairment in people with bipolar disorder.

Studies indicate that, for some, cognitive impairment will be a lasting symptom of their bipolar disorder. For some. There are many variables. Talk to your doctor if you have concerns.


As usual, there are other things that can look the part. For example, ADD (Attention Deficit Disorder) has overlapping symptoms. So you’d definitely want to rule that out before settling on cognitive impairment. And under your doctor’s supervision, you may want to take a look at some of your medications’ side effects.


  1. Discuss concerns with your doctor.
  2. Get enough sleep, 7-1/2 – 9 hours nightly for adults. You may enjoy Bipolar Disorder & Sleep (w/free download).
  3. Accept yourself and your disorder, wherever you are on your journey. You may enjoy Self-Compassion: It’s Okay
  4. Stay up-to-date on research.
  5. Eat a well-balanced diet and eat regularly, including drinking plenty of water everyday.
  6. Try out some mind-sharpening games. There are many free smartphone apps available.


“Studies show that individuals with bipolar maintain their IQ levels once their illness begins.”

Cognitive impairment does not equate stupidity. On your most frustrating days please remember that you are still the same brilliant person you were before your disorder made life more difficult. In fact, you’re even more so now! Why? Because you fight back! You keep moving forward despite your disorder and all that it throws your way, in addition to the stress of everyday life. You’re THE BEAST, not bipolar disorder. We need to put things into proper perspective. We’re winning this fight. Every day.

Do you battle cognitive impairment? How do you manage?


  • Cognitive Impairment in Bipolar Disorder by Russ Federman Ph.D., A.B.P.P. -via
  • Karolinska Institute. Possible mechanism for specific symptoms in bipolar disorder discovered. ScienceDaily, 15 December 2015
  • Neuroprotection in the aftermath of first episode mania, M Berk, R Daglas, M Yucel, SM Cotton -via Wiley Online Library
  • The Management of Cognitive Impairment in Bipolar Disorder: Current Status and Perspectives, Sanches, Marsal MD, PhD*; Bauer, Isabelle E. PhD; Galvez, Juan F. MD; Zunta-Soares, Giovana B. MD; Soares, Jair C. MD, PhD -via American Journal of Therapeutics: November/December 2015 – Volume 22 – Issue 6 – p 477–486



  1. Beth

    I just found your blog and I want to thank you for this! I have so much trouble with word retrieval and memory. I’m bipolar type 1 rapid cycle and it’s mostly when I’m either extremely manic or extremely depressed I notice I’m at a loss for words!

    1. Glad you found your way here! I think that’s one of my biggest issues as well. It can be embarrassing at times. Mid-sentence, like you said, I’m at a total loss for words. Nice. (insert: eye roll emoji) You’re definitely not alone. Thanks so much for reading and for taking the time to leave a comment! Take care!

  2. I’m so glad i read this. I was seriously worrieed the other day when i Couldn’t remember the word for graPefruit. I often don’t recall names but this was the first time in 22 years i had forgotten the word for something so ‘Mundane’. So glad my IQ and intelligence is still there – it has been really worrying me, that i might need to end my current, highly scientific job and do something less taxing. There are a few years left in me…

    1. I agree with you Cally, reading that my intelligence (not that I’m a genius or anything) is still intact made me feel better. It’s so frustrating when I know I’m capable of doing something but my disorder is standing in my way.

      Sounds like you really enjoy and thrive at your job. Good for you! I wish you the best! Thanks for reading =)

  3. Jessica

    So glad I found this article! I struggle with both executive functioning and word retrieval. It comes and goes in waves but that just makes it more unpredictable and frustrating! Here I thought I was the only one as this isnt listed as a “symptom” of BP2.

      1. Arthur

        Jessica you are definitely not alone. I went from a very busy and active person enjoying life and working on a Social Work degree to completely cognitively impaired individual. It has been a year since my episode from of depression with psychosis (bipolar 1). My brain seems so slow now. I get overwhelmed by everything. Making a sandwich seems like an impossible math equation. This is quite frustrating but in my experience executive functioning gradually improves with time. This is the hope I hang onto. It is hard for people like us who struggle. Bipolar is so much more than being super happy or super sad. We have to keep pushing forward as best we can.

      2. This is so true Arthur, and what many people don’t understand. Including some of us living with the disorder. All that goes along with it besides mania and depression, the symptoms we deal with on a daily basis even when we’re stable. But it’s nice to connect with people who understand. Thanks for reading and taking the time to leave a comment. Take care!

  4. My bipolar disorder cognitive issues show up the most with money and time. I have many times when word retrieval is hard, but counting money is consistently a problem. It’s at it’s very worst after grocery shopping when I’m already completely over stimulated. Time is also pretty consistently a problem. It must fall into the “planning” category. I just go grocery shopping with husband now and try hard to not have many time sensitive activities.

  5. Rebekah

    Have you ever had a neuropsychological test done? Quite lengthy, but worth it in my opinion. I can’t definitely separate my impairments based on my epilepsy or my bipolar but my neuropsychologist said it was no coincidence.

  6. James Mossman

    I have a high IQ and I have often, since my diagnosis, felt extraordinarily stupid.. One of the most devastating symptoms of my experience with bi-polar disorder is cognitive impairment, although this is the first instance that I have heard it named. Being 61 years of age makes it difficult for others to understand that my failure to remember words is related and has been related to my illness more so than to any memory short circuit phenomenon of the aging process. This memory problem began when I failed to function in a regular manner, i.e. at the time of the break 14 years ago. Enrolled in a masters program, it was impossible to remember anything I had closely and carefully read just hours before. The impairment alone was cause enough to discontinue my studies, but along with the phenomenon of missing time, extreme depression, and a condition known as “conversion” (I started to fall down when people I was not close to scrutinized me) my academic life abruptly ended. For years I could not focus on reading materials for more than 15 or 20 minutes a day and then could barely recall what I had read when I renewed reading the text the next day.: Tough for an Arts Major. Thank you for website.

    1. I’m sorry to hear this James. I can only imagine how hard this must have been, and continues to be. I’m sure that this only perpetuated your depression. Bipolar is so much more complex than many people realize. Even for those of us living with it, there will always be more learning to do.

      I wish you the best! Thanks so much for stopping by and taking the time to leave a comment.

  7. This explains why I sit there mid-conversation saying, “What was I saying again?” It’s been happening more and more, but I’m most aware of it when I’m in depression mode. Great article as usual Krista. Jam-packed full of important info.
    PS: I’m glad I’m one of the friend requests you remembered lol

    1. Lol. Just wait a few more years and we may not remember each other. Hmm, that’s really not funny at all, is it?

      I worry about the long-term side effects of the antipsychotic medication I’ve been taking for years. But I didn’t want to get into all of that because I don’t feel that I’m knowledgeable enough to have an intelligent conversation about it, and I’m scared of steering someone in the wrong direction. But I’m obviously more concerned about the short-term consequences of not taking them, that would be truly scary. I look at the people who go med-free with envy.

      Anyhow, thanks for stopping by! Have a great week! -Krista

  8. Nsapoo

    Cognitive thinking is one of my worst symptoms. I hate carrying on a conversation talking about, lets says, the food needs to cook in over for 30 min. I try to tell everyone supper will ready, only my words come out all messed up.. I tell them I put the book in the oven or just anything off the wall crazy sounding at times.

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