TY - JOUR
T1 - Predicting Response to Pro-Cognitive Interventions in Mood Disorders
T2 - A Systematic Review by the International Society for Bipolar Disorders Targeting Cognition Task Force
AU - Tsapekos, Dimosthenis
AU - Kalfas, Michail
AU - Schandorff, Johanna M
AU - Del Mar Bonnin, Caterina
AU - Bowie, Christopher R
AU - Balanzá-Martínez, Vicent
AU - Burdick, Katherine E
AU - Carvalho, Andre F
AU - Dols, Annemieke
AU - Douglas, Katie
AU - Gallagher, Peter
AU - Hasler, Gregor
AU - Kessing, Lars V
AU - Kjærstad, Hanne L
AU - Lafer, Beny
AU - Lewandowski, Kathryn E
AU - López-Jaramillo, Carlos
AU - Martinez-Aran, Anabel
AU - McIntyre, Roger S
AU - Porter, Richard J
AU - Purdon, Scot E
AU - Schaffer, Ayal
AU - Stokes, Paul R A
AU - Sumiyoshi, Tomiki
AU - Torres, Ivan J
AU - Van Rheenen, Tamsyn E
AU - Yatham, Lakshmi N
AU - Zarp, Jeff
AU - Young, Allan H
AU - Vieta, Eduard
AU - Miskowiak, Kamilla W
N1 - Publisher Copyright:
© 2025 The Author(s). Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.
PY - 2026/5
Y1 - 2026/5
N2 - INTRODUCTION: Major depressive disorder (MDD) and bipolar disorder (BD) are often associated with persistent cognitive deficits that impair psychosocial functioning. While pro-cognitive interventions show promise, trial findings are inconsistent, potentially due to baseline factors influencing treatment response. This systematic review summarizes evidence on pre-treatment characteristics associated with cognitive improvement and offers methodological recommendations.METHODS: A systematic search was conducted in PubMed/MEDLINE, EMBASE, PsycINFO, and Cochrane Library from inception to February 28, 2025. Eligible studies included primary or secondary analyses of randomized controlled trials (RCTs) investigating predictors of cognitive response to pro-cognitive interventions in MDD and/or BD. Two researchers independently conducted study selection and risk of bias assessments. Findings were synthesized qualitatively.RESULTS: Forty studies (N = 3864) were identified, covering pharmacological treatments (k = 20; N = 2299), psychological therapies (k = 16; N = 1165), brain stimulation (k = 2; N = 168), and physical activity (k = 2; N = 232). Poorer baseline cognitive performance was the most consistent predictor of greater cognitive improvement, though the direction of the effect was not entirely uniform across all studies. Baseline depression severity showed no significant association with cognitive outcomes. Age, education, sex, IQ, diagnosis, and medication status were similarly non-predictive. Risk of bias was high in 77% of studies, mainly due to deviations from specified outcomes, poor randomization processes, and inconsistent handling of missing data. Considerable heterogeneity in interventions, outcome measures, and sample characteristics limited replicability and precluded meta-analysis.CONCLUSION: Poorer baseline cognition emerged as the most reliable predictor of greater cognitive improvement across interventions. More rigorous, well-powered studies are needed to replicate these findings and identify robust predictors to guide personalized pro-cognitive treatment approaches in mood disorders.
AB - INTRODUCTION: Major depressive disorder (MDD) and bipolar disorder (BD) are often associated with persistent cognitive deficits that impair psychosocial functioning. While pro-cognitive interventions show promise, trial findings are inconsistent, potentially due to baseline factors influencing treatment response. This systematic review summarizes evidence on pre-treatment characteristics associated with cognitive improvement and offers methodological recommendations.METHODS: A systematic search was conducted in PubMed/MEDLINE, EMBASE, PsycINFO, and Cochrane Library from inception to February 28, 2025. Eligible studies included primary or secondary analyses of randomized controlled trials (RCTs) investigating predictors of cognitive response to pro-cognitive interventions in MDD and/or BD. Two researchers independently conducted study selection and risk of bias assessments. Findings were synthesized qualitatively.RESULTS: Forty studies (N = 3864) were identified, covering pharmacological treatments (k = 20; N = 2299), psychological therapies (k = 16; N = 1165), brain stimulation (k = 2; N = 168), and physical activity (k = 2; N = 232). Poorer baseline cognitive performance was the most consistent predictor of greater cognitive improvement, though the direction of the effect was not entirely uniform across all studies. Baseline depression severity showed no significant association with cognitive outcomes. Age, education, sex, IQ, diagnosis, and medication status were similarly non-predictive. Risk of bias was high in 77% of studies, mainly due to deviations from specified outcomes, poor randomization processes, and inconsistent handling of missing data. Considerable heterogeneity in interventions, outcome measures, and sample characteristics limited replicability and precluded meta-analysis.CONCLUSION: Poorer baseline cognition emerged as the most reliable predictor of greater cognitive improvement across interventions. More rigorous, well-powered studies are needed to replicate these findings and identify robust predictors to guide personalized pro-cognitive treatment approaches in mood disorders.
KW - ISBD
KW - bipolar disorder
KW - cognitive impairment
KW - cognitive interventions
KW - major depressive disorder
KW - mood disorders
KW - response predictors
KW - systematic review
KW - task force
UR - https://www.scopus.com/pages/publications/105018679115
U2 - 10.1111/acps.70038
DO - 10.1111/acps.70038
M3 - Review article
C2 - 41083219
SN - 0001-690X
VL - 153
SP - 374
EP - 401
JO - Acta Psychiatrica Scandinavica
JF - Acta Psychiatrica Scandinavica
IS - 5
ER -