Relationships between cognition and daily functioning in adults with bipolar disorder: A systematic review and multilevel meta-analysis.

Cognitive impairment is a common, yet underrecognized, feature of bipolar disorder (BD).While cognition has emerged as a contributing factor to poor functioning in BD, previous reviews did not examine the role of cognitive domains (i.e., social cognition, nonsocial cognition) or the role of key potential moderators, including age and sex.A systematic literature search identified studies that included assessments of cognition and functioning in BD (103 reports, 2,200 effect sizes, 9,323 BD participants).Multilevel models tested the association between cognition and functioning, as well as moderation by cognitive domain, functional domain, biological factors, and clinical factors.Better overall cognitive performance was associated with better overall functioning (r = .20,p < .001).In contrast to the schizophrenia literature, nonsocial cognition was more strongly related to functioning (r = .21,p < .001)than social cognition (r = .16,p < .001).The magnitude of the relationship differed across cognitive and functional domains and was moderated by age, sex, clinical factors, and risk of bias.Social and nonsocial cognition make small, but statistically significant, contributions (i.e., 4% variance) to daily functioning in people with BD.This finding supports cognition as a viable treatment target to improve functioning in BD, with appropriate consideration of key moderators. Public Significance StatementThis systematic review and meta-analysis found a small but significant association between cognitive performance and daily functioning in bipolar disorder, suggesting that the cognitive performance of adults with bipolar disorder represents a viable treatment target for improving their daily functioning.The strength of the association was moderated by several factors, including sample characteristics (e.g., proportion of female participants, mean duration of illness) and cognition type (e.g., slightly stronger for nonsocial cognition than for social cognition).These findings suggest that appropriate consideration of moderators may be important when selecting interventions targeting cognitive performance to enhance the daily functioning of people with bipolar disorder.