The Ultimate Guide to Bipolar Disorder and Memory Lapses

Frustrated by mental fogginess? Finding the right words just out of reach? You’re not alone — up to one-third of those with bipolar have similar difficulties. Here’s what you need to know.

Whether diagnosed with bipolar or not, everyone experiences it from time to time:

• Only a couple of minutes into a chat with someone new, and suddenly you realize that you’ve already forgotten their name. You nod, smile, and desperately grasp the far reaches of your working memory to try to recall it … In the process, you also lose track of the conversation. The other person is waiting for a response, and your mind is blank.
• You walk confidently into the next room, filled with purpose, and, as you cross the threshold — “Wait. Why did I come in here again?”
• You have a flash of insight to add to an engaging discussion, so you gather your breath to share your ideas, but you stumble through it, getting stuck on the details: “Oh, you know — that actor, the one with a beard? He was in that show with that other guy! You know who I’m talking about. Anyway, so, what I mean is …”

It’s completely normal to have memory lapses every once in a while. And even more often if you’re sleep-deprived or under a lot of stress.

If this is happening more regularly than you’d like or you’re beginning to feel concerned, first, take a deep breath. Take heart, there are strategies that might set your mind at ease and help make instances like those above less frequent and less stressful. There’s many practical and effective ways to cope with and reduce the stress and frequency of the cognitive slip-ups that sometimes accompany bipolar disorder.

Research Is Catching Up

Researchers and psychiatrists are coming to appreciate that memory lapses and other neurocognitive challenges — such as disorganization, struggling for words, difficulty learning new information — can coexist with the more obvious mood and behavioral symptoms that characterize bipolar. And they may be severe or subtle, temporary or ongoing. The area of the brain where these differences were seen is what helps control our “executive functioning,” that is, activities such as problem-solving, using working memory, and reasoning.

The Brain Is a ‘Big Office’

The brain is organized like a big office with specific departments assigned to complex tasks such as attention, verbal memory, decision-making, spatial memory, motor speed and skill, and logical reasoning. The frontal lobes of the brain contain circuitry that acts like an executive secretary — information comes in, the secretary notes it, organizes it, and sends out messages to the brain’s various departments to get things done.

The ‘Executive’ Functioning

In every phase of bipolar (depression, mania, and stability), studies report marked deficits in verbal memory and what’s known as “frontal executive tasks,” says Joseph Goldberg, MD, a psychiatrist at the Mount Sinai School of Medicine in New York City. He notes that many aspects of intellectual functioning carry on just fine in people with bipolar; the glitches seem limited to specific areas: verbal memory, executive organization, “processing speed,” and attention.

The File Clerk

The hippocampus serves as a kind of file clerk for recording new memories and sending them on to permanent storage. Bipolar disorder has been associated with shrinkage of the hippocampus, which may explain the difficulties people living with bipolar experience when trying to acquire and access various kinds of previously known information.

Brain Fog

Bipolar brain fog has been described as having scattered attention or as an inability to focus on a task or conversation, tune out distractions, and, ultimately, filter information into working memory, says Frederick Goodwin, MD, a leading expert and clinical researcher on bipolar disorder. Attention, he says, is the gateway to learning, memory, and the other higher cognitive processes.

Considering Mood

One aspect to consider is whether any cognitive impairment is directly linked to a mood episode — mania or depression — or if it’s independent of this. It’s known that either depression or mood elevation can have a negative impact on memory, focus, and thinking. For example, many would agree that when they’re acutely depressed, their cognition seems faulty. And while in a manic state, thoughts can be so rapid that it’s difficult to stay attentive.

To monitor this, start documenting any memory-based difficulties and note when they seem most prominent — not just the time of day but also relative to your mood state. (Enlisting a loved one to assist with the task of observation and documentation may be useful.)

Tracking your moods and symptoms can leave you feeling better prepared to discuss these concerns with your doctor and treatment team. Plus, it may help you to identify and cope with hard emotions (frustration, self-judgment, etc.) when memory-related symptoms arise.

Ruling Out Overlaps

Another reason it may be beneficial to track your symptoms is that in order to treat them, it’s necessary to rule out the presence of other neurologically based diagnoses, such as an attention disorder. If you already know that you have both an attention disorder and bipolar, figuring out which deficits come from which condition, as well as what degree of overlap may exist between the two, is a complex but necessary task.

Considering Medications

The next point to consider is whether any symptoms of cognitive deficits could be related to the medications you are prescribed. Since different people react to medications differently, it’s not always an easy answer. Fortunately, it’s also important to remember that taking antipsychotic medication on a daily basis does not mean that memory-related symptoms are inevitable.

Neuropsychological Testing

There are neuropsychological tests that are proving helpful to identify problems that are complicating everyday functioning. Some tests measure planning skills and how quickly and accurately someone responds to stimuli, while other tests are devised to catch misfires in attention and memory. Undergoing a thorough neuropsychological assessment may help correctly diagnose whether you have any persistent areas of deficit related to your bipolar specifically.

Complicated Causes

An older Canadian study that appeared in the Journal of Clinical Psychiatry found that focus, recall, and several aspects of executive functioning were impeded even at the onset of the first manic episode, suggesting that neurocognitive impairments might remain after symptoms subside. These findings seem to indicate that such disturbances are a core and consistent feature of bipolar, but more studies need to be completed to provide greater details.

The good news is that medical science is ongoing, with new discoveries and connections, more information, and increasingly effective solutions being recognized, understood, developed each day.

UPDATED: Originally posted March 29, 2017