Cognitive heterogeneity is a key predictor of differential functional outcome in patients with bipolar disorder.

Bipolar disorder (BD) is a complex illness with variability at the level of symptom presentation, clinical course, cognitive capacity, and everyday function. Cognition is a key predictor of functional disability in BD, however, much remains unknown about the development and presentation of cognitive dysfunction in BD. Studies have shown that 30-50% of affectively stable people with BD are indistinguishable from healthy individuals in terms of cognitive presentation. In contrast, many people with BD have moderate to severe cognitive deficits, in some cases on par with what is typically observed in schizophrenia (SZ). Recent research efforts have aimed to parse this cognitive heterogeneity using unsupervised statistical techniques, resulting in more homogeneous subgroups. This method has provided new insights into the clinical and biological predictors of a potentially - neuroprogressive - declinin - gcognitive course in BD. Future studies that include detailed longitudinal follow-up in large BD cohorts hold promise for guiding the development of novel treatments that reach beyond the primary affective symptoms and target functionally relevant outcomes to promote full recovery.