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Cognitive Impairments - Bipolar vs. ADD?
An_253158 posted:
I have a long standing history of Bipolar Disorder and had a very good academic and stable work history for well over 20 years. However, about two years ago my Bipolar Disorder deteriorated with severe and extended periods of depression. I could also tell my cognitive functions were deteriorating greatly, so coupled with the severe depressive episodes, I had to resigned from work.

Since that time I have also been diagnosed with ADD-Inattentive type and now take Vyvanse for it. I Recently underwent a Neuro Psych Exam to confirm my own feelings about my cognitive functions. Sure enough the results confirmed my feelings with significant impairments (attention, memory, processing speed, visiouspatial skills etc.).

As I understand it ADD can improve overtime or remain stable and cause problems when work becomes more complex, whereas Bipolar is reported to cause cognitive difficulties over illness duration.Since I was relatively high functioning for many years with no academic or work problems, my job complexity didn't change, and I was not on any ADD meds for all those years I'm inclined to think that my Bipolar Disorder is responsible for my impairments.

My question is if it can be differentiated if the impairments are due to Bipolar Disorder or the ADD? I was wondering what the Expert's that study/treat with these disorders think?
Joseph F Goldberg, MD responded:
Dear An,

About a third of people with bipolar disorder can have significant cognitive problems, usually involving problems with attention, verbal memory and executive functioning. ADD is a separate condition that by definition arises in childhood and persists into adulthood in about half of cases. If there was no history of attentional problems in early childhood then in all likelihood you are noticing the cognitive symptoms of bipolar disorder (which can be present even when mood symptoms are absent), rather than an additional diagnosis.

Dr. G.
An_253158 replied to Joseph F Goldberg, MD's response:
Hello Dr. G,

Thank you so much for your reply. My Psychiatrist seems quite sure that I also have the ADD. When I was a child I did have some attention problems, procrastinated a lot and tended to day dream often in class. I think I just adapted to it somehow as I do remember I always felt I had to put more time and effort into my classwork then other students did. I also find the Vyvanse helpful; although even taking it I still have significant problems.

I guess it's a tough diagnosis to make when someone is an adult with Bipolar Disorder. Maybe the combined effect (assuming the ADD is indeed also present) is attributing to my impairments being so bad. With my Bipolar Disorder deteriorating so much recently could be why now I'm no longer able to compensate for attention problems. ADD doesn't usually worsen with age does it?

Thank you,