Geriatric bipolar disorder: Epidemiology, clinical features, assessment, and diagnosis
- Martha Sajatovic, MD
Martha Sajatovic, MD
- Director of Geriatric Psychiatry
- Professor of Psychiatry
- Case Western Reserve University School of Medicine
- Peijun Chen, MD, MPH, PhD
Peijun Chen, MD, MPH, PhD
- Associate Professor of Psychiatry
- Case Western Reserve University School of Medicine
- Staff Geriatric Psychiatrist, Louis Stokes Cleveland VA Medical Center
- Section Editors
- Paul Keck, MD
Paul Keck, MD
- Section Editor — Bipolar Disorders
- Professor of Psychiatry
- University of Cincinnati College of Medicine
- Kenneth E Schmader, MD
Kenneth E Schmader, MD
- Editor in Chief — Geriatric Medicine
- Section Editor — Geriatrics
- Chief, Division of Geriatrics
- Duke University
- Director, Geriatric Research Education and Clinical Center
- Durham VA Medical Centers
The clinical features and treatment of older bipolar patients differ from those of younger patients . Up to 25 percent of all bipolar patients are older adults , and the absolute number of geriatric bipolar patients is expected to increase as the world’s population ages over the next several decades [3,4].
This topic reviews the epidemiology, pathogenesis, clinical features, assessment, diagnosis, and differential diagnosis of geriatric bipolar disorder. The treatment and prognosis of geriatric bipolar disorder are discussed separately. (See "Geriatric bipolar disorder: Acute treatment" and "Geriatric bipolar disorder: Maintenance treatment".)
The minimum age used to define geriatric bipolar disorder is generally 60 years [5,6]. However, some authorities use an age cut-off of 50, 55, or 65 years . The International Society for Bipolar Disorders Task Force on Older-Age Bipolar Disorder recommends that older age bipolar disorder include patients ≥50 years .
Geriatric bipolar disorder includes both aging patients whose mood disorder presented earlier in life and patients whose mood disorder presents for the first time in later life [1,8]. The International Society for Bipolar Disorders Task Force uses the term “older age bipolar disorder” instead of “geriatric bipolar disorder” .
The prevalence of geriatric bipolar disorder varies depending upon the setting and study sample.
- Sajatovic M, Chen P. Geriatric bipolar disorder. Psychiatr Clin North Am 2011; 34:319.
- Sajatovic M, Blow FC, Ignacio RV, Kales HC. Age-related modifiers of clinical presentation and health service use among veterans with bipolar disorder. Psychiatr Serv 2004; 55:1014.
- United Nations, Department of Economic and Social Affairs, Population Division, Population Estimates and Projections Section. http://esa.un.org/unpd/wpp/index.htm (Accessed on June 14, 2011).
- Jeste DV, Alexopoulos GS, Bartels SJ, et al. Consensus statement on the upcoming crisis in geriatric mental health: research agenda for the next 2 decades. Arch Gen Psychiatry 1999; 56:848.
- Young RC, Schulberg HC, Gildengers AG, et al. Conceptual and methodological issues in designing a randomized, controlled treatment trial for geriatric bipolar disorder: GERI-BD. Bipolar Disord 2010; 12:56.
- Sajatovic M, Strejilevich SA, Gildengers AG, et al. A report on older-age bipolar disorder from the International Society for Bipolar Disorders Task Force. Bipolar Disord 2015; 17:689.
- Depp CA, Jeste DV. Bipolar disorder in older adults: a critical review. Bipolar Disord 2004; 6:343.
- Prabhakar D, Balon R. Late-onset bipolar disorder: a case for careful appraisal. Psychiatry (Edgmont) 2010; 7:34.
- Weissman MM, Leaf PJ, Tischler GL, et al. Affective disorders in five United States communities. Psychol Med 1988; 18:141.
- Lin JC, Karno MP, Grella CE, et al. Psychiatric correlates of alcohol and tobacco use disorders in U.S. adults aged 65 years and older: results from the 2001-2002 National Epidemiologic Survey of Alcohol and Related Conditions. Am J Geriatr Psychiatry 2014; 22:1356.
- Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:593.
- Tariot PN, Podgorski CA, Blazina L, Leibovici A. Mental disorders in the nursing home: another perspective. Am J Psychiatry 1993; 150:1063.
- Depp CA, Lindamer LA, Folsom DP, et al. Differences in clinical features and mental health service use in bipolar disorder across the lifespan. Am J Geriatr Psychiatry 2005; 13:290.
- Al Jurdi RK, Marangell LB, Petersen NJ, et al. Prescription patterns of psychotropic medications in elderly compared with younger participants who achieved a "recovered" status in the systematic treatment enhancement program for bipolar disorder. Am J Geriatr Psychiatry 2008; 16:922.
- Oostervink F, Boomsma MM, Nolen WA, EMBLEM Advisory Board. Bipolar disorder in the elderly; different effects of age and of age of onset. J Affect Disord 2009; 116:176.
- Goetz I, Tohen M, Reed C, et al. Functional impairment in patients with mania: baseline results of the EMBLEM study. Bipolar Disord 2007; 9:45.
- Sajatovic M, Kales HC. Diagnosis and management of bipolar disorder with comorbid anxiety in the elderly. J Clin Psychiatry 2006; 67 Suppl 1:21.
- Seedat S, Scott KM, Angermeyer MC, et al. Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Arch Gen Psychiatry 2009; 66:785.
- Sajatovic M, Kessing LV. Bipolar disorder in the elderly. In: Bipolar Disorder: Clinical and Neurobiological Foundations, Yatham LN, Maj M. (Eds), Wiley-Blackwell, West Sussex 2010. p.488.
- Fujikawa T, Yamawaki S, Touhouda Y. Silent cerebral infarctions in patients with late-onset mania. Stroke 1995; 26:946.
- Berk M, Kapczinski F, Andreazza AC, et al. Pathways underlying neuroprogression in bipolar disorder: focus on inflammation, oxidative stress and neurotrophic factors. Neurosci Biobehav Rev 2011; 35:804.
- Wium-Andersen MK, Ørsted DD, Nordestgaard BG. Elevated C-reactive protein and late-onset bipolar disorder in 78 809 individuals from the general population. Br J Psychiatry 2016; 208:138.
- Yassa R, Nair V, Nastase C, et al. Prevalence of bipolar disorder in a psychogeriatric population. J Affect Disord 1988; 14:197.
- Beyer JL, Kuchibhatla M, Cassidy F, Krishnan KR. Stressful life events in older bipolar patients. Int J Geriatr Psychiatry 2008; 23:1271.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
- Goldstein BI, Herrmann N, Shulman KI. Comorbidity in bipolar disorder among the elderly: results from an epidemiological community sample. Am J Psychiatry 2006; 163:319.
- Burt T, Prudic J, Peyser S, et al. Learning and memory in bipolar and unipolar major depression: effects of aging. Neuropsychiatry Neuropsychol Behav Neurol 2000; 13:246.
- Broadhead J, Jacoby R. Mania in old age: A first prospective study. Int J Geriatr Psychiatry 1990; 5:215.
- Young RC, Kiosses D, Heo M, et al. Age and ratings of manic psychopathology. Bipolar Disord 2007; 9:301.
- Chu D, Gildengers AG, Houck PR, et al. Does age at onset have clinical significance in older adults with bipolar disorder? Int J Geriatr Psychiatry 2010; 25:1266.
- Gildengers AG, Butters MA, Seligman K, et al. Cognitive functioning in late-life bipolar disorder. Am J Psychiatry 2004; 161:736.
- Tsai SY, Lee HC, Chen CC, Huang YL. Cognitive impairment in later life in patients with early-onset bipolar disorder. Bipolar Disord 2007; 9:868.
- Samamé C, Martino DJ, Strejilevich SA. A quantitative review of neurocognition in euthymic late-life bipolar disorder. Bipolar Disord 2013; 15:633.
- Robinson LJ, Thompson JM, Gallagher P, et al. A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. J Affect Disord 2006; 93:105.
- Arts B, Jabben N, Krabbendam L, van Os J. Meta-analyses of cognitive functioning in euthymic bipolar patients and their first-degree relatives. Psychol Med 2008; 38:771.
- Kessing LV, Nilsson FM. Increased risk of developing dementia in patients with major affective disorders compared to patients with other medical illnesses. J Affect Disord 2003; 73:261.
- Sajatovic M, Blow FC, Ignacio RV. Psychiatric comorbidity in older adults with bipolar disorder. Int J Geriatr Psychiatry 2006; 21:582.
- Gildengers AG, Mulsant BH, Begley A, et al. The longitudinal course of cognition in older adults with bipolar disorder. Bipolar Disord 2009; 11:744.
- Wu KY, Chang CM, Liang HY, et al. Increased risk of developing dementia in patients with bipolar disorder: a nested matched case-control study. Bipolar Disord 2013; 15:787.
- Almeida OP, McCaul K, Hankey GJ, et al. Risk of dementia and death in community-dwelling older men with bipolar disorder. Br J Psychiatry 2016; 209:121.
- Brown SL. Variations in utilization and cost of inpatient psychiatric services among adults in Maryland. Psychiatr Serv 2001; 52:841.
- Kessing LV. Diagnostic subtypes of bipolar disorder in older versus younger adults. Bipolar Disord 2006; 8:56.
- Cassidy F, Ahearn EP, Carroll BJ. Substance abuse in bipolar disorder. Bipolar Disord 2001; 3:181.
- Dols A, Rhebergen D, Beekman A, et al. Psychiatric and medical comorbidities: results from a bipolar elderly cohort study. Am J Geriatr Psychiatry 2014; 22:1066.
- Regier DA, Farmer ME, Rae DS, et al. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990; 264:2511.
- Depp CA, Davis CE, Mittal D, et al. Health-related quality of life and functioning of middle-aged and elderly adults with bipolar disorder. J Clin Psychiatry 2006; 67:215.
- Depp CA, Mausbach BT, Eyler LT, et al. Performance-based and subjective measures of functioning in middle-aged and older adults with bipolar disorder. J Nerv Ment Dis 2009; 197:471.
- Beyer JL, Kuchibhatla M, Looney C, et al. Social support in elderly patients with bipolar disorder. Bipolar Disord 2003; 5:22.
- Martino DJ, Igoa A, Marengo E, et al. Cognitive and motor features in elderly people with bipolar disorder. J Affect Disord 2008; 105:291.
- Gildengers AG, Butters MA, Chisholm D, et al. Cognitive functioning and instrumental activities of daily living in late-life bipolar disorder. Am J Geriatr Psychiatry 2007; 15:174.
- Martire LM, Hinrichsen GA, Morse JQ, et al. The Mood Disorder Burden Index: a scale for assessing the burden of caregivers to adults with unipolar or bipolar disorder. Psychiatry Res 2009; 168:67.
- Sajatovic M, Popli A, Semple W. Ten-year use of hospital-based services by geriatric veterans with schizophrenia and bipolar disorder. Psychiatr Serv 1996; 47:961.
- Kessing LV. Recurrence in affective disorder. II. Effect of age and gender. Br J Psychiatry 1998; 172:29.
- Angst J, Gamma A, Sellaro R, et al. Recurrence of bipolar disorders and major depression. A life-long perspective. Eur Arch Psychiatry Clin Neurosci 2003; 253:236.
- Kupka RW, Luckenbaugh DA, Post RM, et al. Rapid and non-rapid cycling bipolar disorder: a meta-analysis of clinical studies. J Clin Psychiatry 2003; 64:1483.
- Cruz N, Vieta E, Comes M, et al. Rapid-cycling bipolar I disorder: course and treatment outcome of a large sample across Europe. J Psychiatr Res 2008; 42:1068.
- Gildengers AG, Mulsant BH, Begley AE, et al. A pilot study of standardized treatment in geriatric bipolar disorder. Am J Geriatr Psychiatry 2005; 13:319.
- American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry 2002; 159:1.
- Angst F, Stassen HH, Clayton PJ, Angst J. Mortality of patients with mood disorders: follow-up over 34-38 years. J Affect Disord 2002; 68:167.
- Work Group on Psychiatric Evaluation, American Psychiatric Association Steering Committee on Practice Guidlines. Psychiatric evaluation of adults. Second edition. American Psychiatric Association. Am J Psychiatry 2006; 163:3.
- American Psychiatric Association Practice Guideline for the Psychiatric Evaluation of Adults, Second Edition, 2006. http://www.psych.org/MainMenu/PsychiatricPractice/PracticeGuidelines_1.aspx (Accessed on July 18, 2011).
- Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189.
- Freudenreich O, Nejad SH, Francis A, Fricchione GL. Psychosis, mania, and catatonia. In: Textbook of Psychosomatic Medicine: Psychiatric Care of the Medically Ill, Second Edition, Levenson JL. (Ed), American Psychiatric Publishing, Washington, DC 2011. p.219.
- Van Gerpen MW, Johnson JE, Winstead DK. Mania in the geriatric patient population: a review of the literature. Am J Geriatr Psychiatry 1999; 7:188.
- Woolley JD, Wilson MR, Hung E, et al. Frontotemporal dementia and mania. Am J Psychiatry 2007; 164:1811.
- The ICD-10 Classification of Mental and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines. http://www.who.int/classifications/icd/en/bluebook.pdf (Accessed on September 27, 2012).
- Brooks JO 3rd, Hoblyn JC. Secondary mania in older adults. Am J Psychiatry 2005; 162:2033.
- Antelmi E, Fabbri M, Cretella L, et al. Late onset bipolar disorder due to a lacunar state. Behav Neurol 2014; 2014:780742.
- Taylor CA, Jung HY. Disorders of Mood After Traumatic Brain Injury. Semin Clin Neuropsychiatry 1998; 3:224.
- Satzer D, Bond DJ. Mania secondary to focal brain lesions: implications for understanding the functional neuroanatomy of bipolar disorder. Bipolar Disord 2016; 18:205.
- General population
- Clinical settings
- Sex ratio
- CLINICAL FEATURES
- - Cognitive impairment
- - General medical disorders
- - Psychiatric disorders
- Substance use disorders
- Anxiety disorders
- Psychosocial functioning
- Course of illness
- - Mortality
- DIFFERENTIAL DIAGNOSIS
- General medical conditions
- INFORMATION FOR PATIENTS