Atypical features of bipolarity in old age

doi:10.1017/CBO9780511544019.012

11 - Atypical features of bipolarity in old age

Published online by Cambridge University Press: 10 August 2009

Kenneth I. Shulman

Edited by

Andreas Marneros and

Frederick Goodwin

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Kenneth I. Shulman: Affiliation:
University of Toronto Sunnybrook and Women's, Toronto, Ontario Canada
Andreas Marneros: Affiliation:
Martin Luther-Universität Halle-Wittenburg, Germany
Frederick Goodwin: Affiliation:
George Washington University, Washington DC

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Summary

Introduction

Studying an elderly cohort confers several special advantages compared to younger or mixed-age populations. In the first instance, one has available a lifelong clinical course that has already unfolded. This allows for tracking of age of onset and describing long-term clinical patterns in a way that is much more practical than extensive prospective studies of younger patients. Second, genetic patterns of inheritance can be more fully explored as the exposure in first-degree relatives, especially children and siblings, will be much longer than in studies of younger probands. Third, an elderly cohort offers the opportunity to study lesions of the brain, thus casting more light on localization and pathogenesis, which can be extrapolated back to potential neurophysiological patterns in younger bipolars. Finally, outcome studies of the elderly can reveal differential rates of mortality and psychosocial vulnerability which can be compared to controls, other mood disorders, and neuropsychiatric conditions of late life.

Atypical features

These special aspects of study in the elderly result in features of bipolarity which are quite different from the usual cohorts of bipolar disorder whose mean age of onset is in the early 20s (Weissman et al., 1991). Not surprisingly, atypical features described in this chapter will include:

late age of onset
prolonged latency from first depression to first mania
high prevalence of neurologic comorbidity
presence of cognitive impairment
poor outcome characterized by increased mortality and finally increased nosologic confusion related to the presence of neurologic comorbidity and the similarity of secondary mania to other neurological conditions with disinhibition syndromes (Shulman, 1997)

Keywords

bipolarity cognitive impairment depression mortality therapeutic range neurologic comorbidity old age

Information

Type: Chapter
Information: Bipolar Disorders
Mixed States, Rapid Cycling and Atypical Forms
, pp. 252 - 262
DOI: https://doi.org/10.1017/CBO9780511544019.012 [Opens in a new window]
Publisher: Cambridge University Press
Print publication year: 2005

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