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11 - Atypical features of bipolarity in old age

Published online by Cambridge University Press:  10 August 2009

By
Kenneth I. Shulman
Edited by
Andreas Marneros  and
Frederick Goodwin
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:

  1. late age of onset

  2. prolonged latency from first depression to first mania

  3. high prevalence of neurologic comorbidity

  4. presence of cognitive impairment

  5. 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

bipolaritycognitive impairmentdepressionmortalitytherapeutic rangeneurologic comorbidityold age
Type
Chapter
Information
Bipolar Disorders
Mixed States, Rapid Cycling and Atypical Forms
 , pp. 252 - 262
Publisher: Cambridge University Press
Print publication year: 2005

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