Clinical types of bipolar disorder in elderly

The aim: was to analize the prevalence of clinical types of bipolar disorder (BD) according to bipolar spectrum concept in geriatric in-patients.
Study design: comparative study of the prevalence of different types of BD in aged patients with regard to the age of disease onset (before and after 60 years) in accordance with bipolar spectrum concept.
Methods: all the patients included to the study were examined by psychopathological, clinical and psychometrical method (Hamilton Depression Rating Scale — HAM–D, Hamilton Anxiety Rating Scale — HARS, Young Mania Rating Scale — YMRS, MiniMental State Examination — MMSE, Montreal Cognitive Assessment — MoCA and Bipolarity Index by G. Sachs). Statistical data processing was held by STATISTICA 10.0 for Windows OS. 

Results: according to bipolar spectrum concept the 1st type of BD occurred in 42,7% (n = 50) examined patients, the 2nd type — in 40,2% (n = 47), the 3rd type — in 8,5% (n = 10), the 4th type — in 3,4% (n = 4), the 5th type — in 1,7% (n = 2) and the 6th type — in 3,4% (n = 4). The 1st type of BD was more often presented in patients with disease onset in young and adult age (54,0%) and in men (45,5%). The 2nd type of BD was more common for patients with disease onset in involution period (56,0%) and with late-onset BD after 60 years (50,0%), also this type more often occurred in women (46,8%). The 3rd and the 4th types were presented rarely, although, like the 1st type of BD they occurred predominantly in patients with early-onset BD (9,2 and 3,9% consequently) and in men (10,9 and 5,5% consequently). The rarest type of BD was the 5th type. The 6th type of BD was presented only in a cohort of patients with late-onset of BD (25,0%) with the same frequency in men and women. Among approximately 1/3 of examined patients the disease had its onset in the second life half (after 50 years). New onset BD occuring in the involution period (50–59 years) was more common for women, late-onset BD at the age of 60 anf older — for men. The occurrence rate of mixed affecteive states and hypomanic states increases in case of BD onset during the involution period. For late-onset BD (age 60 and older) depressive episodes with signs of transitoral cognitive disfunction were more common.
Conclusion: every type of bipolar spectrum concept may occur in aged patients. New-onset BD in elderly has some special characteristics: during the involution period BD more ofter onsets in women, at the age of 60 and older — in men. Progressively as aging the frequency of new-onset BD with predominant depressive disturbances and cognitive performance disturbances increases. 

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