Clinical Features of Bipolar Disorder in Elderly In-Patients

Background: as a result of global population aging the amount of aged patients with bipolar disorder (BD) is gradually growing both with the disease onset in the first half of life and with disease onset after 60 years.

Aim of the study was to observe clinical features and course of BD in elderly.

Material and methods: continuous sample of bipolar in-patients of geriatric clinical units of MHRC aged 60 and older (n = 146) in 2014–2017 were included to comparative study. According to the aim and tasks of the study the patients were divided into 3 groups depending on the age of BD onset: with early-onset BD (0–49 years), new onset in the involution period (50–59 years) and with late-onset BD (60 years and older). All of the patients were examined by psychopathological, clinical and psychometrical method (Hamilton Depression Rating Scale — HAM-D, Hamilton Anxiety Rating Scale — HARS, Young Mania Rating Scale — YMRS, Mini-Mental State Examination — MMSE and Montreal Cognitive Assessment — MoCA).

Results: early-onset BD (0–49 years) occurred in 92 patients (63%), new-onset BD in involution period (50–59 years) — in 35 cases (24%), late-onset BD (60 years and older) — in 19 patients included to the study (13%). Early-onset BD was more common in men, while new onset in the involution period — in women. Late-onset BD occurred in men and women with equal frequency. In the majority of patients BD started with depressive episode. Mixed affective episodes showed to be more common as a first BD episode with the increase of disease onset age. Age features of clinical course of affective episodes, cognitive functioningand premorbid characteristics of enrolled patients were viewed and discussed in the study. Early-onset BD leads to more frequent affective episode formation in elderly up to rapid cycling forms, while late-onset BD leads to more prolonged clinical course of affective episodes in comparison with early-onset BD. Premorbid features occur more often in patients with disease onset in thefirst half of life than in patients with late-onset BD. Cognitive functioning of all observed patients stay under age norm during intermission.

Conclusion: BD can have its onset at every age, even after 60 years, though in the majority of patients BD onsets before 50 years. Due to ageing, regardless to the age of disease onset depressions and manias in all elderly patients get age-related patterns, mixed affective states become more common.

1. Safarova TP, Yakovleva OB, Shesh-enin VS i dr. New ways of optimization of antide-pressant therapy of geriatric depressive in-patients. Psikhiatriya. 2017;75(3):5–13. (In Russ.).

2. Mosolov SN, Kostyukova EG, Ushkalova AV. Klinika i terapiya bipolyarnoj depressii. M.: AMA-PRESS, 2009. (In Russ.).

3. Rouch I, Marescaux C, Padovan C et al. Hospitalisa-tion for Bipolar Disorder: Comparison between Young and Elderly Patients. Psychology. 2015;6:126–131. DOI:10.4236/psych.2015.61011.

4. Sajatovic M, Strejilevich SA, Gildengers AG et al. A report on olderage bipolar disorder from the Inter-national Society for Bipolar Disorders Task Force. Bipolar Disord. 2015;17(7):689–704. DOI:10.1111/bdi.12331.

5. Young RC, Gyulai L, Mulsant BH et al. Pharmacothera-py of Bipolar Disorder in Old Age. Am. J. Geriatr. Psy-chiatry. 2004;12(4):342–357. DOI:10.1097/00019442-200407000-00002.

6. Safarova TP, Sheshenin VS, Fedorov VV. The effectiveness of pharmacolog-ical therapy of elderly in-patients with functional mental disorders. Psikhiatriya. 2013;57(1):24–33. (In Russ.).

7. Lehmann SW, Forester BP. Bipolar Disorder in Older Age Patients. Springer International AG, 2017. DOI:10.1007/978-3-391-48912-4.

8. Zung S, Cordeiro Q, Lafer B et al. Bipolar disorder in the elderly: clinical and socio-demographic characteristics. Scientia Medica, Porto Alegre. 2009;19(4):162–169.

9. Almeida OP, Fenner S. Bipolar disorder: similarities and differences between patients with ill-ness onset before and after 65 years of age. Int. Psychogeriatr. 2002;14(3):311–322. DOI:10.1017/s1041610202008517.

10. Banga A, Gyurmey T, Matuskey D et al. Late-life onset bipolar disorder presenting a case of pseudo-demen-tia: a case discussion and review of literature. Yale Journal of Biology and Medicine. 2013;86:235–244.

11. Oostervink F, Boomsma MM, Nolen WA. EMBLEM Advisory Board. Bipolar disorder in the elderly; different effects of age and of age of onset. J. Af-fect. Disord. 2009;116(3):176–183. DOI:10.1016/j.jad.2008.11.012.

12. Forester BP, Ajilore O, Spino C, Lehmann S. Clinical Characteristics of Patients with Late Life Bipolar Disorder in the Community: Data from the NNDC Re gistry. Am. J. Geriatr. Psychiatry. 2015;23(9):977–984. DOI:10.1016/j.jagp.2015.01.001.

13. Azorin JM, Kaladjian A, Adida M, Fakra E. Late-on-set Bipolar Illness: The Geriatric Bipolar Type VI. CNS Neurosci. Ther. 2012;18:208–213. DOI:10.1111/j.1755-5949.2011.00255.x.

14. Alves GS, Knöchel C, Paulitsch MA et al. White Matter Microstructural Changes and Episodic Memory Dis-turbances in Late-Onset Bipolar Disorder. Front Psy-chiatry. 2018;9:480. DOI:10.3389/fpsyt.2018.00480.

15. Almeida OP, Hankey GJ, Yeap BB et al. Older men with bipolar disorder: Clinical associations with ear-ly and late onset illness. Int. J. Geriatr. Psychiatry.2018;33(12):1613–1619. DOI:10.1002/gps.4957.

16. Croarkin PE, Luby JL, Cercy K et al. Genetic Risk Score Analysis in Early-Onset Bipolar Disorder. J. Clin. Psychiatry. 2017;78(9):1337–1343. DOI:10.4088/JCP.15m10314.

17. Kalman JL, Papiol S, Forstner AJ et al. Investigating polygenic burden in age at disease onset in bipolar disorder: Findings from an international multicentric study. Bipolar Disord. 2019;21(1):68–75. DOI:10.1111/bdi.12659.

18. Rubino E, Vacca A, Gallone S et al. Late onset bipolar disorder and frontotemporal dementia with mutation in progranulin gene: a case report. Amyotroph. Later-al Scler. Frontotemporal Degener. 2017;18(7–8):624–626. DOI:10.1080/21678421.2017.1339716.

19. Dols A, Beekman A. Older Age Bipolar Disorder. Psychi-atr. Clin. North Am. 2018;41(1):95–110. DOI:10.1016/j.psc.2017.10.008.

20. Shipilova ES. Clinical types of bipolar disorder in elderly. Psikhiatriya.2018;80(4):14–23. (In Russ.).

21. Strejilevich SA, Szmulewicz AG, Igoa A et al. Epi sodic density, subsyndromic symptoms and mood instability in late-life bipolar disorders: a 5-year follow-up study. Int. J. Geriatr. Psychiatry. 2019;Mar 12. DOI: 10.1002/gps.5094. [Epub ahead of print].

22. Young RC, Mulsant BH, Sajatovic M et al. A Ran-domized Double-Blind Controlled Trial of Lithium and Divalproex in the Treatment of Mania in Older Patients With Bipolar Disorder. Am. J. Psychi-atry. 2017;174(11):1086–1093. DOI:10.1176/appi.ajp.2017.15050657.

23. Safarova TP, Yakovleva OB, Shesh-enin VS i dr. New ways of optimization of antide-pressant therapy of geriatric depressive in-patients. Psikhiatriya. 2017;75(3):5–13. (In Russ.).