ABSTRACT
BACKGROUND: Information about differences between younger and older patients with bipolar disorder and between older patients with early and late age of onset of illness during long-term treatment is scarce. OBJECTIVES: This study aimed to investigate the differences in treatment and treatment outcome between older and younger manic bipolar patients and between early-onset bipolar (EOB) and late-onset bipolar (LOB) older patients. METHOD: The European Mania in Bipolar Longitudinal Evaluation of Medication study was a 2-year prospective, observational study in 3459 bipolar patients on the treatment and outcome of patients with an acute manic or mixed episode. Patients were assessed at 6, 12, 18, and 24 months post-baseline. We calculated the number of patients with a remission, recovery, relapse, and recurrence and the mean time to achieve this. RESULTS: Older patients did not differ from younger bipolar patients in achieving remission and recovery or suffering a relapse and in the time to achieve this. However, more older patients recurred and in shorter time. Older patients used less atypical antipsychotics and more antidepressants and other concomitant psychiatric medication. Older EOB and LOB patients did not differ in treatment, but more older LOB patients tended to recover than older EOB patients. CONCLUSION: Older bipolar manic patients did not differ from younger bipolar patients in short-term treatment outcome (remission and recovery), but in the long term, this may be more difficult to maintain. Distinguishing age groups in bipolar study populations may be useful when considering treatment and treatment outcome and warrants further study.
Subject(s)
Antidepressive Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Bipolar Disorder/drug therapy , Acute Disease , Adult , Age Factors , Age of Onset , Aged , Bipolar Disorder/psychology , Female , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Prospective Studies , Psychiatric Status Rating ScalesABSTRACT
BACKGROUND: Late onset disorders are often associated with cerebral disfunctioning and cognitive impairment in elderly patients. It is unknown whether the age of onset affects cognition in patients with bipolar disorder. The authors compare cognition and clinical characteristics of early- and late-onset bipolar patients in a stable and euthymic condition. METHOD: One hundred and nineteen older patients (age >60) with an early- (<40 years) or late-onset bipolar disorder and a group of 78 comparison subjects were extensively tested for cognitive functioning. RESULTS: Bipolar subjects scored lower on most cognitive measures. The late-onset patients were more impaired in psychomotor performance and mental flexibility than the early-onset patients. These differences could not be explained by differences in exposure to cerebrovascular risk factors. CONCLUSIONS: Older patients with bipolar disorder have substantial cognitive impairments. Late onset bipolar disorder is associated with more severe cognitive impairment than early-onset bipolar disorder. For clinical practice, it is important to develop treatment strategies which take this into account.
Subject(s)
Age of Onset , Bipolar Disorder/psychology , Cognition Disorders/diagnosis , Adult , Age Distribution , Aged , Aged, 80 and over , Aging/psychology , Bipolar Disorder/complications , Bipolar Disorder/epidemiology , Case-Control Studies , Cognition Disorders/complications , Cognition Disorders/epidemiology , Cognition Disorders/psychology , Female , Humans , Male , Middle Aged , Netherlands/epidemiology , Neuropsychological Tests , Psychiatric Status Rating Scales , Psychomotor Performance , Severity of Illness Index , Statistics, NonparametricABSTRACT
BACKGROUND: Information about differences between younger and elderly patients with bipolar disorder and between elderly patients with early and late age of onset of illness is limited. METHOD: The European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) study was a 2-year prospective, observational study in 3459 bipolar patients on the treatment and outcome of patients with an acute manic or mixed episode. Within this study, elderly patients (>60 years of age; n=475) were compared with younger patients (<50 years of age; n=2286), and within the elderly group, Late Onset Bipolar (LOB) patients (onset > or =50 years; n=141) were compared with Early Onset Bipolar (EOB) patients (<50 years; n=323). RESULTS: In the year prior to enrollment, elderly patients, especially those with EOB, more frequently reported a rapid cycling course of illness, but fewer suicide attempts. At baseline, elderly patients more often used one psychotropic medication and demonstrated less severe manic and psychotic symptoms, but no difference in depressive symptomatology. However, prior to enrollment and during the acute phase of treatment, elderly patients more frequently received antidepressants. Atypical antipsychotics were given less frequently. Regarding 12-week outcomes, there was no difference between elderly and younger patients, although LOB elderly recovered faster, and were discharged sooner than EOB elderly patients. LIMITATIONS: Information about somatic conditions was not systematically collected nor was information about concurrent use of non-psychiatric medication which might have given some indication of somatic comorbidity. CONCLUSION: Elderly bipolar manic patients differ from younger bipolar manic patients regarding treatment but not treatment outcome. LOB elderly patients demonstrated a more favourable outcome. The use of medication and the occurrence of rapid cycling in EOB elderly patients warrant further study.
