Illness Chronology, Brain Morphology and Mixed Symptom Presentations in Older Age Bipolar Disorder: Emerging Findings from the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE –BD) Project

Abstract

Roughly 25% of those with bipolar disorder (BD) are 60 years or older, and this proportion is likely to increase in tandem with changes in global demographics. Aging-related trajectories may also start in mid adulthood and lead to worse health outcomes such as cognitive decline and early mortality. The Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) project, a multi-national research initiative, pools archival research and clinical datasets to provide an evidence platform with potential to advance knowledge on older age BD (OABD). Key goals of investigators collaborating on the GAGE-BD project are to examine correlates of age of onset, understand BD mood symptom presentations, and set the stage for future investigations in aging-related changes in brain structure and functioning. In the first presentation, Dr. Lavin will describe an analysis of clinical correlates of late vs. early-onset BD. The majority of patients with BD have an onset before 40 years old. However, a significant number of individuals have onset of illness after age 40, commonly referred to as late-onset BD. This examination of a large international dataset sheds light on the association between the age of onset of BD symptoms and the distribution of risk factors and course of illness. Findings can yield important insights into the mechanisms involved in the evolution of BD across the life-span. In the second presentation, Dr. Blumberg will present on a new initiative to link neuroimaging findings with clinical data from the GAGE –BD sample. This talk will summarize procedures to harmonize aggregate data and how multi-national teams can collaborate to grow research capacity that is intended to better understand aging-related changes in brain structure and the relationship of the changes to demographic and clinical factors. Preliminary findings comparing older adults with BD to healthy participants on gray matter volume from structural magnetic resonance imaging (MRI) data, and white matter microstructure from diffusion-weighted MRI data, will be presented. In the third presentation, Dr. Eyler will discuss BD symptom severity mixity in OABD. The Diagnostic and Statistical Manual (DSM-5) includes a ‘with mixed features’ specifier that applies to a manic /hypomanic or to a depressive episode. Findings from the GAGE-BD samples suggested mixed features are relatively common in OABD, but do not suggest that mixity is associated with functional status. Future studies need to investigate whether mixed symptoms could contribute to BD neuroprogression in later life. Following the presentations, there will be discussion and ample opportunity for questions regarding emerging issues most relevant to OABD