Abstract
Data regarding older age bipolar disorder (OABD) are sparse. Two major groups are classified as patients with first occurrence of mania in old age, the so called “late onset” patients (LOBD), and the elder patients with a long-standing clinical history, the so called “early onset” patients (EOBD). The aim of the present literature review is to provide more information on specific issues concerning OABD, such as epidemiology, aetiology and treatments outcomes. We conducted a Medline literature search from 1970–2021 using the MeSH terms “bipolar disorder” and “aged” or “geriatric” or “elderly”. The additional literature was retrieved by examining cross references and by a hand search in textbooks. With sparse data on the treatment of OABD, current guidelines concluded that first-line treatment of OABD should be similar to that for working-age bipolar disorder, with specific attention to side effects, somatic comorbidities and specific risks of OABD. With constant monitoring and awareness of the possible toxic drug interactions, lithium is a safe drug for OABD patients, both in mania and maintenance. Lamotrigine and lurasidone could be considered in bipolar depression. Mood stabilizers, rather than second generation antipsychotics, are the treatment of choice for maintenance. If medication fails, electroconvulsive therapy is recommended for mania, mixed states and depression, and can also be offered for continuation and maintenance treatment. Preliminary results also support a role of psychotherapy and psychosocial interventions in old age BD. The recommended treatments for OABD include lithium and antiepileptics such as valproic acid and lamotrigine, and lurasidone for bipolar depression, although the evidence is still weak. Combined psychosocial and pharmacological treatments also appear to be a treatment of choice for OABD. More research is needed on the optimal pharmacological and psychosocial approaches to OABD, as well as their combination and ranking in an evidence-based therapy algorithm.
Highlights
Epidemiology of Bipolar Disorder in Old Age PatientsThe elderly represents the fastest growing group of the population
We identified a post-hoc analysis [65] of pooled data from two quetiapine monotherapy clinical trials in patients aged ≥55 years, and one study each in bipolar depression and maintenance
Do not distinguish between EOBD and late onset bipolar disorder (LOBD) and whether there is a difference among both groups in terms of pharmacotherapy and adverse drug effects remains subject to further investigation
Summary
The elderly represents the fastest growing group of the population. The share of those. A record analysis of 35,000 community patients suggests that the prevalence of bipolar disorder in older patients differs only marginally from the one in younger patients [6] This is in line with more recent epidemiological studies that report a proportion of 0.5–1% of old age bipolar I and II patients [7,8]. Summarizing the different studies, 5–10% of patients were ≥50 years of age when they experienced their first manic episode, constituting the subgroup of late onset bipolar disorder (LOBD) [7,10,13,14]. Azorin and colleagues described distinct phenotypes in BD patients with early, middle and late onset [18] The purpose of this educational literature review is to summarize the- still sparseknowledge of OABD and its epidemiology, aetiology and treatments outcomes
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