title: Frontal signal hyperintensities in mania in old age.
abstract: OBJECTIVE
  Signal hyperintensities (SH) on magnetic resonance (MR) imaging have been associated with increased age and with mood disorders. Frontal and subcortical neuropathology has been implicated in the pathophysiology of mania and bipolar disorders. The authors assessed frontal and subcortical SH in elderly bipolar manic patients and the comparison group, and hypothesized that SH scores would be greater in the patient group.
  
  
  METHODS
  MR imaging was performed in patients aged > or = 60 years with bipolar disorder, mania, and in a same-aged community comparison group. SH were rated blindly using the Boyko system. Frontal deep white matter and basal ganglia SH were assessed in the left and right hemispheres.
  
  
  RESULTS
  SH scores were significantly greater in patients (N = 40) than the comparison group (N = 15) in frontal deep white matter (left: p = 0.003; right: p = 0.023) based on Mann-Whitney two-sample exact tests. The SH scores in the subcortical gray regions overlapped in these groups. In patients, higher right frontal SH scores were associated with later age at onset of mania.
  
  
  CONCLUSIONS
  Frontal deep white matter SH may be increased in elders with bipolar disorder. Further study of the relationship of SH to age at onset in elders is warranted.
authors.affiliation: Department of Psychiatry, NY Presbyterian Hospital, Weill Medical College of Cornell University, Westchester Division, White Plains, NY 10605, USA. jdeasis@med.cornell.edu
authors.forename: Jose M
authors.initials: JM
authors.lastname: de Asis
authors.forename: Blaine S
authors.initials: BS
authors.lastname: Greenwald
authors.forename: George S
authors.initials: GS
authors.lastname: Alexopoulos
authors.forename: Dimitris N
authors.initials: DN
authors.lastname: Kiosses
authors.forename: Manzar
authors.initials: M
authors.lastname: Ashtari
authors.forename: Moonseong
authors.initials: M
authors.lastname: Heo
authors.forename: Robert C
authors.initials: RC
authors.lastname: Young
mesh_terms: D000368:Aged; D001714:Bipolar Disorder / Q000175:diagnosis / Q000473:pathology* / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005625:Frontal Lobe / Q000473:pathology* / Q000503:physiopathology*; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index