The longitudinal course of cognition in older adults with bipolar disorder.
OBJECTIVE
Epidemiological studies suggest that elders with bipolar disorder (BD) may be at increased risk for dementia compared to the general population. We sought to investigate whether older adults with BD would present with more cognitive dysfunction than expected for their age and education, and whether they would experience a more rapid cognitive decline over three-year prospective follow-up.


METHODS
Thirty-three subjects age > or = 50, mean (SD) age 69.7 (7.9) years, with BD I (n = 28) and II (n = 5) had neuropsychological examination at baseline and longitudinally over three years. All subjects were administered the Dementia Rating Scale (DRS) when euthymic. Thirty-six mentally healthy comparators ('controls'), equated on age and education, were selected from ongoing studies in our research center examining the longitudinal relationship between late-life mood disorders and cognitive function.


RESULTS
Compared to mentally healthy comparators, subjects with BD performed significantly worse on the DRS at baseline [mean (SD) 135.2 (4.7); n = 33 versus 139.5 (3.3); n = 36], and over follow-up [131.9 (7.7); n = 14 versus 139.1 (3.4); n = 22]. There was a group-by-time interaction between the subjects with BD and the controls [group x time: F(1,64) = 5.07, p = 0.028].


CONCLUSIONS
In our study, older adults with BD had more cognitive dysfunction and more rapid cognitive decline than expected given their age and education. Cognitive dysfunction and accelerated cognitive decline may lead to decreased independence, with increased reliance on family and community supports, and potential placement in assisted-living facilities.
Gildengers
Ariel G
AG
Intervention Research Center for Late-life Mood Disorders and the Advanced Center for Intervention and Services Research, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. gildengersag@upmc.edu
Mulsant
Benoit H
BH
Begley
Amy
A
Mazumdar
Sati
S
Hyams
Adriana V
AV
Reynolds Iii
Charles F
CF
Kupfer
David J
DJ
Butters
Meryl A
MA
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001714:Bipolar Disorder / Q000150:complications*; D003072:Cognition Disorders / Q000209:etiology*; D018450:Disease Progression; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index