Understanding Late-Onset Bipolar Disorder
Understanding bipolar disorder for seniors
Bipolar disorder is a severe, chronic psychiatric disorder that includes both the highs and lows of mood states. Those suffering from the disorder often experience serious functional disability, financial problems, increased thoughts of suicide and an overall decreased quality of life. Until recently, the extent of late onset bipolar disorder was called into question. It was assumed that individuals who reported symptoms of mania and depression either had developed the illness earlier in life but had not pursued treatment until later, or that they were over reporting the seriousness of the manic symptoms and actually were suffering from unipolar depression. However, it is now recognized that there is a specific form of bipolar disorder that can develop in older adults.
In contrast to younger individuals with bipolar disorder, studies have determined that older adults are more likely to be hospitalized for manic symptoms and experience a greater degree of disability related to the depressive symptoms. Additionally, older adults are more likely to be “rapid cyclers” meaning they experience more than 4 episodes of depression or mania over the course of a single year, making treatment a must.
Statistics of late-onset bipolar disorder
Research indicates bipolar disorder is not infrequent in this age group. While prevalence rates of late onset bipolar were estimated to be between .1% to .4% (compared to younger age groups with prevalence rates estimated as between .4% and 1%), 10% to 25% of all individuals over age 50 suffering from a mood disorder are diagnosed with Bipolar Disorder. Additionally, due to high rates of misdiagnosis, this is considered to be an underestimate. In older populations, those diagnosed with bipolar disorder are twice as likely to be women while no significant differences in gender have been found in younger populations.
While it can be difficult to determine true co-occurring conditions in older populations due to normal fluctuations in health and realistic worries and concerns, research suggests that certain disorders do co-occur with late onset bipolar disorder. These include:
- Generalized Anxiety Disorder
- Social Anxiety / Social Phobia
- Post-traumatic Stress Disorder
- Substance / medication induced anxiety disorder
Causes of late-onset bipolar disorder
The specific causes of Late Onset Bipolar Disorder are unknown, however there is support indicating certain factors are linked to the development of this group of disorders.
Genetic – While it has been established that there is a genetic contribution to late onset bipolar disorder, it does not appear to be as strong as for the early onset type. However, few genetic investigations have been conducted on the condition in this age group to date.
Neurological Illness – There is some evidence that late onset bipolar disorder is associated with dementia. In cases investigated, the dementia preceded the onset of bipolar disorder.
Cerebrovascular Disease- Completed strokes and transient ischemic attacks defined as a short blockages of blood flow to the brain leading to minor symptoms of stroke for 24 hours or less have been shown to precede the onset of late onset bipolar disorder in a subset of patients.
White Matter Hyper-intensities – This represents small lesions found throughout the brain. These lesions have been discovered in the brains of some individuals with late onset bipolar disorder through the use of imaging studies.
Posterior Cortical Atrophy (Benson’s syndrome) – This involves shrinkage of the back portion of the brain. While this has been hypothesized as a direct cause of late onset bipolar disorder, it has also been suggested that this may be an indirect cause, first causing the development of dementia with Lewy bodies.
Signs and Symptoms
Signs and symptoms of late-onset bipolar disorder
The symptoms of bipolar disorder appear be more severe and frequent than what is found in younger individuals and account for greater disability.
Symptoms of depression include:
- Long lasting sadness
- Feeling as if moving is an effort or as if one is trying to push through water
- Feeling as if everything around the person is slowed down
- Disproportionate concerns about the state of one’s health
- Lack of interest in enjoyable activities
- Frequent episodes of crying with or without cause
- Feeling as if, due to loss of function or retirement, the person has no worth or value that they can contribute to any area or person in their life
- A sense of helplessness over the perceived inability to control anything within their environment
- Weight fluctuations – In later life decreased appetite and weight loss is more common than increased appetite and weight gain
- Agitated pacing, inability to sit still and constant fidgeting
- Difficulty sleeping – In late-life it is most likely for the individual to awaken in the early morning and not get enough sleep overall.
- Difficulty paying attention and concentrating
- Impaired memory and decision making – These symptoms often cause the individual to conclude they have dementia leading to increased depression and severe anxiety symptoms
- Numerous physical symptoms such as pain or gastrointestinal problems.
- Chronic, ambiguous physical complaints with no discernable medical cause
- Social withdrawal
- Excessive help seeking behavior and becoming overly dependent on others to make important life decisions
- Being overly demanding and displaying anger outbursts with no detectable cause
- Confusion and disorientation
Symptoms of Mania include:
While the symptoms of mania overlap with those seen in younger individuals there are also some that are unique to presentation in seniors. Symptoms of mania or hypomania include:
- Psychomotor agitation (in the manic phase this is seen coupled with intense frustration, irritability of other negative external mood indicators)
- Moving faster than usual, leading to falls and injuries
- Decreased need for sleep (this differs from sleep problems seen in the depressive stage as in the manic stage decreased sleep does not lead to feelings of fatigue during the day)
- Hyperverbal speech or being overly talkative, talking in a rambling manner or speaking in an incoherent manner
- Complex paranoid delusions
Effects of late-onset bipolar disorder
Effects of Late-Onset Bipolar Disorder vary depending on the individual, any illnesses or diseases from which they may be suffering and with their current life circumstances. Some of the more common effects include:
- Increasing inability to tolerate physical pain
- Hyper-vigilance related to bodily functions and interpreting normal aches and pains as an indication of a catastrophic illness
- Impaired cognitive functioning (e.g. planning, memory, decision making, problem solving)
- Debilitating effects on general ability to function normally in daily activities
- Increased use of medical health services/Decreased use of behavioral health services
- Increased risk of morbidity and mortality due to complications of other illnesses and risk of suicide