Clinical correlates of late‐onset versus early‐onset bipolar disorder in a global sample of older adults

Abstract

Objectives Late‐onset bipolar disorder (LOBD) represents a significant subgroup of bipolar disorder (BD). However, knowledge for this group is mostly extrapolated from small studies in subjects with early/mixed age of illness onset. In this global sample of older adults with BD (OABD: ≥50 years old) we aim to characterize the sociodemographic and clinical presentation of LOBD (≥40 years at BD onset) compared to early‐onset BD (EOBD: <40 years at BD onset). Methods The Global Aging and Geriatric Experiments in Bipolar Disorder consortium provided international data on 437 older age bipolar disorder participants. We compared LOBD versus EOBD on depression, mania, functionality, and physical comorbidities. Exploratory analyses were performed on participants with BD onset ≥50 years old. Results LOBD (n = 105) did not differ from EOBD (n = 332) on depression, mania, global functioning, nor employment status (p > 0.05). Late‐onset bipolar disorder was associated with higher endocrine comorbidities (odds ratio = 1.48, [95%CI = 1.0,12.1], p = 0.03). This difference did not remain significant when subjects with BD onset ≥50 years old were analyzed. Limitations This study is limited by the retrospective nature of the variable age of onset and the differences in evaluation methods across studies (partially overcame by harmonization processes). Conclusion The present analysis is in favor of the hypothesis that LOBD might represent a similar clinical phenotype as classic EOBD with respect to core BD symptomatology, functionality, and comorbid physical conditions. Large‐scale global collaboration to improve our understanding of BD across the lifespan is needed.

Sociodemographic and clinical characteristics of people with oldest older age bipolar disorder in a global sample: Results from the global aging and geriatric experiments in bipolar disorder project

“…In a separate GAGE-BD study by our group, our group specifically looked at early onset BD (EABD) versus late onset BD (LOBD) in OABD/OOABD. 32 The results showed similar outcomes between LOBD and EOBD in severity of depression, mania, or functioning as well as prevalence of comorbidities except elevated risk of cardiovascular disease in LOBD. Therefore, it is less likely that differences in age of onset are driving the different…”

“…On the other hand, the better psychiatric outcomes of the OOABD and OABD might be a “cohort effect.” It is possible that these 3 groups of patients might represent 3 different cohorts of patients and each group had its own trajectory, that is, patients with late onset BD have a better outcome. In a separate GAGE‐BD study by our group, our group specifically looked at early onset BD (EABD) versus late onset BD (LOBD) in OABD/OOABD 32 . The results showed similar outcomes between LOBD and EOBD in severity of depression, mania, or functioning as well as prevalence of comorbidities except elevated risk of cardiovascular disease in LOBD.…”

Usage Patterns of Traditional Chinese Medicine for Patients with Bipolar Disorder: A Population-Based Study in Taiwan

“…There are several cut-off BD onset ages in the literature. For example, forty years old is a cut-off for early-onset and late-onset bipolar disorder (EOBD and LOBD) [26]. Approximately 30-60% of BD patients experience onset between ages 15 and 19, called pediatric or juvenile BD [27,28].…”

Older age bipolar disorder

“…Regarding age of onset, the GAGE-BD project compared EOBD and LOBD patients [ 23 ▪ ]. The authors reported that EOBD patients were not different in terms of severity of depressive and manic symptoms and functioning than LOBD patients.…”