The role of vascular risk factors in late onset bipolar disorder

Subramaniam, Hari; Dennis, Michael; Byrne, E. Jane

doi:10.1002/gps.1730

Cited by 64 publications

(35 citation statements)

References 22 publications

(24 reference statements)

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“…The lack of association between age of onset and cognitive dysfunction is in line with some of prior reports 17,18 but not with others suggesting greater cognitive impairment in people with later age of BD onset. The lack of association between age of onset and cognitive dysfunction is in line with some of prior reports 17,18 but not with others suggesting greater cognitive impairment in people with later age of BD onset.…”

Section: Discussionsupporting

confidence: 88%

Homocysteine, rather than age of onset, is a better predictor for cognitive function in older adults with bipolar disorder

Chen

Liu

et al. 2019

Int J Geriat Psychiatry

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Objectives The association between older‐age bipolar disorder and cognitive impairments may be mediated by vascular burden. The aim of the study was to examine the difference of cognitive function between older people with late‐onset bipolar disorder (LOBD) and early‐onset bipolar disorder (EOBD) by considering rigorous vascular risk burden evaluation, comprehensive cognitive tests, and relevant biochemistry data. Methods We recruited 95 outpatients aged over 55 with a DSM‐IV‐TR diagnosis of bipolar I disorder. Fifty had LOBD, defined by age of onset after 40. Cognitive function was evaluated through a battery of tests assessing verbal memory, attention/speed, visuospatial function, verbal fluency, and cognitive flexibility. Vascular risk assessments included individual disorders, 10‐year Framingham cardiovascular risk scores, and serum levels of homocysteine, vitamin B12, folate, and triiodothyronine. Results No differences were observed between LOBD and EOBD on any cognitive test after adjusting for potential confounders. In addition to age and educational years, multiple linear regression analyses indicated significantly negative associations between serum homocysteine levels and cognitive performances in attention, psychomotor speed, verbal memory, and executive function. Conclusions Among older people with bipolar disorder, LOBD is not associated with more cognitive dysfunction in this study. However, higher serum homocysteine levels were significantly associated with worse cognitive performance in this particular group. Clinicians therefore have to pay attention to the cognitive function in older bipolar patients with higher levels of homocysteine.

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Section: Discussionsupporting

confidence: 88%

Homocysteine, rather than age of onset, is a better predictor for cognitive function in older adults with bipolar disorder

Chen

Liu

et al. 2019

Int J Geriat Psychiatry

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“…About 90%‐95% of older adults with bipolar disorder have their initial episode prior to age 50 years, although there is a minority who will have a later onset 624, 625. Late onset is often related to neurological or physical comorbidity,626 and may carry a negative prognosis,627 although this is not a consistent finding 628…”

Section: Specific Populationsmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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“…It is possible that the common antiangiogenic effect of lithium and valproate mediated by VEGF contributes to the neuroprotective effects in bipolar disorder. Although the participants in our study did not show significant side effects of lithium, it is also possible that change in VEGF expression may be involved in the vascular risk (Subramaniam et al ., ) and nephrotoxicity (Grunfeld and Rossier, ) in patients with long‐term lithium pharmacotherapy. As lithium exists as an ion in the body and the half‐life is very short, it is expected that VEGF mRNA levels are normalized 2 weeks after discontinuation if VEGF is involved in the effect of lithium.…”

Section: Discussionmentioning

confidence: 99%

Lithium decreases VEGF mRNA expression in leukocytes of healthy subjects and patients with bipolar disorder

Kikuchi

Iga

Tayoshi

et al. 2011

Hum. Psychopharmacol Clin Exp

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The role of vascular risk factors in late onset bipolar disorder

Cited by 64 publications

References 22 publications

Homocysteine, rather than age of onset, is a better predictor for cognitive function in older adults with bipolar disorder

Homocysteine, rather than age of onset, is a better predictor for cognitive function in older adults with bipolar disorder

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Lithium decreases VEGF mRNA expression in leukocytes of healthy subjects and patients with bipolar disorder

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