Martha Sajatovic1, Annemiek Dols2, Soham Rej3, Osvaldo P Almeida4, Alexandra J M Beunders2, Hilary P Blumberg5, Farren B S Briggs6, Brent P Forester7,8, Regan E Patrick7, Orestes V Forlenza9, Ariel Gildengers10, Esther Jimenez11, Eduard Vieta11, Benoit Mulsant12, Sigfried Schouws13, Nadine Paans14, Sergio Strejilevich15, Ashley Sutherland16, Shangying Tsai17, Betsy Wilson18, Lisa T Eyler16,19. 1. Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. 2. GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Neuroscience, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands. 3. Lady Davis Institute, McGill University, Montreal, Canada. 4. University of Western Australia, Perth, Australia. 5. Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA. 6. Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA. 7. Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, USA. 8. Harvard Medical School, Boston, MA, USA. 9. Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. 10. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 11. Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. 12. Department of Psychiatry, University of Toronto, Center for Addiction and Mental Health, Toronto, ON, Canada. 13. GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam, the Netherlands. 14. GGZ inGeest, Amsterdam UMC, VU Medical Center, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands. 15. AREA, Assistance and Research in Affective Disorders, Buenos Aires, Argentina. 16. Department of Psychiatry, University of California San Diego, San Diego, CA, USA. 17. Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 18. Case Western Reserve University School of Medicine, Cleveland, OH, USA. 19. Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA.
Abstract
OBJECTIVE: Literature on older-age bipolar disorder (OABD) is limited. This first-ever analysis of the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) investigated associations among age, BD symptoms, comorbidity, and functioning. METHODS: This analysis used harmonized, baseline, cross-sectional data from 19 international studies (N = 1377). Standardized measures included the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS), and Global Assessment of Functioning (GAF). RESULTS: Mean sample age was 60.8 years (standard deviation [SD] 12.2 years), 55% female, 72% BD I. Mood symptom severity was low: mean total YMRS score of 4.3 (SD 5.4) and moderate-to-severe depression in only 22%. Controlled for sample effects, both manic and depressive symptom severity appeared lower among older individuals (p's < 0.0001). The negative relationship between older age and symptom severity was similar across sexes, but was stronger among those with lower education levels. GAF was mildly impaired (mean =62.0, SD = 13.3) and somatic burden was high (mean =2.42, SD = 1.97). Comorbidity burden was not associated with GAF. However, higher depressive (p < 0.0001) and manic (p < 0.0001) symptoms were associated with lower GAF, most strongly among older individuals. CONCLUSIONS: Findings suggest an attenuation of BD symptoms in OABD, despite extensive somatic burden. Depressive symptom severity was strongly associated with worse functioning in older individuals, underscoring the need for effective treatments of BD depression in older people. This international collaboration lays a path for the development of a better understanding of aging in BD.
OBJECTIVE: Literature on older-age bipolar disorder (OABD) is limited. This first-ever analysis of the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) investigated associations among age, BD symptoms, comorbidity, and functioning. METHODS: This analysis used harmonized, baseline, cross-sectional data from 19 international studies (N = 1377). Standardized measures included the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS), and Global Assessment of Functioning (GAF). RESULTS: Mean sample age was 60.8 years (standard deviation [SD] 12.2 years), 55% female, 72% BD I. Mood symptom severity was low: mean total YMRS score of 4.3 (SD 5.4) and moderate-to-severe depression in only 22%. Controlled for sample effects, both manic and depressive symptom severity appeared lower among older individuals (p's < 0.0001). The negative relationship between older age and symptom severity was similar across sexes, but was stronger among those with lower education levels. GAF was mildly impaired (mean =62.0, SD = 13.3) and somatic burden was high (mean =2.42, SD = 1.97). Comorbidity burden was not associated with GAF. However, higher depressive (p < 0.0001) and manic (p < 0.0001) symptoms were associated with lower GAF, most strongly among older individuals. CONCLUSIONS: Findings suggest an attenuation of BD symptoms in OABD, despite extensive somatic burden. Depressive symptom severity was strongly associated with worse functioning in older individuals, underscoring the need for effective treatments of BD depression in older people. This international collaboration lays a path for the development of a better understanding of aging in BD.
Authors: Martha Sajatovic; Janis H Jenkins; Roknedin Safavi; Jane A West; Kristin A Cassidy; William J Meyer; Joseph R Calabrese Journal: Am J Geriatr Psychiatry Date: 2007-12-10 Impact factor: 4.105