Studies of hospital admissions for late life mania reveal a late average age of onset. Moreover, when compared to age and sex-matched hospitalized depressives, elderly manic patients have a significantly higher prevalence of co-morbid neurologic disorders of a heterogeneous nature, dominated by cerebrovascular pathology. The increased co-morbidity is reflected in a significantly increased mortality risk after admission in elderly manic patients.
The neurologic co-morbidity is relevant to the neurological literature which describes disinhibition syndromes which are similar in presentation to “secondary mania” in the psychiatric literature. Localization studies have consistently found a tendency for the presence of right-sided brain lesions with baso-temporal connections to the limbic system (orbito-frontal cortex).
Evidence of cerebrovascular pathology including periventricular hyperintensities and deep white matter lesions on MRI are associated with mania. Silent cerebral infarctions are highest in a late onset manic group. Similar to the vascular depression hypothesis, a comparable hypothesis for evidence of vascular mania can be made based on clinical, cognitive and neuroimaging findings.
Implications for management of mania in old age will be discussed.
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