Objective: Bipolar affective disorder and aging are both risk factors for deficits in cognitive function, yet few studies have examined the age- related effects on cognitive function of eraly-onset bipolar patients. The aim of this study is to investigate the correlates of cognitive function in the elderly bipolar patients with early- onset age (< 40).
Design: Retrospectively reviewing chart and cross-sectional assessment of elderly bipolar patients onset < 40 years old.
Materials and Methods: All the patients of Taipei Medical University Hospital and Taipei City Psychiatric Center were included with the criteria of bipolar I disorder (DSM-IV) diagnosis and 60 years old or older. Clinical data and final diagnosis were obtained by a combination of reviewing medical records and directly interviewing with patients and reliable family member. Mini-Mental State Examination (MMSE)was used to evaluate the cognitive function. One point of the cerebrovascular disease risk/burden score was given for each of these diagnoses: hypertension, diabetes, peripheral vascular disease, coronary artery disease, history of transient ischemic attack or stroke, atrial fibrillation, and carotid bruit. Multiple regression techniques were used to determine the correlates of cognitive function.
Results: A total of 52 early-onset patients with mean 66.7 (SD=6.5) years old and mean 27.1 (SD=0.9) years of age at onset were recruited in this study. There were 16 patients (30.7%) have experienced a decline in MMSE score to below 24, suggesting a clinically significant cognitive disorder. Multiple step-wise regression showed that age has the strongest adverse effect (adjusted R2= 0.205) on MMSE score among all variables. However, model without including the age variable showed that the first manic episode before 40 years old and the cerebrovascular disease risk/burden score have significantly negative effect on cognitive function and collectively contributed 16% of the MMSE score.
Conclusion: The proportion, approximately one-third, of cognitive dysfuction in early-onset elderly bipolar patients is comparable to other reports emerged from geriatric bipolar patients with mixed age at onset. Except for aging effects, early-onset manic patients with concurrent cardio-vascular diseases or diabetes are at greater risk for development of cognitive dysfunction.
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