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The longitudinal course of cognition in older adults with bipolar disorder

Authors

  • Ariel G Gildengers,

    1. Intervention Research Center for Late-life Mood Disorders and the Advanced Center for Intervention and Services Research, Department of Psychiatry
    2. The Bipolar Disorder Center for Pennsylvanians, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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  • Benoit H Mulsant,

    1. Intervention Research Center for Late-life Mood Disorders and the Advanced Center for Intervention and Services Research, Department of Psychiatry
    2. The Bipolar Disorder Center for Pennsylvanians, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
    3. Centre for Addiction and Mental Health and the Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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  • Amy Begley,

    1. Intervention Research Center for Late-life Mood Disorders and the Advanced Center for Intervention and Services Research, Department of Psychiatry
    2. The Bipolar Disorder Center for Pennsylvanians, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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  • Sati Mazumdar,

    1. Intervention Research Center for Late-life Mood Disorders and the Advanced Center for Intervention and Services Research, Department of Psychiatry
    2. The Bipolar Disorder Center for Pennsylvanians, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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  • Adriana V Hyams,

    1. Intervention Research Center for Late-life Mood Disorders and the Advanced Center for Intervention and Services Research, Department of Psychiatry
    2. The Bipolar Disorder Center for Pennsylvanians, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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  • Charles F Reynolds III,

    1. Intervention Research Center for Late-life Mood Disorders and the Advanced Center for Intervention and Services Research, Department of Psychiatry
    2. The Bipolar Disorder Center for Pennsylvanians, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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  • David J Kupfer,

    1. Intervention Research Center for Late-life Mood Disorders and the Advanced Center for Intervention and Services Research, Department of Psychiatry
    2. The Bipolar Disorder Center for Pennsylvanians, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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  • Meryl A Butters

    1. Intervention Research Center for Late-life Mood Disorders and the Advanced Center for Intervention and Services Research, Department of Psychiatry
    2. The Bipolar Disorder Center for Pennsylvanians, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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  • BHM has received research support or honoraria from AstraZeneca, Corcept, Eisai, Eli Lilly & Co., Lundbeck, Forest, GlaxoSmithKline, Janssen and Pfizer; and owns stock of less than $10,000 in value in Akzo-Nobel, Alkermes, AstraZeneca, Biogen Idec, Ceslsion, Elan, Eli Lilly & Co., Forest, General Electric, Orchestra Therapeutics and Pfizer. CFR has received research support in the form of pharmaceutical supplies for his NIH-sponsored research from GlaxoSmithKline, Forest, Pfizer, Eli Lilly & Co., Bristol-Myers Squibb and Wyeth. AGG, AB, SM, AVH, DJK and MAB have no conflicts of interest to report.

Corresponding author:
Ariel G. Gildengers, M.D.
Intervention Research Center
for Late-life Mood Disorders
Department of Psychiatry
Western Psychiatric Institute and Clinic
3811 O’Hara Street
Pittsburgh, PA 15213, USA
Fax: 412-246-6030
E-mail: gildengersag@upmc.edu

Abstract

Objectives:  Epidemiological studies suggest that elders with bipolar disorder (BD) may be at increased risk for dementia compared to the general population. We sought to investigate whether older adults with BD would present with more cognitive dysfunction than expected for their age and education, and whether they would experience a more rapid cognitive decline over three-year prospective follow-up.

Methods:  Thirty-three subjects age ≥ 50, mean (SD) age 69.7 (7.9) years, with BD I (n = 28) and II (n = 5) had neuropsychological examination at baseline and longitudinally over three years. All subjects were administered the Dementia Rating Scale (DRS) when euthymic. Thirty-six mentally healthy comparators (‘controls’), equated on age and education, were selected from ongoing studies in our research center examining the longitudinal relationship between late-life mood disorders and cognitive function.

Results:  Compared to mentally healthy comparators, subjects with BD performed significantly worse on the DRS at baseline [mean (SD) 135.2 (4.7); n = 33 versus 139.5 (3.3); n = 36], and over follow-up [131.9 (7.7); n = 14 versus 139.1 (3.4); n = 22]. There was a group-by-time interaction between the subjects with BD and the controls [group × time: F(1,64) = 5.07, p = 0.028].

Conclusions:  In our study, older adults with BD had more cognitive dysfunction and more rapid cognitive decline than expected given their age and education. Cognitive dysfunction and accelerated cognitive decline may lead to decreased independence, with increased reliance on family and community supports, and potential placement in assisted-living facilities.

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