Cognition and Bipolar Disorder in Older Adults (Including Question of ?Neuroprogression?)

STREJILEVICH S.A., MARTINO D.J.

Mental Health and Illness of the Elderly

Springer

Año: 2017; p. 2 - 14

The rise in life expectancy has in turn led to an increase in the proportion of older adults with bipolar disorder (OABD), with the consequent need to improve understanding of the clinical features of this population. However, only in the last decade has the neurocognitive profile of OABD begun to be described.Cross-sectional studies in OABD showed impairments in verbal memory, attention, and executive functions with medium to large effect sizes regarding healthy controls, which closely resemble the findings of younger patients. Like- wise, the first longitudinal studies in OABD tend to find that cognitive deficits are static rather than progressive. Therefore, both cross-sectional and longitudinal studies do not appear to support the notion of progressive cognitive impairment over the course of the disease, which is proposed as the hypothesis for neuropro- gression and staging models for BD.On the other hand, preliminary evidence has suggested a possible association between BD and an increased risk of developing dementia, although the under- lying causes are still matters of speculation. Some cases of late-onset BD may represent early stages of neurodegenerative or cerebrovascular diseases and contribute to in part to this association. In addition, there are multiple factors that can affect cognitive function in OABD such as the exposure to psychotropic drugs and different medical and psychiatric comorbidities.The clinical and theoretical implications of these topics are discussed through- out this chapter.