Can Bipolar Disorder Lead To Alzheimer’s

February 14, 2022

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Is There A Link Between Mental Illness And Dementia

Mental Health: Living with Bipolar Disorder

There is limited and sometimes conflicting research on the relationship between an early adult diagnosis of bipolar disorder and later development of dementia. Theres a slight association between adult psychiatric disorders especially depression and schizophrenia and risk for dementia later in life, according to one research review from Johns Hopkins University. Another study from the American Journal of Geriatric Psychiatry showed a high correlation between having an early adult bipolar disorder diagnosis and a higher risk of dementia in old age.

When To Seek Help

In almost all cases, bipolar disorder requires professional treatment.

While you can take steps to reduce mood episodes and ease symptoms on your own, support from a trained mental health professional is usually key to lasting improvement.

If you believe you could have bipolar disorder, connecting with a therapist as soon as possible can put you on the path to exploring effective treatment options and getting relief. Therapists can also offer more guidance on navigating sleep problems and other nighttime distress.

Reaching out to a therapist becomes even more important if you notice unusual evening wakefulness along with fogginess and difficulty concentrating, restlessness, irritability, or any mix of mania and depression. Mixed mood episodes are serious, so its best to get help right away.

Already working with a therapist? Dont hesitate to mention any changes in the pattern of mood episodes, such as symptoms that suddenly get worse at night. Your therapist can help you identify possible causes and consider alternate approaches to treatment, if needed.

Mental Health And Medication Considerations In Seniors

Fortunately, there are many medications on the market to deal with bipolar disorder and other mental health or mood disorders, even in seniors. There are some considerations though that differ in seniors. For example, lithium and some other kidney-cleared drugs need to be used with caution. Lower kidney function typical with aging can make it harder to clear. Toxicity can occur which can have drastic consequences, up to and including death. Therefore, doctors who prescribe medication for mental health conditions in seniors need to be fully versed in geriatric medicine. They also need to be aware of any health conditions or other medications a senior may be taking.

That doesnt mean that these medications cannot be used, of course. It just means that dosing and other aspects of treatment need to be more thoroughly considered. Often, a reduced dosage can be useful to prevent any unintentional consequences, while still treating the underlying conditions. Most quality assisted living facilities, including Creekstone, have medical experts on staff or on call who are available to help with medication management. They are fully aware of the health conditions and complications that can occur in seniors. This enables them to manage medication dosage, frequency, and selection accordingly. They work in concert with a patients physician, psychologist/psychiatrist, and other health professionals to ensure quality care.

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Positive Genetic Correlation Between Mood Disorders And Ad

We initially selected three large recently published GWAS studies for MD16 , BD17 , and AD18 to obtain summary statistics and evaluate the genetic correlation between these conditions . We found a small but significant genetic correlation between MD and AD , and between BD and AD . These results indicate that mood disorders and AD share causal variants, with small to moderate effect sizes.

Polygenic Overlap And Pleiotropy

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Polygenic overlap accounts for the fraction of genetic variants with a non-zero genetic effect that is causally associated with both traits over the overall number of variants identified as causal for each trait. Polygenic overlap was estimated using two methods. First, the polygenic overlap was estimated using a bivariate causal mixture model implemented in MiXer v1.2.0 software19. This method uses a bivariate causal mixture model, an expansion of the cross-trait LDSR method, in which a relaxed infinitesimal assumption is applied .

We additionally used a pleiotropy-informed conditional false discovery rate to assess common variants associated with AD and mood disorders 13. This method detects shared susceptibility loci in related phenotypes by applying a Bayesian method that tests the association of genetic variants to the principal phenotype when conditional on a second and related phenotype using the posterior probability of a false positive association12,13.

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Identification Of Shared Loci

Finally, we applied conjFDR to assess for SNPs jointly associated with AD and BIP. We used effect sizes from the original data sources to determine the allelic direction of effects in both traits.

We identified two SNPs at two loci at a conjFDR< 0.05 . A 2 kb upstream variant at was associated with AD and BIP with the same direction of effect on AD and BIP . is widely expressed in the developing and adult human brain . An intronic variant within VAC14 was associated with AD and BIP with opposite directions of effect in AD and BIP . VAC14 is also widely expressed in the developing and adult human brain . Both SNPs have p-values > 5 × 10-8 for both traits in the original GWASs and are thus not identified by traditional methods.

Table 1. SNPs with related genes jointly associated with Alzheimers disease and bipolar disorder at a conjunctional false discovery rate ) < 0.05.

Figure 2. Conjunctional Manhatton plot of loci jointly associated with Alzheimers disease and bipolar disorder at a conjuntional false discovery rate < 0.05.

Can Bipolar Disorder Show Up Later In Life

Yes, but infrequently. The majority of bipolar disorders have their onset in the late teens and early adult years, says Dr. Bruce Shapiro, adjunct professor of psychiatry at New York Medical College. Its estimated that only about 10% of individuals who have a bipolar disorder will have an onset after age 50, and that 5% will have an onset of the disorder after age 60.

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Bipolar Disorder And Mortality

Men with bipolar disorder also showed an increased risk of premature mortality. There was a 69.7% mortality rate per 1,000 person-years in men with bipolar disorder, compared with 49.4% in those without
There was also a shorter time to death, when adjusted for age, in those with bipolar disorder
As with dementia, adjusting for alcohol and substance use disorders had little effect on the estimate .

Study Selection And Quality Assessment

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Two authors independently reviewed all abstracts and papers to evaluate whether the study would meet criteria for inclusion in the meta-analysis. If there was any disagreement between the authors about the inclusion of a study, a third author reviewed the study and made a decision about the inclusion / exclusion of the study from the meta-analysis.

After reviewing the references, we selected the studies for data extraction and analysis based on the following criteria: cohort, case-control or case-registry study identification of bipolar disorder and control / comparison groups report of dementia cases in the bipolar disorder and control groups.

We used the NewcastleâOttawa Scale to assess the quality of each study selected for inclusion in the meta-analysis . This measure assesses methodological aspects of observational studies such as selection of cases and controls, comparability of population ascertainment of exposure to risk, quality of case ascertainment and outcome assessment.

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Bipolar Disorder And Dementia

There was an increased risk of dementia for men with bipolar disorder, compared with those without a diagnosis. During the study period 13% of the whole sample developed dementia, compared with 25.4% of the group of participants who had bipolar disorder
There was also evidence of a shorter time to a diagnosis of dementia in men with bipolar disorder when adjusted for age
This also held when adjusted for a history of alcohol and substance use .

Epidemiology Of Bd In Ms

Few studies have investigated the prevalence of BD in patients with MS and vice versa. The first epidemiologic study of this kind, conducted on a large sample in Monroe County , found 10 patients had both MS and BD while epidemiologic data indicated that the expected number of cases would only be 5.4. Joffe et al. conducted a systematic psychiatric evaluation on 100 consecutive MS patients attending a neurology clinic and found a 13% lifetime prevalence of BD. Fis et al. examined the prevalence of BD among hospital service utilizers in Nova Scotia and compared these measures for the MS and non-MS population. The prevalence of BD in hospitalized MS patients was 1.97%, significantly higher than the 0.92% for the non-MS hospital utilizers. In a prospective study in 658 consecutive patients with MS attending an outpatient clinic, Edwards, and Constantinescu found that MS population had significantly increased rates of BD compared to the general population . Finally, Johansson et al. studied comorbidity between MS and BD in a nationwide cohort. The risk of MS was compared in psychiatric patients and in matched unexposed individuals. The risk of MS was increased in patients with BD and major depression while the risk of MS in schizophrenia was decreased .

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Bipolar Disorder In Older Men Linked To Increased Risk Of Dementia

Last year I blogged about the increased risk of premature death in people with bipolar disorder. Although not all people with bipolar disorder will necessarily have poor long-term outcomes, it is clear that the disorder is associated with factors affecting longevity.

People with bipolar disorder experience:

Long-term usage of lithium or antipsychotic medication
Increased risk of suicide
Difficulty securing employment or maintaining positive social relationships
Long periods of either depression or manic episodes.

Lithium And Risk For Alzheimer’s Disease In Elderly Patients With Bipolar Disorder

Published online by Cambridge University Press: 02 January 2018

Paula V. Nunes: Affiliation:Laboratory of Neuroscience LIM27, Department and Institute of Psychiatry, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
Orestes V. Forlenza: Affiliation:Laboratory of Neuroscience LIM27, Department and Institute of Psychiatry, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
Wagner F. Gattaz*: Affiliation:Laboratory of Neuroscience LIM27, Department and Institute of Psychiatry, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
*: Professor Wagner F. Gattaz, Department & Institute of Psychiatry, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil. Email:

Symptoms Of Late Onset Bipolar Disorder

One of the reasons bipolar disorder is often misdiagnosed in seniors is because the symptoms are slightly different.

According to professor of clinical psychiatry at Columbia University, Michael First, M.D., seniors seldom exhibit the classic signs of a manic episode. Instead of feeling elated and displaying risky behaviors, seniors are more likely to show signs of agitation and irritability. This is often confused with the normal feelings of aging, leading to misdiagnosis.

Some of the other symptoms commonly noted in seniors with bipolar disorder include,

Confusion
Psychosis
Hyperactivity

When bipolar disorder does appear in adults over 60, the symptoms can be sudden and severe. It often seems to cycle faster between depression and mania, and some seniors report experiencing both episodes at the same time.

Seniors with bipolar disorder frequently experience problems with cognitive function that often include,

Problems with memory
Loss of perception and judgement
Difficulty problem solving

Since these are also common signs of dementia and Alzheimers, the bipolar disorder is often misdiagnosed.

What Can We Do To Help Ageing Men With Bipolar Disorder

Unfortunately this study does not answer this question, as the underlying mechanism for this association is still unknown. Possible reasons include the long-term usage of medication or the negative impact of episodes of depression and mania on cognitive functions.

Further research is needed to clarify this link with the aim of optimising treatment and care for older men with bipolar disorder who show significant reductions in cognitive function.

Women were excluded from this study, so will have to wait and see if other studies can answer this question for them.

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Case Reckless Driving Impulse Buying

Mr. A, age 73, is admitted to the inpatient psychiatric unit at a community hospital for evaluation of a psychotic episode. His admission to the unit was initiated by his primary care physician, who noted that Mr. A was not making sense during a routine visit. Mr. A was speaking rapidly about how he had discovered that high-dose omega-3 fatty acid supplements were a cure for Alzheimers disease. He also believes that he was recently appointed as CEO of Microsoft and Apple for his discoveries.

Three months earlier, Mr. A had started taking high doses of omega-3 fatty acid supplements because he believed they were the cure for memory problems, pain, and depression. At that time, he discontinued taking nortriptyline, 25 mg/d, and citalopram, 40 mg/d, which his outpatient psychiatrist had prescribed for major depressive disorder . Mr. A also had stopped taking buprenorphine, 2 mg, sublingual, 4 times a day, which he had been prescribed for chronic pain.

Mr. As wife reports that during the last 2 months, her husband had become irritable, impulsive, grandiose, and was sleeping very little. She added that although her husbands ophthalmologist had advised him to not drive due to impaired vision, he had been driving recklessly across the metropolitan area. He had also spent nearly $15,000 buying furniture and other items for their home.