Late age onset bipolar disorder presents challenge

SAN DIEGO — “As the waist gets bigger, the brain gets smaller.” 

So said Roger S. McIntyre, MD, professor of psychiatry and pharmacology, head of the mood disorders and psychopharmacology unit at University of Toronto, to several hundred clinicians attending a breakfast session on bipolar disorders presented here at the Psych Congress 2019.

McIntyre presented a rapid-fire series of clinical pearls addressing older age bipolar disorder (OABD), which included his observation that the brains of bipolar disorder patients — old or young — who are obese differ from brain imaging studies of bipolar disorder patients who are normal weight. 

“It may be that obesity ‘metastasizes’ to the brain… We have observed that obese bipolar disorder patients have more cognitive issues,” he said.

McIntyre also offered these observations:

  • Patients who declare manic episodes over age 50 are more likely to have neurological or vascular disease and experience more confused states.
  • Death due to a disease affecting the brain is more common among those who declare bipolar disorder after age 60.
  • Cardiovascular disease is the leading cause of death in bipolar disease at any age, and sub-clinical bipolar disease is detectable in pediatric bipolar disorder.
  • Adults with bipolar disorder are likely to present with impaired executive function, attention, memory, and processing speed.

Finally, McIntyre cautioned that bipolar patients with older age onset “do respond to treatment, just not in the same way that we see with younger patients, which can be challenging.”


Written by Peggy Peck, Editor-in-Chief, BreakingMED, is a service of @Point of Care, LLC, which provides daily medical news reports curated to serve the unique needs of busy physicians and other healthcare professionals.