Patricia Hall, MD, Department of Psychiatry, University of Western Ontario, London, ON.
Verinder Sharma, MB, BS, FRCPC, Professor, Faculty of Medicine and Dentistry, University of Western Ontario, London, ON.

Bipolar disorder is less common in the older adult population. However, the quality of life for older adults with bipolar disorder is significantly impacted. Older patients with bipolar disorder have more cognitive and functional impairment than younger patients. Studies show that older adults with bipolar disorder also have an increased risk of suicide, dementia, and medical illness, as well as a higher mortality rate. This article provides a review of the epidemiology, clinical features, suicide risk, comorbidities (including dementia), and management of bipolar disorder in older adults.
Key words: bipolar disorder, mania, bipolar depression, treatment.

Kenneth I. Shulman, MD, SM, FRCPsych, FRCPC, Professor, Department of Psychiatry, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto, Toronto, ON.

Mania in old age represents a neuropsychiatric syndrome reflecting its neurobiologic basis. This paper reviews the evidence for affective vulnerability (usually genetic) that is associated with the late manifestation of mania often precipitated by neurologic disease. Cerebrovascular pathology is a common comorbidity that is evident clinically or by neuroimaging. Localization of brain lesions to the right side and involving the orbito-frontal circuit appear to be specific to late-onset mania. The implications for management of mania in old age require further systematic evaluation.
Key words: mania, old age, neuropsychiatric syndrome, bipolar disorder, secondary mania.