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.