Nineteenth-century neuropsychiatrists felt that the aged bipolar patient
usually developed chronic mania, which eventually turned into dementia. The
authors' elderly patients seemed to experience few such denouements, so
they evaluated the course and treatment response of 81 bipolar patients
over the age of 55. Fifty-six responded well to lithium. Advanced age had
no effect on course or outcome. However, with increased clinical evidence
of neurological illness there was an increased incidence of chronic mania,
a poorer response to lithium, and more frequent and severe neurotoxicity.
Extrapyramidal syndromes were particularly devastating.