The authors review current understanding of manic syndromes and bipolar
disorders in the elderly, emphasizing the limited number of systematic
studies available. Discussion is focused on the validity of late age at
onset as a nosologic distinction in geriatric patients. This issue is
contrasted with possible age-associated effects on early-onset illness.
Data regarding incidence and prevalence in the elderly are assessed, and
the high average age at onset of mania is noted. The review cites evidence
that relatively low rates of familial affective disorder and increased
frequency of certain diseases and drug use are associated with late age at
onset. Aspects of psychopathology in the elderly, course of illness, and
outcomes including chronicity, mortality, and cognitive impairment/dementia
are considered. Management of these elderly patients is briefly discussed,
highlighting questions concerning response to lithium salts.