2021-12-15

050_ Characterization of early and late onset in older adults with bipolar disorder (OABD)

Research Question and Aims

Bipolar disorder is a chronic psychiatric disease associated with excitotoxicity and neuroinflammation processes that may contribute among other factors to accelerate normal aging mechanisms therefore its progression as a neurodegenerative disorder has been explored. Patients with bipolar disorder who are around the fiftieth decade of their lives are defined as older-age bipolar disorder (OABD), referring to patients ≥50 years old according to International Society for Bipolar Disorders (ISBD) Older Adults with Bipolar Disorder (OABD) Task Force. It represents a heterogeneous group that includes both patients with an early onset of the disease (EOBD) referring to those patients who have their first manic/hypomanic episode at <50 years old, and patients with a late onset of the disease (LOBD), to those patients who have their first manic/hypomanic episode aged >50 years, without a previous depressive episode. Literature on OABD is limited. Deficits of everyday functioning are common in OABD with mood symptoms, cognitive deficits and medical conditions all contributing to disability. Different clinical, cognitive and etiology factors between early and late onset have been detected across the literature. The greater severity of cognitive deficits frequently found, as well as the greater presence of medical and neurological burden in LOBD patients compared to EOBD and healthy controls, among other factors, support the evidence that LOBD may be a disease with a differentiated etiology. Thus, further research addressing the age of onset is required. The age of onset could be a valid clinical indicator and could help to understand the heterogeneous presentation of the disease. The goals of this study are: i) to identify profiles of OABD patients according to the onset of the illness, and ii) to look for associations of early and late onset with psychopathology, cognitive, functional outcomes and genetic risk.

Analytic Plan

Bipolar disorder is a chronic psychiatric disease associated with excitotoxicity and neuroinflammation processes that may contribute among other factors to accelerate normal aging mechanisms therefore its progression as a neurodegenerative disorder has been explored. Patients with bipolar disorder who are around the fiftieth decade of their lives are defined as older-age bipolar disorder (OABD), referring to patients ≥50 years old according to International Society for Bipolar Disorders (ISBD) Older Adults with Bipolar Disorder (OABD) Task Force. It represents a heterogeneous group that includes both patients with an early onset of the disease (EOBD) referring to those patients who have their first manic/hypomanic episode at <50 years old, and patients with a late onset of the disease (LOBD), to those patients who have their first manic/hypomanic episode aged >50 years, without a previous depressive episode. Literature on OABD is limited. Deficits of everyday functioning are common in OABD with mood symptoms, cognitive deficits and medical conditions all contributing to disability. Different clinical, cognitive and etiology factors between early and late onset have been detected across the literature. The greater severity of cognitive deficits frequently found, as well as the greater presence of medical and neurological burden in LOBD patients compared to EOBD and healthy controls, among other factors, support the evidence that LOBD may be a disease with a differentiated etiology. Thus, further research addressing the age of onset is required. The age of onset could be a valid clinical indicator and could help to understand the heterogeneous presentation of the disease. The goals of this study are: i) to identify profiles of OABD patients according to the onset of the illness, and ii) to look for associations of early and late onset with psychopathology, cognitive, functional outcomes and genetic risk.

Resources needed

Neuropsychological variables
v1_nrpsy_tmt_A_rt
v1_nrpsy_tmt_B_rt
v1_nrpsy_dgt_sp_frw
v1_nrpsy_dgt_sp_bck
v1_nrpsy_dg_sym
v1_nrpsy_mwtb
v2_nrpsy_vlmt_corr
v2_nrpsy_vlmt_lss_d
v2_nrpsy_vlmt_lss_t
v2_nrpsy_vlmt_rec

Demographic
v1_sex
v1_age
v1_marital_stat
v1_partner
v1_no_bio_chld
v1_stp_chld
v1_liv_aln
v1_school
v1_prof_dgr
v1_ed_status
v1_curr_paid_empl
v1_disabl_pens

Clinical
v1_cur_psy_trm
v1_age_1st_out_trm
v1_daypat_inpat_trm
v1_age_1st_inpat_trm
v1_dur_illness
v1_1st_ep

Medication
v1_Antidepressants
v1_Antipsychotics
v1_Mood_stabilizers
v1_Tranquilizers
v1_Other_psychiatric
v1_lith
v1_lith_prd

Family
v1_fam_hist

Substance use
v1_ever_smkd
v1_lftm_alc_dep
v1_evr_ill_drg

Somatic disease
v1_chol_trig
v1_hyperten
v1_ang_pec
v1_heart_att
v1_stroke
v1_diabetes
v1_hyperthy
v1_hypothy
v1_osteopor
v1_asthma
v1_autoimm
v1_cancer
v1_stom_ulc
v1_kid_fail
v1_epilepsy
v1_migraine
v1_parkinson
v1_tbi
v1_liv_cir_inf

Suicide
v1_scid_evr_suic_ide
v1_suic_attmpt
v1_scid_no_suic_attmpt

Diagnostic
v1_scid_dsm_dx_cat
v1_scid_age_MDE
v1_scid_no_MDE
v1_scid_age_mania
v1_scid_no_mania
v1_scid_age_hypomania
v1_scid_no_hypomania
v1_scid_ever_delus
v1_scid_ever_halls
v1_scid_ever_psyc
v1_scid_age_fst_psyc

Scales
v1_idsc_sum
v1_ymrs_sum
v1_gaf
v1_bdi2_sum
v1_whoqol_itm14
v1_whoqol_dom_glob
v1_whoqol_dom_phys
v1_whoqol_dom_psy
v1_whoqol_dom_soc
v1_whoqol_dom_env
v1_cape_itm37A

Genomics data
Raw genotypes (GSA chip) and imputed data from PsyCourse patients and healthy controls.