Illness progression in older‐age bipolar disorder: Exploring the applicability, dispersion, concordance, and associated clinical markers of two staging models for bipolar disorder in an older population. (7th October 2022)

• Record Type: Journal Article
• Authors: van der Markt, Afra; Beunders, Alexandra J. M.; Korten, Nicole C. M.; Schouws, Sigfried N. T. M.; Beekman, Aartjan T.F.; Kupka, Ralph W.; Klumpers, Ursula; Dols, Annemiek
• Is Part Of: International journal of geriatric psychiatry. Volume 37:Number 11(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-10-07
• Subjects: aging -- bipolar disorder -- illness progression -- OABD -- older age bipolar disorder -- staging; Geriatric psychiatry -- Periodicals; Geriatric Psychiatry -- Periodicals; 618.97689
• DOI: 10.1002/gps.5816
• Languages: English
• ISSNs: 0885-6230

Abstract

Abstract: Objectives: The validity and applicability of two existing staging models reflecting illness progression have been studied in bipolar disorder (BD) in adults, but not in older adult populations. Staging model A is primarily defined by the number and recurrence of mood episodes, model B is defined by the level of inter‐episodic functioning. This study aimed to explore the applicability, dispersion, and concordance of, and associations with clinical markers in these two staging models in older‐age bipolar disorder (OABD). Methods: Using cross‐sectional data from the Dutch Older Bipolars study, OABD outpatients ( N = 126, ≥50 years) were staged using models A and B. Dispersion over the stages and concordance between the models were assessed. Associations were explored between model stages and clinical markers (familial loading, childhood abuse, illness duration, episode density, treatment resistance, Mini‐Mental State Examination, and composite cognitive score). Results: Ninety subjects could be assigned to model A, 111 to model B, 80 cases to both. The majority (61%) had multiple relapses (model A, stage 3C) but were living independently (model B, stage I‐III). Concordance between models was low. For model A, the markers childhood abuse, illness duration, and episode density significantly increased over subsequent stages. Model B was not associated with a significant change in any marker. Conclusions: Assigning stages to OABD subjects was possible for both models, with age‐related adjustments for model B. Model B as currently operationalized may be less suitable for OABD or may measure different aspects of illness progression, reflected by its low correspondence with model A and lack of associated clinical markers. Key points: Assigning stages to OABD subjects was possible for both models with age‐related adjustments for the model based on functioning. Dispersion over the stages was sufficient. Using model A, the majority (61%) of subjects concentrated in stage 3C (multiple relapses, N = 51); subcategories improved dispersion. Using model B, most subjects concentrated in stages I and II. Overall, the majority of subjects had multiple relapses but were still living autonomously. Concordance between model A (based on number of episodes) and model B (based on inter‐episodic functioning) was low. For model A, the markers childhood abuse, illness duration, and episode density significantly increased over subsequent stages. Illness progression according to model B was not associated with a significant change in any marker.