BACKGROUND
Older adults with bipolar disorder (BD) are at high risk for severe mood symptoms, cognitive difficulties, and early mortality; however, underlying brain alterations have received little study. Gray matter decreases in ventral prefrontal cortex (VPFC) seen in younger persons with BD, and additionally in dorsal PFC (DPFC), are implicated. Here, cortical thickness was examined in an international sample.
METHODS
Cortical thickness in 34 regions was measured from structural magnetic resonance imaging data using enhancing neuroImaging genetics through meta-analysis pipelines for individuals with BD (n = 308) and non-psychiatric comparison participants (n = 287), ages 40-70y, from six Global Aging and Geriatric Experiments in BD (GAGE-BD) consortium sites. Group differences were assessed for VPFC, DPFC and remaining cortical regions, covarying for scanner, age and sex. Results were considered significant corrected for false discovery fate (FDR) at pFDR < 0.05. Relationships with demographic and clinical factors were explored.
RESULTS
Cortical thickness was significantly lower among BD in VPFC and DPFC, and additional distributed regions (pFDR < 0.05) and negatively associated with age (p < 0.05); group and age did not interact significantly. Relationships with BD subtype and medications were observed; lithium was associated with higher frontal pole and anterior cingulate thickness (pFDR < 0.05).
CONCLUSIONS
In this international middle and older aged adult BD sample, lower VPFC cortical thickness was observed, suggesting these deficits persist from younger age. DPFC and additional regions of reduced cortical thickness could contribute to the older adult BD phenotype. Cortical thinning was more pronounced among older individuals regardless of diagnosis. Lithium may lessen cortical thinning.
Rebecca B. Marks, A. Sankar, L. Colic et al.· Bipolar Disorders· 0 citations
BACKGROUND
In the U.S., about one million people with active epilepsy are adults aged 55+. Older adults with epilepsy (OAWE) experience complex health conditions that compromise quality of life (QOL). The contribution of depressive symptom dimensions to health-related QOL remains underexplored in OAWE.
METHODS
We analyzed baseline data from 13 epilepsy self-management studies in the CDC-sponsored MEW-DB (Managing Epilepsy Well Database), including adults ages 55 and older (N = 198). The primary outcome was health-related QOL, assessed via the 10-item Quality of Life in Epilepsy scale (QOLIE-10), which was inverse rank normalized (mean = 0, SD = 1). Primary predictors included the Patient Health Questionnaire (PHQ-9) total score, cognitive and somatic symptom sub scores, and suicide ideation. Multivariable mixed-effects linear regression was used to assess associations. Models included a random intercept for originating study.
RESULTS
Participants were x̄ = 60.8 years (range: 55-79); 60.6% female and 68.7% White. On average, participants had mild depressive symptoms (mean PHQ-9 = 8.3). Depressive symptom severity was significantly associated with worse QOL. Cognitive (β = 0.17 SD, 95% CI: 0.12-0.21, p = 5.6 × 10-13), somatic (β = 0.19 SD, 95% CI: 0.14-0.23, p = 3.3 × 10-17), and total depressive (PHQ-9 total) symptoms (β = 0.10 SD, 95% CI: 0.08-0.12, p = 3.8 × 10-21) were associated with worse QOLIE-10 total scores when adjusting for likely confounders. Suicide ideation was not associated with QOLIE-10 (β = 0.07 SD, 95% CI: -0.15 to 0.29, p = 0.51). Past 30-day seizure occurrence was associated with worse total QOLIE-10 only when depressive terms were excluded from the multivariable model (β = 0.38 SD, 95% CI: 0.05-0.72, p = 0.024).
CONCLUSIONS
Among OAWE, depressive symptoms are strongly linked to reduced QOL. These findings underscore the importance of integrated mental health screening and intervention for OAWE.
Elaine T. Kiriakopoulos, Farren Briggs, Nicole Fiorelli et al.· Epilepsy & Behavior· 0 citations
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