Older Patients With BD-I and -II Do Not Differ by Function, Cognition, Somatic Burden

Similarities in older-aged patients with BD-I and BD-II were found in the areas of general functioning, cognitive performance and somatic burden.

A cross-sectional study published in Bipolar Disorders found little differences with regard to general functioning, cognitive impairment, or somatic burden between older patients with bipolar disorder (BD)-I or -II.

Data for this study were sourced from the Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) project, which collected data internationally for patients with BD. For this analysis, Global Assessment of Functioning (GAF) scores, cognitive g-scores measured using neurophysiological tests, and somatic burden outcomes measured by tallying the presence or absence of 8 disease domains of interest were compared between older patients (N=963) with BD-I (n=714) and BD-II (n=249).

Among the entire study cohort, patients had a mean age of 63.1 (SD, 8.8) years, 56.1% were women, BD onset at 31.7 (SD, 15.0) years of age, they had 20.0 (SD, 44.3) affective episodes in their lifetime, 58.9% did not have depression, 74.6% had been hospitalized for a psychiatric condition, 40.4% used lithium, and 45.5% used antipsychotic medications.

Stratified by BD type, the patients with BD-I were younger (mean, 62.8 vs 64.1 years; P =.048), more had been hospitalized for a psychiatric condition (80.8% vs 57.6%; P <.001), fewer had severe depression (3.0% vs 8.2%; P =.007), fewer had late-onset disease (12.3% vs 19.7%; P =.013), more took antipsychotic medications (47.7% vs 39.0%; P =.023), and they had had fewer affective episodes (mean, 19.5 vs 21.3; P =.045).

BD-I and BD-II older-aged patients appeared similar in general functioning, cognitive performance and somatic burden.

After controlling for study cohort, between-group differences in the proportion of patients who were hospitalized for psychiatric conditions (t, 6.088; P <.001), using antipsychotic medications (t, -2.953; P =.003), with late-onset disease (t, 2.645; P =.008), and with mild or severe depression (t, -2.045; P =.041) were observed.

No significant differences in the outcomes of interest were reported, in which the patients with BD-I and BD-II had mean GAF scores of 60.6 and 62.0 (P =.473), cognitive g-scores of -0.002 and 0.16 (P =.191), and somatic burden scores of 2.47 and 2.45 (P =.831), respectively.

Similar findings were observed in sensitivity analyses.

The results of this study may not be generalizable for patients experiencing acute affective episodes or experiencing manic symptoms, as the GAGE-BD cohort included mostly outpatients who were not experiencing such symptoms.

Study authors concluded, “In this GAGE-BD study, some clinical differences in past treatment history and current presentation were observed between BD-I and BD-II patients, but these may in part be the result of diagnostic definitions (ie, confounding by indication). BD-I and BD-II older-aged patients appeared similar in general functioning, cognitive performance and somatic burden.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Beunders AJM, Klaus F, Kok AAL, et al. Bipolar I and bipolar II subtypes in older age: results from the global aging & geriatric experiments in bipolar disorder (GAGE-BD) project. Bipolar Disord. Published online November 15, 2022. doi:10.1111/bdi.13271