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Bipolar Disorder and Dementia: What's the Connection?

By Angel RidoutJuly 19, 2022
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Understanding the similarities, differences, and the relationship between dementia and bipolar disorder is vitally important to effectively caring for a loved one.

Although bipolar disorder and dementia differ significantly, research suggests they’re linked in some key ways. For instance, there’s strong evidence that people with bipolar disorder have a higher risk of developing dementia. 

Additionally, the conditions might have similar symptoms. This is especially true of late-onset bipolar disorder, a less common diagnosis that can appear at a similar stage of life as dementia.


In this article:


What is late-onset bipolar disorder?

Bipolar disorder, formerly called manic depression, is defined by mood changes that alternate between depression and mania. Mania is typically characterized by euphoria, hyperactivity, disorganized or impulsive behavior, and less need for sleep. Late-onset bipolar disorder is a new diagnosis of a manic or hypomanic (less extreme) episode after age 50 that isn’t explained by other potential causes like drugs, brain lesions, or brain injuries.

Can bipolar disorder show up later in life?

Yes, bipolar disorder can appear later in life, but less frequently than in younger people.

“The majority of bipolar disorders have their onset in the late teens and early adult years,” says Dr. Bruce Shapiro, adjunct professor of psychiatry at New York Medical College. “It’s estimated that only about 10% of individuals who have a bipolar disorder will have an onset after age 50 and that 5% will have an onset of the disorder after age 60.”

How is bipolar disorder different in elderly adults than in younger people?

Seniors have similar symptoms as younger adults with bipolar disorder, although seniors are likely to have longer hospital stays. Younger adults are more likely to have substance abuse issues in addition to bipolar symptoms. Elderly adults are also more likely to show a mix of depression and manic symptoms.

“These are very serious issues in seniors, and it is often overlooked that the rate of suicide is higher in senior years than in any other age group,” Shapiro says.

What are the similarities and differences between late-onset bipolar disorder and dementia?

A graphic shows the similarities and differences between bipolar disorder and dementia.

Late-onset bipolar disorder and dementia have many of the same symptoms, including:

  • Agitation
  • Depressed mood
  • Restlessness
  • Anxiety
  • Auditory hallucinations

However, there are some significant differences. People with bipolar disorder are more likely to have a slower buildup to mania and a slower change from mania to a depressed mood. While some people with bipolar disorder experience multiple rapid mood changes throughout the day, this symptom is more commonly seen in people with dementia — especially in the evenings, a phenomenon known as sundown syndrome.

Is mania a symptom of dementia?

Mania can be a symptom in all types of dementia, but it’s more commonly seen in frontal lobe dementia and Lewy body dementia. Both diseases can cause agitation, hyperactivity, inappropriate social behavior, and other symptoms often associated with mania.

Do both dementia and bipolar disorder cause psychosis and hallucinations?

Yes, dementia and bipolar disorder can both cause psychosis and hallucinations. Brain changes caused by dementia can result in dementia psychosis, hallucinations, and delusions. These are common in frontal lobe dementia and Lewy body dementia, especially in the later stages of the disease. Hallucinations and delusions may also occur in the later stages of Alzheimer’s disease. Psychosis is uncommon in bipolar disorder, but some people may experience delusions and auditory hallucinations.

Generally, if an individual with bipolar disorder experiences auditory hallucinations or psychosis, they are given a diagnosis of bipolar disorder with psychotic features. Psychosis and hallucinations are more likely to happen during a manic phase.

What’s the link between bipolar and dementia?

A graphic ov a Venn diagram shows the connection between bipolar disorder and dementia.

The risk of developing dementia is much higher among people who’ve had bipolar disorder, according to several studies. A 2020 analysis determined that people with bipolar disorder are about three times more likely to develop dementia, while another expansive analysis also found a significantly increased risk.

The number of bipolar episodes someone experiences could also play a role in dementia risk. In a 2004 study published in the Journal of Neurology, Neurosurgery & Psychiatry, the rate of dementia increased about 6% with each bipolar episode that led to a hospital admission.

However, a drug often prescribed to people with bipolar disorder could lower their risk for dementia. Lithium appeared to reduce the risk of people with bipolar disorder developing dementia by nearly 50%, according to a 2020 analysis published in Acta Psychiatrica Scandinavica.

How can I tell if my aging loved one has bipolar disorder or dementia?

Mental illness can be very difficult to diagnose in seniors, as confusion, erratic behavior, and memory loss are symptoms of both dementia and mental illness. This makes it difficult to differentiate between the two conditions, and it’s why experts recommend consulting with a mental health professional who specializes in treating older adults.

Common signs of bipolar disorder

People with bipolar disorder typically exhibit these depressed behaviors:

  • Loss of interest in previously enjoyed activities
  • Eating too much or too little
  • Sleeping too much or too little
  • Fatigue and inability to concentrate
  • Feelings of hopelessness and worthlessness
  • Suicidal thoughts and behaviors

Bipolar disorder often includes these manic behaviors:

  • Agitation and increased energy
  • Decreased need for sleep
  • Grandiose ideas and plans
  • Impulsivity and reckless behaviors
  • Racing thoughts which are often manifested in rapid speech
  • Euphoria

Common signs of dementia

People with dementia usually experience these cognitive changes:

  • Memory loss
  • Getting lost in familiar surroundings
  • Difficulty planning or reasoning
  • Communication difficulties

Dementia commonly brings these psychological changes:

  • Depression
  • Agitation, especially in the evening
  • Anxiety
  • Hallucinations and delusions
  • Behaving inappropriately

How to diagnose late-onset bipolar disorder and dementia

A mental health professional — such as a geriatric psychologist (or geropsychologist), psychiatrist, or neuropsychiatrist — will attempt to clarify whether symptoms suggest anxiety, bipolar disorder, dementia, depression, or psychosis. Potential types of testing for dementia and late-onset bipolar include:

  • Cognitive tests
  • Complete medication and supplement review
  • Laboratory assessments
  • Mental status examinations
  • Neuroimaging, such as a CT scan or MRI
  • Thorough developmental, physical, and social history
  • Discussions with family members or caregivers

How is bipolar disorder in elderly loved ones treated and managed?

Bipolar disorder in seniors is typically treated much like it is in younger adults, with medications and talk therapy. However, there are some key differences. 

Medications

Mood stabilizers such as lithium and Depakote can be very effective in helping people manage behavioral symptoms, Shapiro says.

“(However), the metabolism in seniors differs from that of a younger individual,” he says. “There are often changes in kidney and liver function in this age group. These changes will make the senior more sensitive to medications, and many medications must be given with 1/3 to 1/2 reduction of the usual adult dosage in the elderly.”

Lithium in particular must be used cautiously, as seniors’ kidneys can’t clear the drug efficiently.

“Seniors who take mood-stabilizing medications may have behavioral or personality changes, particularly if they experience changes in the blood levels of their mood-stabilizing medication,” Shapiro says. “This is generally addressed with blood level testing and medication dosage adjustments.”

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Talk therapy

The therapy needs of seniors differ from those of younger adults. Cognitive decline, loss of loved ones, memory changes, physical changes, and retirement can all bring on significant emotional issues. Geropsychologists are well-suited to help seniors explore and deal with these issues.

“Treatment of seniors often involves working with the family as well,” Shapiro says. “The role of psychotherapy, with both individuals and families, has unfortunately all too often been minimized during the geriatric years. Short-term, problem-focused therapies can be very beneficial in the treatment of seniors.”

Personalized help finding assisted living or memory care

Do you have a senior loved one who has been diagnosed with bipolar disorder or dementia? A Place for Mom’s Senior Living Advisors can help if you’re looking for assisted living or memory care facilities. Their services come at no cost to you.

Sources

Diniz, B., Teixeira, A., Cao, F., Gildengers, A., Soares, J., Butters, M., & Reynolds, C. (2017, January). History of Bipolar disorder and the risk of dementia: A systematic review and meta-analysis. American Journal of Geriatric Psychiatry.

Jain, A. & Mitra, P. (2022, May). Bipolar Affective Disorder. StatPearls Publishing LLC.

Kessing, L., & Andersen, P. (2004, November). Does the risk of developing dementia increase with the number of episodes in patients with depressive disorder and in patients with bipolar disorder?Journal of Neurology, Neurosurgery & Psychiatry.

McDonald, W., & Nemeroff, C. (1998). Practical guidelines for diagnosing and treating mania and bipolar disorder in the elderlyMedscape Psychiatry & Mental Health eJournal.

Morgan, S. (2017, April). Psychotic and bipolar disorders: Behavioral disorders in dementiaAmerican Family of Physicians.

Onyike, C. (2016, April). Psychiatric aspects of dementiaContinuum – American Academy of Neurology.

Prabhakar, D., & Balon, R. (2010, January). Late-onset bipolar disorderPsychiatry MMC.

Velosa, J., Delgado, A., Finger, E., Berk, M., Kapczinski, F., de Azevedo Cardoso, T. (2020, January). Risk of dementia in bipolar disorder and the interplay of lithium: A systematic review and meta-analysesActa Psychiatrica Scandinavica.

The information contained in this article is for informational purposes only and is not intended to constitute medical, legal, or financial advice or to create a professional relationship between A Place for Mom and the reader. Always seek the advice of your health care provider, attorney, or financial advisor with respect to any particular matter, and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not endorse the contents of the third-party sites.

Author
Angel Ridout

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