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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.

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Title: 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.
Authors: van der Markt, Afra (AUTHOR), Beunders, Alexandra J. M. (AUTHOR), Korten, Nicole C. M. (AUTHOR), Schouws, Sigfried N. T. M. (AUTHOR), Beekman, Aartjan T.F. (AUTHOR), Kupka, Ralph W. (AUTHOR), Klumpers, Ursula (AUTHOR), Dols, Annemiek (AUTHOR)
Source: International Journal of Geriatric Psychiatry. Nov2022, Vol. 37 Issue 11, p1-11. 11p.
Subjects: Bipolar disorder, Older people, Biomarkers, Cross-sectional method, Mental illness, Statistical reliability, Disease progression
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. [ABSTRACT FROM AUTHOR]
Copyright of International Journal of Geriatric Psychiatry is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Label: Title
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  Data: 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.
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  Data: <searchLink fieldCode="AR" term="%22van+der+Markt%2C+Afra%22">van der Markt, Afra</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Beunders%2C+Alexandra+J%2E+M%2E%22">Beunders, Alexandra J. M.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Korten%2C+Nicole+C%2E+M%2E%22">Korten, Nicole C. M.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Schouws%2C+Sigfried+N%2E+T%2E+M%2E%22">Schouws, Sigfried N. T. M.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Beekman%2C+Aartjan+T%2EF%2E%22">Beekman, Aartjan T.F.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kupka%2C+Ralph+W%2E%22">Kupka, Ralph W.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Klumpers%2C+Ursula%22">Klumpers, Ursula</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Dols%2C+Annemiek%22">Dols, Annemiek</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22International+Journal+of+Geriatric+Psychiatry%22">International Journal of Geriatric Psychiatry</searchLink>. Nov2022, Vol. 37 Issue 11, p1-11. 11p.
– Name: Subject
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  Data: <searchLink fieldCode="DE" term="%22Bipolar+disorder%22">Bipolar disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Older+people%22">Older people</searchLink><br /><searchLink fieldCode="DE" term="%22Biomarkers%22">Biomarkers</searchLink><br /><searchLink fieldCode="DE" term="%22Cross-sectional+method%22">Cross-sectional method</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+illness%22">Mental illness</searchLink><br /><searchLink fieldCode="DE" term="%22Statistical+reliability%22">Statistical reliability</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+progression%22">Disease progression</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: <bold>Objectives: </bold>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).<bold>Methods: </bold>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).<bold>Results: </bold>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.<bold>Conclusions: </bold>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. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of International Journal of Geriatric Psychiatry is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1002/gps.5816
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              Text: Nov2022
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