Background: Recent reports have suggested that bipolar disorder beginning in late life is strongly associated with organic brain disease whereas early-onset cases are more likely to be associated with a family history of mood disorder. It is not yet clear whether late-onset bipolar disorder is therefore a “phenocopy” of the classic early-onset disorder, sharing symptoms but having a different etiology, or whether people with early- and late-onset bipolar disorder have a common underlying vulnerability that interacts with age-specific triggering factors. Aim: The present study examines the administrative records of patients treated for bipolar disorder, to establish whether differences between early- and late-onset cases might be consistent with their having distinct etiological processes. Methods: We used a file containing administrative data for all patients with a diagnosis of bipolar disorder who were in contact with the health services of Western Australia between 1980 and 1998. For each contact with psychiatric services, the file provided the patient's age, gender, marital status, educational achievement, employment, ethnic origin, postcode of residence, primary and secondary diagnoses, and the duration of the (administrative) episode. Subjects were designated “late-onset” when their first contact with psychiatric services occurred at or after 65 years of age. Results: Between 1980 and 1998 there were 33,004 service contacts involving 6,182 individuals whose primary or secondary clinical diagnosis was bipolar disorder. This indicates that the prevalence of bipolar disorder in Western Australia is approximately 0.4%. Most patients had an onset of illness between 15 and 45 years of age, but 492 patients (8%) were aged 65 years or over at the time of first contact with mental health services. We observed that the relative frequency of late-onset bipolar disorder increased between 1980 and 1998 (1% to 11%). There was an excess of women in our cohort (3:2), but no difference in the age of onset between males and females. Early onset was associated with a subsequently lower socioeconomic status, aboriginal ethnicity, and a higher frequency of mixed affective episodes, other mood disorders, schizophrenia, and schizoaffective disorder. Patients with late-onset bipolar disorder were more likely to have a diagnosis of organic mental disorder recorded (2.8% vs. 1.2%). There was no evidence of a bimodal pattern of age-specific incidence. Conclusion: The observed differences between early- and late-onset bipolar disorders are small and most likely attributable to differences in the duration of illness. Only a small proportion of patients with bipolar disorder were ever diagnosed with an organic mental disorder, which suggests that the reported association between late onset of illness and organic factors may be of limited clinical relevance.

Dementia incidence in Aboriginal Australians is among the highest in the world, and is associated with age and head injury.

ObjectiveThis study aimed to develop a culturally acceptable and valid scale to assess depressive symptoms in older Indigenous Australians, to determine the prevalence of depressive disorders in the older Kimberley community, and to investigate the sociodemographic, lifestyle and clinical factors associated with depression in this population.MethodsCross-sectional survey of adults aged 45 years or over from six remote Indigenous communities in the Kimberley and 30% of those living in Derby, Western Australia. The 11 linguistic and culturally sensitive items of the Kimberley Indigenous Cognitive Assessment of Depression (KICA-dep) scale were derived from the signs and symptoms required to establish the diagnosis of a depressive episode according to the DSM-IV-TR and ICD-10 criteria, and their frequency was rated on a 4-point scale ranging from ‘never’ to ‘all the time’ (range of scores: 0 to 33). The diagnosis of depressive disorder was established after a face-to-face assessment with a consultant psychiatrist. Other measures included sociodemographic and lifestyle factors, and clinical history.ResultsThe study included 250 participants aged 46 to 89 years (mean±SD = 60.9±10.7), of whom 143 (57.2%) were women. The internal reliability of the KICA-dep was 0.88 and the cut-point 7/8 (non-case/case) was associated with 78% sensitivity and 82% specificity for the diagnosis of a depressive disorder. The point-prevalence of a depressive disorder in this population was 7.7%; 4.0% for men and 10.4% for women. Heart problems were associated with increased odds of depression (odds ratio = 3.3, 95% confidence interval = 1.2,8.8).ConclusionsThe KICA-dep has robust psychometric properties and can be used with confidence as a screening tool for depression among older Indigenous Australians. Depressive disorders are common in this population, possibly because of increased stressors and health morbidities.

Congestive heart failure is associated with a pattern of generalized cognitive decline. Structural brain changes, functional capacity and biochemical parameters are associated with the cognitive performance of patients with CHF, but their contribution appears modest. The design of a definitive case-control study is described.

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