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

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.

Older age bipolar disorder

“…However, participants with higher mastery still reported less psychiatric symptoms than participants with a lower sense of mastery [ 38 ]. Furthermore, earlier mentioned staging models A and B were explored in the first-ever study on staging in OABD patients [ 39 ]. For model A, based on the number and recurrence of mood episodes, a higher stage and thus less favorable course of illness was associated with childhood abuse, longer illness duration, and higher episode density.…”

“…For model A, based on the number and recurrence of mood episodes, a higher stage and thus less favorable course of illness was associated with childhood abuse, longer illness duration, and higher episode density. Model B, based on inter-episodic functioning, may be less suitable for OABD as currently operationalized or may measure different aspects of illness progression [ 39 ].…”