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ObjectiveAlthough 25% of people with bipolar disorder (BD) are over age 60, there is a dearth of research on older age bipolar disorder (OABD). This report describes an initial effort to create an integrated OABD database using the U.S. National Institute of Mental Health Data Archive (NDA). Goals were to: 1) combine data from three BD studies in the United States that included overlapping data elements; 2) investigate research questions related to aims of the original studies; and 3) take an important first step toward combining existing datasets relevant to aging and BD.MethodsData were prepared and uploaded to the NDA, with a focus on data elements common to all studies. As appropriate, data were harmonized to select or collapse categories suitable for cross-walk analysis. Associations between age, BD symptoms, functioning, medication load, medication adherence, and medical comorbidities were assessed. The total sample comprised 451 individuals, mean age 57.7 (standard deviation: 13.1) years.ResultsMedical comorbidity was not significantly associated with either age or functioning and there did not appear to be an association between medication load, comorbidity, age, and adherence. Men and African-Americans were significantly more likely to have poor adherence. Both BD mania and depression symptoms were associated with functioning, but this differed across studies.ConclusionDespite limitations including heterogeneity in study design and samples and cross-sectional methodology, integrated datasets represent an opportunity to better understand how aging may impact the presentation and evolution of chronic mental health disorders across the lifespan.

Objective: Some individuals with bipolar disorder (BD) experience manic and depressive symptoms concurrently, but data are limited on symptom mixity in older age bipolar disorder (OABD). Using the Global Aging & Geriatric Experiments in Bipolar Disorder Database, we characterized mixity in OABD and associations with everyday function.Methods: The sample (n = 805), from 12 international studies, included cases with both mania and depression severity ratings at a single timepoint. Four mixity groups were created: asymptomatic (A), mixed (Mix), depressed only (Dep), and manic only (Man). Generalized linear mixed models used mixity group as the predictor variable; cohort was included as a random intercept. Everyday function was assessed with the Global Assessment of Functioning score.Results: Group proportions were Mix (69.6%; n = 560), followed by Dep (18.4%; n = 148), then A (7.8%; n = 63), then Man (4.2%; n= 34); levels of depression and mania were similar in Mix compared to Dep and Man, respectively. Everyday function was lowest in Mix, highest in A, and intermediate in Man and Dep. Within Mix, severity of depression was the main driver of worse functioning. Groups differed in years of education, with A higher than all others, but did not differ by age, gender, employment status, BD subtype, or age of onset.Conclusions: Mixed features predominate in a cross-sectional, global OABD sample and are associated with worse everyday function. Among those with mixed symptoms, functional status relates strongly to current depression severity. Future studies should include cognitive and other biological variables as well as longitudinal designs to allow for evaluation of causal effects. [ABSTRACT FROM AUTHOR]

Objectives: To compare the prevalence of physical morbidities among men and women with older adult bipolar disorder (OABD), and men with and without OABD.Methods: Cross-sectional analysis of the collaborative Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) database and non-OABD data from the Health in Men Study. OABD defined as bipolar disorder among adults aged greater than or equal to 50 years. Outcomes of interest were diseases affecting the cardiovascular, respiratory, gastrointestinal, renal, musculoskeletal and endocrinological systems.Results: We examined 1407 participants with OABD aged 50-95 years, of whom 787 were women. More women than men showed evidence of morbidities affecting the respiratory, gastrointestinal, musculoskeletal and endocrinological systems. More men with than without OABD showed evidence of cardiovascular, renal and endocrinological diseases.Conclusion: GAGE-BD data showed that physical morbidities affect more women than men with OABD, and more men with than without OABD. The underlying reasons for these differences require clarification. [ABSTRACT FROM AUTHOR]

Objectives: To assess long-term safety and efficacy of deutetrabenazine in younger (<55 years) and older (≥55 years) adult participants with tardive dyskinesia (TD).Design: Three-year, single-arm, open-label extension (OLE) study enrolling participants who completed the 12-week, pivotal ARM-TD or AIM-TD studies.Setting: Seventy-six centers in the United States and Europe.Participants: A total of 337 participants with TD (119 younger and 218 older).Intervention: Deutetrabenazine was initiated at 12 mg/day and titrated once weekly by 6 mg/day using a response-driven dosing regimen until adequate dyskinesia control was reached or a clinically significant adverse event occurred.Measurements: This post hoc analysis assessed change and percent change from baseline in total motor Abnormal Involuntary Movement Scale (AIMS) score, response rates for ≥50% AIMS improvement, Clinical Global Impression of Change (CGIC), Patient Global Impression of Change (PGIC), and safety in younger and older participants with TD.Results: After 3 years of open-label treatment, mean deutetrabenazine dose was ∼39.5 mg/day in both groups. Mean±SE changes from baseline in total motor AIMS score were -6.7 ± 0.62 and -6.5 ± 0.47 in younger and older participants, respectively (percent changes: -61.4% ± 4.10% and -54.6% ± 3.01%); 76% of younger and 62% of older participants achieved ≥50% AIMS response. Most younger and older participants achieved treatment success per CGIC (67% and 76%) and PGIC (64% and 63%). Deutetrabenazine was generally well tolerated in both groups.Conclusions: Deutetrabenazine treatment was associated with sustained improvements in total motor AIMS score, treatment success, and improved quality of life, and was well tolerated in younger and older adults with TD in this 3-year OLE study. [ABSTRACT FROM AUTHOR]

As described in the DSM-5-TR, middle-aged and elderly individuals have an increased risk for tardive dyskinesia (TD), a persistent and potentially disabling movement disorder associated with exposure to antipsychotics and other dopamine receptor blocking agents. Valbenazine, a highly selective vesicular monoamine transporter 2 (VMAT2) inhibitor, is the only FDA-approved TD medication with once-daily dosing and no requirements or cautions for dose adjustment in elderly patients (≥65 years). To further elucidate long-term TD outcomes in elderly patients, data from two valbenazine studies (KINECT 3-extension [K3] and KINECT 4 [K4]) were analyzed post hoc in participants who were ≥65 years old. The analyses were also conducted in participants who were ≥55 years old to capture information in those who may be considered middle-aged. K3 and K4 study participants received valbenazine (40 or 80 mg) once daily for 48 weeks. Data were pooled from the K3/K4 baseline visit and post-baseline visits (Week 8 [both studies], Week 12/16 [K4/K3], Week 24 [K4 only], Week 32/36 [K3/K4], and Week 48 [both studies]) and analyzed by age (≥55 yrs, ≥65 yrs). Analyses based on Abnormal Involuntary Movement Scale (AIMS) total score included: mean change from baseline to end of treatment, which was the primary efficacy endpoint in both studies; and treatment response, defined as ≥50% AIMS improvement from baseline. For the Clinical Global Impression of Change-Tardive Dyskinesia (CGI-TD) and Patient Global Impression of Change (PGIC), response was defined as a rating of "much improved" or "very much improved" (score ≤2). The pooled AIMS, CGI-TD, and PGIC data were analyzed descriptively with no imputation for missing values. Safety assessments included treatment-emergent adverse events (TEAEs) and psychiatric stability, as assessed using the following scales: Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale for Schizophrenia (CDSS) in patients with schizophrenia/schizoaffective disorder; Young Mania Rating Scale (YMRS) and Montgomery-Åsberg Depression Rating Scale (MADRS) in patients with mood disorder. In both age groups, mean improvements in AIMS total score increased over time. At Week 8 (first pooled post-baseline visit) and Week 48 (end of treatment), mean score changes from baseline in elderly participants (≥65 yrs) were -4.5 and -8.8, respectively. The percentage of participants in this age group who met response thresholds were as follows: AIMS ≥50% improvement (40.0% [20/50] and 82.1% [23/28] for Weeks 8 and 48, respectively); CGI-TD ≤2 (33.3% [17/51] and 92.9% [26/28]); PGIC ≤2 (43.1% [22/51] and 85.7% [24/28]). Similar results were found in participants aged ≥55 yrs. Safety analyses indicated similar incidences between age groups for any TEAE (76.8% and 72.7% for ≥55 yrs [n=190] and ≥65 yrs [n=55], respectively) and serious TEAEs (20.5% and 18.2%). The percentage of participants who discontinued due to a TEAE increased with age (18.9% and 25.5%). Mean changes from baseline to Week 48 in psychiatric symptom scale scores were minimal, indicating maintenance of psychiatric stability in both age groups. Long-term treatment with once-daily valbenazine led to clinically meaningful reductions of TD symptoms in elderly patients with TD (≥65 yrs) and those who were middle-aged or elderly (≥55 yrs). After 48 weeks of valbenazine treatment, >80% of participants in the ≥65 yrs age group met rigorous thresholds of TD improvement, with similar results in the ≥55 yrs. age group. These results may help clinicians make treatment decisions for managing TD in older patients, including those who are middle-aged or elderly. Neurocrine Biosciences, Inc. [ABSTRACT FROM AUTHOR]

Stigma negatively affects individuals with cognitive impairment and dementia. This literature review examined the past decade (January 2004 to December 2015) of world-wide research on dementia-related stigma. Using standard systematic review methodology, original research reports were identified and assessed for inclusion based on defined criteria. Initial database searches yielded 516 articles. After removing duplicates and articles that did not fit inclusion criteria (419), 97 articles were reviewed, yielding a final total of 51 publications, mainly originating in the United States and Europe. Studies were assessed for date, geographic region, sample description, methodology, and key findings. Reports were evaluated on 1) how stigmatizing attitudes may present in various subgroups, including in racial or ethnic minorities; 2) stigma assessment tools; and 3) prospective or experimental approaches to assess or manage stigma. Stigma impedes help-seeking and treatment, and occurs broadly and world wide. Stigmatizing attitudes appear worse among those with limited disease knowledge, those with little contact with people with dementia, in men, in younger individuals, and in the context of ethnicity and culture. In some cases, healthcare providers may have stigmatizing attitudes. In research studies, there does not appear to be consensus on how to best evaluate stigma, and there are few evidence-based stigma reduction approaches. Given the projected increase in persons with dementia globally, there is a critical need for research that better identifies and measures stigma and tests new approaches that can reduce stigmatizing attitudes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety and effectiveness of 6 months of treatment with lurasidone in older adults with a diagnosis of bipolar I depression.Design: Post-hoc analysis of a multicenter, 6-month, open-label extension study.Setting: Outpatient.Participants: Patients aged 55 to 75 years with a DSM-IV-TR diagnosis of bipolar I depression who had completed 6 weeks of double-blind, placebo-controlled treatment with either lurasidone monotherapy (1 study) or adjunctive therapy with lithium or valproate (2 studies).Intervention: Flexible doses of lurasidone, 20 to 120 mg/day, either as monotherapy, or adjunctive with lithium or valproate.Measurements: Effectiveness was assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS; change from open-label-baseline to month-6, observed case analysis).Results: A total of 141 older adults entered the extension study (monotherapy, N = 55; 39%; adjunctive therapy, N = 86; 61%). At the end of 6 months of open-label treatment with lurasidone, as monotherapy or adjunctive therapy, minimal changes were observed in the older adult sample in mean weight (-1.0 kg and -0.4 kg, respectively); and median total cholesterol (-2.0 mg/dL and +6.0 md/dL, respectively), triglycerides (+2.5 mg/dL and +6.0 mg/dL, respectively), and HbA1c (0.0% and -0.1%, respectively). Patients treated with 6 months of lurasidone showed a mean improvement on the MADRS in both the monotherapy (-6.2) and adjunctive therapy (-6.7) groups.Conclusions: Results of these post-hoc analyses found that up to 7.5 months of lurasidone treatment for bipolar depression in older adults was associated with minimal effects on weight and metabolic parameters, with low rates of switching to hypomania or mania, and was well tolerated. The antidepressant effectiveness of lurasidone in this age group was maintained over the 6-month treatment period. [ABSTRACT FROM AUTHOR]

Roughly 25% of those with bipolar disorder (BD) are 60 years or older, and this proportion is likely to increase in tandem with changes in global demographics. Aging-related trajectories may also start in mid adulthood and lead to worse health outcomes such as cognitive decline and early mortality. The Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) project, a multi-national research initiative, pools archival research and clinical datasets to provide an evidence platform with potential to advance knowledge on older age BD (OABD). Key goals of investigators collaborating on the GAGE-BD project are to examine correlates of age of onset, understand BD mood symptom presentations, and set the stage for future investigations in aging-related changes in brain structure and functioning. In the first presentation, Dr. Lavin will describe an analysis of clinical correlates of late vs. early-onset BD. The majority of patients with BD have an onset before 40 years old. However, a significant number of individuals have onset of illness after age 40, commonly referred to as late-onset BD. This examination of a large international dataset sheds light on the association between the age of onset of BD symptoms and the distribution of risk factors and course of illness. Findings can yield important insights into the mechanisms involved in the evolution of BD across the life-span. In the second presentation, Dr. Blumberg will present on a new initiative to link neuroimaging findings with clinical data from the GAGE –BD sample. This talk will summarize procedures to harmonize aggregate data and how multi-national teams can collaborate to grow research capacity that is intended to better understand aging-related changes in brain structure and the relationship of the changes to demographic and clinical factors. Preliminary findings comparing older adults with BD to healthy participants on gray matter volume from structural magnetic resonance imaging (MRI) data, and white matter microstructure from diffusion-weighted MRI data, will be presented. In the third presentation, Dr. Eyler will discuss BD symptom severity mixity in OABD. The Diagnostic and Statistical Manual (DSM-5) includes a 'with mixed features' specifier that applies to a manic /hypomanic or to a depressive episode. Findings from the GAGE-BD samples suggested mixed features are relatively common in OABD, but do not suggest that mixity is associated with functional status. Future studies need to investigate whether mixed symptoms could contribute to BD neuroprogression in later life. Following the presentations, there will be discussion and ample opportunity for questions regarding emerging issues most relevant to OABD [ABSTRACT FROM AUTHOR]

Valbenazine is a selective and potent vesicular monoamine transporter 2 (VMAT2) inhibitor approved for the treatment of tardive dyskinesia (TD), a persistent and potentially disabling movement disorder associated with prolonged exposure to antipsychotics or other dopamine-receptor blocking agents (DRBAs). Valbenazine is the only approved TD medication with once-daily dosing and no requirements or cautions for dosing based on age. Older adults (≥55 years) have an increased risk for TD after a shorter duration of treatment with DRBAs, and previous analyses have shown that valbenazine is effective and well tolerated in this population (Sajatovic et al, Int J Geriatr Psychiatry 2020). The current presentation includes findings from the first analyses to evaluate the effects of an approved TD medication in an elderly population, using the more conventional age cutoff of ≥65 years. Data from two long-term studies (KINECT 3-extension, KINECT 4) of participants receiving up to 48 weeks of once-daily treatment with valbenazine (40 mg or 80 mg) were pooled and analyzed by age (≥65 and <65 years). Analyses included mean change from baseline (CFB) to Week 48 in Abnormal Involuntary Movement Scale (AIMS) total score. AIMS response at Week 48 was also assessed as follows: clinically meaningful response (≥30% improvement from baseline); protocol-defined response (≥50% improvement from baseline). Additional analyses included response thresholds for Clinical Global Improvement-Tardive Dyskinesia (CGI-TD) and Patient Global Impression of Change (PGIC) as follows: rating of "minimally improved" or better (score ≤3) at Week 48 (CGI-TD≤3, PGIC≤3); rating of "much improved" or "very much improved" (score ≤2) at Week 48 (CGI-TD≤2, PGIC≤2). Treatment-emergent adverse events (TEAEs) were also monitored. Treatment outcomes were generally robust and comparable between the age subgroups. Pooled AIMS results indicated substantial improvements in TD movements were found in both age subgroups with valbenazine 40 mg (≥65 years, n=8; <65 years, n=46) and 80 mg (≥65 years, n=20; <65 years, n=105): mean CFB (≥65 years, -6.4 and -9.8 [for 40 and 80 mg, respectively]; <65 years, -5.5 and -8.3); clinically meaningful ≥30% response (≥65 years, 75% and 95%; <65 years, 61% and 80%); and protocol-defined ≥50% response (≥65 years, 75% and 85%; <65 years, 50% and 70%). CGI-TD and PGIC response rates indicated that clinician- and patient-reported global improvements were also substantial in both age subgroups: CGI-TD≤3 (≥65 years, 88% and 100% [for 40 and 80 mg, respectively]; <65 years, 89% and 97%); CGI-TD≤2 (≥65 years, 88% and 95%; <65 years, 62% and 83%); PGIC≤3 (≥65 years, 88% and 100%; <65 years, 89% and 94%); PGIC≤2 (≥65 years, 75% and 90%; <65 years, 77% and 80%). Analyses of TEAEs indicated no statistically significant differences between age subgroups for the incidence of any TEAEs (≥65 years, 73%; <65 years, 72%) or any serious TEAEs (≥65 years, 18%; <65 years, 17%). However, discontinuations due to TEAEs were significantly more common in elderly participants (≥65 years, 26%; <65 years, 13%; P <0.05). These analyses, which are the first to evaluate any approved TD medication in patients ≥65 years, indicate that long-term treatment with once-daily valbenazine is appropriate and beneficial for this age group. Elderly study participants had clinically meaningful and substantial improvements in TD that were comparable to (or better than) those in the younger cohort. These results may provide clinicians with important information about the management of TD in elderly patients. Neurocrine Biosciences, Inc. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the utility of Patient-Reported Outcomes Measure Information System Depression Scale (PROMIS-8a) compared with selected "Legacy" depression scales, including the Montgomery-Asberg Depression Rating Scale (MADRS), Geriatric Depression Scale (GDS), and GDS-Short Form (GDS-SF). Additionally, the measures' properties were assessed across levels of cognitive functioning.Methods: This cross-sectional analysis was extracted from a prospective cohort study. PROMIS-8a and Legacy depression measures were administered to individuals aged at least 70 years grouped by cognitive status based on the Saint Louis University Mental Status Examination. McNemar tests were run to determine if measures categorized the absence or presence of depression differently and item analysis evaluated classification discrepancies.Results: Sample mean age was 78, and most participants were women (71%), white (79%), with at least a high school education (89%). The percentage of individuals with at least mild depression was similar across measures (20.7% PROMIS-8a, 19.0% MADRS, 17.9% GDS, 13.9% GDS-SF). PROMIS-8a total score correlated moderately with MADRS (r = 0.56, df = 295, p <0.01), GDS (r = 0.68, df = 291, p <0.01), and GDS-SF (r = 0.60, df = 291, p <0.01), and predictive validity of the measures was similar. There were no significant mean differences on depression measures by cognitive status.Conclusion: Although all measures identified a similar percent of depressed individuals, the classification differed by measure. Item analysis showed that PROMIS-8a was more likely to identify feelings of dysphoria while the MADRS and GDS were more likely to identify physiologic aspects of depression. Given the brevity and ease of administration of the PROMIS-8a, it appears to be a useful depression screen for community-dwelling older adults. [ABSTRACT FROM AUTHOR]

The article presents a study analyzing psychiatric and medical co-morbidity in a Dutch bipolar elderly cohort by record review and structured clinical interviews, revealing a relative uncommon psychiatric co-morbidity and common medical co-morbidity and medication use. Topics discussed include an overview of bipolar disorder, the low prevalence of anxiety spectrum disorders, and the prevalence of substance abuse disorders.

Tardive dyskinesia (TD) is a persistent and potentially disabling movement disorder associated with prolonged antipsychotic exposure. Compared to younger patients, older patients have a higher risk of TD and may develop symptoms earlier during antipsychotic treatment. Valbenazine, a novel and highly selective vesicular monoamine transporter 2 (VMAT2) inhibitor, is approved to treat TD in adults of all ages, with no dose adjustment required for older patients. The long-term effects of valbenazine on TD were evaluated in KINECT 4 (NCT02405091), an open-label study in which participants received up to 48 weeks of once-daily treatment with valbenazine. Abnormal Involuntary Movement Scale (AIMS) data from this study were analyzed post hoc to evaluate treatment responses in older (≥55 to 85 years) and younger (18 to <55 years) patients. KINECT 4 included participants who met the following criteria: ages 18 to 85 years; DSM-IV diagnosis of schizophrenia, schizoaffective disorder, or mood disorder; neuroleptic-induced TD for ≥3 months prior to screening; stable psychiatric status (Brief Psychiatric Rating Scale score <50); no high risk of active suicidal ideation or behavior. Stable doses of concomitant medications to treat psychiatric and medical disorders were allowed. Valbenazine dosing was initiated at 40?mg, with escalation to 80?mg at Week 4 based on clinical assessment of TD and tolerability; a dose reduction to 40?mg was allowed per clinical need. AIMS responses, ranging from ≥10% to 100% improvement from baseline in AIMS total score (sum of items 1-7), were analyzed at Week 48 based on scoring by site investigators, with certain thresholds defined descriptively as follows: minimal response (≥10% total score improvement from baseline); clinically meaningful response (≥30% improvement); robust response (≥50% improvement [protocol-defined threshold for AIMS response]); and maximal response (80-100% improvement). To further evaluate clinically meaningful changes in TD symptoms, shift analyses were conducted for each AIMS item (representing 7 different body regions) as follows: improvement/shift from score ≥3 (moderate/severe) at baseline to score ≤2 (none/minimal/mild) at Week 48. Of 163 participants in the safety/efficacy population, 103 (63.2%) had an available AIMS assessment at Week 48. At Week 48, the percentages of patients who met the criteria for minimal response (≥10% AIMS total score improvement from baseline) or clinically meaningful (≥30% improvement) response were similar between the older and younger subgroups (≥55 years; <55 years): minimal (97.1% [68/70]; 97.0% [32/33]); clinically meaningful (95.7% [67/70]; 90.9% [30/33]). For higher thresholds of AIMS response, older patients seemed more likely to experience improvements, as indicated by results for robust response (88.6% [62/70]; 81.8% [27/33]) and maximal response (44.3% [31/70]; 27.3% [9/33], which included 10 total patients who had 100% improvement (11.4% [8/70]; 6.1% [2/33]). For shift analyses (defined as AIMS item score ≥3 at baseline and score ≤2 at Week 48), some results were limited by small sample sizes. However, 100% of both older and younger participants met the shift criteria for lips, upper extremities, and lower extremities. Results for the remaining AIMS items were as follows (≥55?years, <55 years): face (100% [29/29], 91.7% [11/12]); jaw (97.4% [37/38], 100% [13/13]); tongue (100% [44/44], 93.3% [14/15]);and trunk (100% [18/18], 62.5% [5/8]). After 48 weeks of treatment with once-daily valbenazine, >95% of all KINECT 4 participants (older and younger) had a minimal AIMS total score response (≥10% improvement), >90% had a clinically meaningful response (≥30% improvement), and >80% had a robust response (≥50% improvement). Older patients seemed more likely than younger patients to achieve a maximal response, including 100% improvement, although these results may be limited by smaller sample sizes. Shift analyses based on AIMS item scores were supportive of AIMS total score responses. Together, the results presented in this post hoc analysis suggest that valbenazine is an appropriate long-term treatment for both older and younger adults with TD. This research was funded by: This study was sponsored by Neurocrine Biosciences, Inc. [ABSTRACT FROM AUTHOR]

Introduction Nutrition is an important factor that contributes to physical health and general wellbeing, and particularly so in the elderly. For instance, malnutrition has been linked with poor health outcomes, and old age is associated with micro-nutrients changes that appear to significantly correlate with poorer health outcomes including cerebrovascular diseases, bone demineralization, frailty and impaired immune function. However, little is known about the role of nutrition in older adults with bipolar disorders (OABD). To better understand this issue, we conducted a systematic review of literature on nutrition in OABD. Methods We searched databases including Medline/PubMed, PsychINFO, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Register FDA, and clinical trial registries till May 2018 for eligible reports. The search string combined MeSH terms for Bipolar disorder, nutrition and older adults. This was supplemented by snowball searching of references of included studies and relevant reviews for additional studies. Data extraction was done by at least two persons independently. Results Fifteen studies that included a subpopulation of OABD were included. The topic foci of the papers include nutritients (including vitamins B 12 , vitamin D, folate, homocysteine, and creatinine) deficiencies, use of herbal-nutritional products, influence of nutrients on affective and cognitive outcomes, and relationship of nutritional factors with MRI measures of white matter densities. The sample sizes of OABD are generally small and follow-up is limited. Conclusions Our findings underscore the need for novel research including trials to shed more light on the benefits and therapeutic applications of nutrition in OABD. This research was funded by No Funding to declare. [ABSTRACT FROM AUTHOR]

Introduction Epilepsy has been reported by the CDC to have a prevalence of 1.2% in the United States, which accounts for roughly 3.4 million adults in 2015. Nearly 1 million of those adults are aged 55 or older.1 Epilepsy is more likely to develop in older adults because risk factors for epilepsy are more common as people age including stroke/cardiovascular disease, neurodegenerative disorders, brain tumor and long-term sequelae of alcohol abuse.2 As our population ages, there will be even more older people with epilepsy. A common comorbidity in epilepsy is depression. While the prevalence of depression in patients with epilepsy varies in literature, it is estimated to be between 15% and 37%.3 The significance of depressive symptoms on quality of life has been shown to be greater than that of short-term seizure control.4 For older people, balancing epilepsy treatment in conjunction with other health problems can present with great difficulty. Many antiepileptic's also have side effects such as bone loss, dizziness and greater risk for falls, which can make someone more likely to fall and become injured.5 This analysis, from a large pooled dataset of multiple epilepsy treatment studies, examined presence and symptom severity of depression in older adults (age > 55) with epilepsy in comparison to younger adults (age <55) with epilepsy. Methods Analysis was completed using baseline data and clinical variables from 9 studies of the Managing Epilepsy Well (MEW) Network integrated research database (MEW DB). Patients were divided into two groups; age 18-55 and age greater than or equal to 55. A total of 935 adults participated, out of which 161 (17.2 %) were of age 55 or greater and 774 adults younger than 55 (82.8 %). Other demographics included were gender, race, marital status, highest education level and annual income. Standardized rating scales included Quality of Life in Epilepsy (QOLIE-10) and Patient Health Questionnaire (PHQ-9) for depressive symptoms. The QOLIE-10 scoring was harmonized to accommodate slightly different versions of this scale within the integrated dataset. Results The mean age for older patients was 61.5 vs. 34.4 for younger patients. Approximately 60% of patients in both groups were females. Among older patients 109 (76.2%) were white, 24 (16.8%) African Americans, and 4 (3.1%) Hispanic. Majority of these patients (78.6%) had a college education and 53.4% were either married or co-habiting. Demographics of the under 55 group were largely similar. Mean PHQ-9 score was 8.5 in older patients vs. 9.5 in younger patients (p= 0.07). Amongst older patients, those with moderate-severe depression defined as PHQ-9 > 10 had an average of 7 seizures in 30 days, compared to those with scores <10 with an average of 2.7 seizures in 30 days (p=0.447). QOLIE-10 scores followed a similar pattern in that severe depression (PHQ 9 >10) in both younger and older groups was associated with worse QOL (p=<0.001). Conclusions Depression is common in people with epilepsy across the lifespan. Depression is more common in those with poorly controlled epilepsy, and more severe depressive symptoms are associated with poorer quality of life. However, we did not find that these findings were different in older vs. younger patients. Methodological limitations such as the clinical trials' data source and relatively young age of the sample overall could have biased findings. Future analyses need to sample more elderly people with epilepsy including the "old-old" and those with more extensive medical comorbidity. This research was funded by: This study was supported in part by CDC grants U48DP001930 (CWRU), U48DP005030 (CWRU) U48DP005008 (NYU), 148DP005013 (WA), and 1U48DP005018 (Geisel School of Medicine at Dartmouth) under the Health Promotion and Disease Prevention Research Centers Program. [ABSTRACT FROM AUTHOR]

Introduction Poor medication adherence in people with bipolar disorder (BD) is common. Younger age is a reported risk factor for medication non-adherence in individuals with BD. The literature on the relationship between adherence and symptoms is conflicting. Additionally, self-stigma in BD patients is well-documented, and could have negative effects on self-care that includes medication treatments. Stigma experienced by BD patients may have implications on quality of life, social dysfunction, and suicidality. Lastly, while previous analysis demonstrates that a customized adherence enhancement (CAE) program targeted to mixed-age poorly adherent patients with BD increases medication adherence and functional status compared to a rigorous BD-specific educational (EDU) program, how specific adherence promotion efforts improve adherence in relation to patient age has not been studied. This secondary analysis from a completed randomized controlled trial (RCT) comparing two interventions in poorly adherent patients with BD evaluated medication adherence, psychiatric symptom severity, functional status, and internalized stigma levels in older (age ≥55 years old) vs. younger (age <55 years old) adults at baseline and over time. Given demographic changes that project an increase in both proportions and absolute numbers of people with serious mental illnesses such as BD, findings may have practical implications for clinical care. Methods Data for this analysis derived from a prospective six-month NIMH-funded RCT comparing a CAE intervention intended to promote BD medication adherence with EDU in 184 poorly-adherent individuals with BD. We chose an age 55 cut-off to differentiate younger (n=144) vs. older (n=40) subgroups within the sample, consistent with a recent consensus recommendation to consider that people with BD on average lose one to two decades of life compared to the general population. Medication adherence was measured with the Tablets Routine Questionnaire (TRQ). BD symptoms were measured using the Montgomery–Åsberg Depression Rating Scale (MADRS), the Young Mania Rating Scale (YMRS), and the Brief Psychiatric Rating Scale (BPRS). Participants were also rated with Clinical Global Impression—Bipolar Version (CGI-BP). Global Assessment of Functioning (GAF) was used to measure functional status. Attitudes regarding self-stigma were assessed with the Internalized Stigma for Mental Illness scale (ISMI). To evaluate for age-related differences in change over time in TRQ, BPRS, and GAF in the entire sample, treatment arms were combined and younger vs. older subgroups were compared. Mann-Whitney U was used to analyze non-parametric continuous variables, chi-square for categorical variables, and t-test for normally distributed continuous variables. In analysis with very small N comparisons, Fisher's exact test was used. To evaluate for age-related differences in change over time in TRQ, BPRS, and GAF in each treatment arm, mixed longitudinal models were fit. Covariates included main effects for age, treatment, and time, as well as three-way interaction terms involving age, treatment, and time. Results BASELINE FINDINGS In our sample, older participants had significantly lower anxiety disorder comorbidity compared to younger participants, considering participants with one or more (56.4% vs. 78.4%) and two or more anxiety disorders (41.0% vs. 57.5%). There were no statistically significant differences in past-week and past-month adherence with BD medications between older and younger participants (past week TRQ: 37.2 vs. 43.0; past month TRQ: 38.5 vs. 40.8). There were no significant differences in YMRS, BPRS, and GAF scores between the two groups. Older adults had significantly lower MADRS scores than their younger counterparts (14.9 vs. 18.9, p=0.011) and significantly lower CGI-BP (3.08 vs. 3.47, p=0.025), indicating comparatively lower depressive and overall symptom severity. Older adults had significantly lower ISMI scores than their younger counterparts (61.95 vs. 69.27, p=0.001), indicating relatively lower internalized stigma. These findings remained significant in four of five ISMI subscales: alienation (p=0.017), stereotype endorsement (p=0.002), discrimination experience (p=0.001), and social withdrawal (p=0.013). Only age-related differences in the subscale of stigma resistance were not significant (p=0.450). LONGITUDINAL FINDINGS In the combined group (CAE plus EDU), evaluation over time showed no significant difference between older and younger participants in TRQ, BPRS, and GAF. There were no significant findings and no interaction between time and age group when analyzed globally, regardless of treatment arm assignment at baseline. In analysis evaluating for change over time between older and younger participants by treatment arm, for TRQ, there was a significant finding of interaction between time, age group, and treatment arm (p = 0.007) such that there was a trend for older individuals to have worse adherence over time in the EDU vs. the CAE intervention arm. For BPRS and GAF, there were no significant findings and no interaction between time, age group, and treatment arm. Conclusions This secondary analysis from an RCT comparing two interventions in poorly adherent patients with BD found that older adults may be less depressed and anxious, with less self-stigma compared to younger people with BD and poor adherence. CAE is a behavioral intervention that may yield sustained benefit with respect to medication adherence in adults with BD who are age 55 and older. This research was funded by Research reported in this poster was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R01MH093321. Support was also received from the Clinical and Translational Science of Cleveland, UL1TR000439 from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health and NIH roadmap for Medical Research. [ABSTRACT FROM AUTHOR]

Abstract Bipolar disorder (BD) is a prevalent mental disorder that causes disability throughout the life-span. Because of demographic trends, there is a growing population of individuals with older-age bipolar disorder (OABD). This symposium, presented by members of the International Society of Bipolar Disorders OABD taskforce, will highlight new data relevant to OABD and to aging with BD. The session chair, Martha Sajatovic, will first speak about the development of the Aging and Geriatric Experiments in BD (AGE-BD) integrated dataset, and present initial results regarding the interplay of clinical, demographic, and medical variables across adulthood. Second, Lisa Eyler will discuss the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) BD Working Group, a large, ecologically-valid sample of 3020 participants from 13 sites worldwide and present her analysis of ENIGMA data that showed advanced "brain age" among those with BD compared to those without and examined clinical correlates of advanced brain age. The third speaker, David Harper, will present recently analyzed resting state fMRI data in older bipolar depressed individuals vs healthy controls. The fourth speaker, Ariel Gildengers, will present on the relationship between bipolar disorder and medical burden on cognition and brain health in older adults. [ABSTRACT FROM AUTHOR]

Introduction Older age is a significant risk factor for developing tardive dyskinesia (TD). Valbenazine, a novel and highly selective vesicular monoamine transporter 2 (VMAT2) inhibitor, is approved to treat TD in adults, regardless of age. We report a comparison of the long-term safety and tolerability of once-daily valbenazine in adults with TD aged ≥55 vs. <55 years. Methods Data were pooled from two phase 3 studies, KINECT 3 (NCT02274558: valbenazine 40 or 80 mg, 6-week double-blind placebo-controlled period, 42-week double-blind extension) and KINECT 4 (NCT02405091: valbenazine 40 or 80 mg, 48-week open-label treatment). KINECT 3/4 study completers could enroll in a subsequent rollover study (NCT02736955: valbenazine 40 or 80 mg, additional ≤72-week open-label treatment or until valbenazine became commercially available). For safety analyses, participants were categorized by age (older, ≥55y; younger, <55y), and valbenazine doses were pooled. Outcomes included treatment-emergent adverse events (TEAEs), vital signs, electrocardiograms (ECGs), and the Columbia-Suicide Severity Rating Scale (C-SSRS). Significance testing between age subgroups (≥55y vs. <55y) was conducted for summary TEAEs. Results Analyses included 383 KINECT 3/4 participants (≥55y=239; <55y=144) and 160 rollover participants (≥55y=109; <55y=51). Mean ages [and ranges] were as follows (older, younger): KINECT 3/4 participants (62.5 [55 to 83] years; 46.9 [26 to 54] years); rollover participants (62.5 [55 to 83] years, 47.9 [34 to 54] years). In KINECT 3/4, the summary of TEAEs in older and younger participants was as follows (≥55y vs. <55y): any TEAE (77.8% vs. 64.6%; P <0.01); serious TEAE (19.2% vs. 10.4%; P <0.05); and discontinuation due to TEAE (19.7% vs. 11.8%; P <0.05). Headache was the most common TEAE in both age subgroups during KINECT 3/4 (≥55y, 9.6%; <55y, 8.3%). In the rollover study, the incidence of TEAEs was not significantly different between older and younger participants (≥55y vs. <55y): any TEAE (53.2% vs. 52.9%; P >0.05); serious TEAE (10.1% vs. 9.8%; P >0.05); and discontinuation due to TEAE (3.7% vs. 9.8%; P >0.05). The most common TEAE was somnolence among older participants (4.6%) and cough among younger participants (9.8%). During both KINECT 3/4 and the rollover study, no clinically important changes in vital signs or ECGs were found in either age subgroup, and most participants (>90%) had no worsening in C-SSRS scores from baseline. Conclusions In older (≥55y) and younger (<55y) adults who received >1 year of once-daily valbenazine for TD, TEAEs and other safety outcomes were consistent with previous long-term analyses. These results confirm that valbenazine is generally safe and well-tolerated in all adults with TD. This research was funded by This research was fully funded by Neurocrine Biosciences, Inc. [ABSTRACT FROM AUTHOR]

Introduction Older adults have an increased risk of developing tardive dyskinesia (TD), a persistent and often debilitating movement disorder that is associated with antipsychotic treatment. Valbenazine is currently approved to treat TD in adults of all ages, with no dose adjustment required for older patients. Valbenazine has been evaluated in 2 long-term Phase III studies (KINECT 3, KINECT 4) in which adults with TD (18 to 85 years) received once-daily treatment (40 or 80 mg) for up to 48 weeks. Completers from these studies were eligible to enter a long-term, open-label rollover study (NCT02736955) in which global improvements and patient satisfaction were assessed. Data from the rollover study were analyzed post hoc to further investigate the long-term effects of valbenazine in participants categorized by age (<55 years, ≥55 years). Methods Completers from KINECT 3 or KINECT 4 were re-initiated at 40 mg following washout of prior valbenazine treatment. Dose was escalated after 4 weeks to 80 mg based on tolerability and clinical assessment of TD. Reduction to 40 mg was allowed if 80 mg was not tolerated; participants unable to tolerate 40 mg were discontinued from the study. The study was designed to include 72 weeks of treatment, but few participants reach Week 60 and none reach Week 72 because valbenazine became commercially available. Both doses of valbenazine (40 and 80 mg) were pooled. Analyses were conducted at Week 48 and end-of-treatment (EOT), based on the last available post-baseline value. Assessments included the Clinical Global Impression of Severity-TD (CGIS-TD: range, 1 [normal/not at all ill] to 7 [extremely ill]) and Patient Satisfaction Questionnaire (PSQ: range, 1 [very satisfied] to 5 [very dissatisfied]). All outcomes were analyzed descriptively in age subgroups (younger, <55 years; older, ≥55 years). Results The study included 51 younger participants (mean age, 47.9 years; range, 34-54 years) and 109 older participants (mean age, 62.5 years; range, 55-83 years). A total of 56 participants reached the Week 48 visit (<55y, n=18; ≥55y, n=38); 156 were included in EOT analyses (<55y, n=47; ≥55y, n=109). Mean decreases (improvements) from baseline in CGIS-TD score were similar in the younger and older subgroups at Week 48 (<55y, -1.7; ≥55y, -1.8) and greater in the older subgroup at EOT (<55y, -1.5; ≥55y, -1.9). In both subgroups, the percentage of participants with CGIS-TD score ≤2 (normal/not at all ill or borderline ill) increased from baseline (before restarting valbenazine) (<55y, 14.0%;≥55y, 14.7%) to Week 48 (<55y, 50.0%; ≥55y, 71.1%) and EOT (<55y, 61.7%; ≥55y, 72.5%). At baseline, almost all participants (<55y, 100%; ≥55y, 98.2%) were somewhat or very satisfied with their prior valbenazine experience (PSQ score ≤2). Participants continued to express satisfaction with valbenazine with PSQ scores ≤2 at Week 48 (<55y, 100%; ≥55y, 97.4%) and EOT (<55y, 93.6%; ≥55y, 98.1%). Conclusions A clinician-based global assessment indicated ongoing, meaningful TD improvements with once-daily valbenazine in both younger and older adults. Patient satisfaction rates remained high, even in patients treated for >1 year. These results, along with the safety results presented separately at this meeting, indicate that valbenazine is an effective long-term treatment for TD. This research was funded by This research was fully funded by Neurocrine Biosciences, Inc. [ABSTRACT FROM AUTHOR]

The article offers information on the 2017 American Journal of Geriatric Psychiatry (AAGP) Annual Meeting to review all recent studies that included OABD (older adults with bipolar disorder) to be held on March 24 to 27, 2017, in Dallas, Texas.

The article offers information on the symposium "Advances in Therapeutics in Geriatric Psychiatry" to be hosted by the research committee of the organization American Association for Geriatric Psychiatry (AAGP).

The article focuses on the effect of lifestyle interventions such as exercise, mindfulness, and yoga to treat neuropsychiatric disorders.found in older people, and talks of exercise to reduce depressive symptoms, mindfulness to reduce cortisol levels, and yoga to improve verbal memory.

The article talks about data collected regarding the role played by managing medical comorbidity and patient self-management using peereducation while caring for older adults suffering from Bipolar Disorder (BD).