Bipolar disorder in older adults is often underdiagnosed or misdiagnosed as dementia, early Alzheimer’s disease, or even normal age-related cognitive decline (Brown et al., 2011). It is important to distinguish older age bipolar disorder from these diagnoses because treatments and medications are different for each of these illnesses of aging.
If you think you have older age bipolar disorder, this article will describe your symptoms, the cognitive impact of your illness, the differences between apathy and mild cognitive impairment (MCI), and supportive interventions and activities that can mitigate the influence of the disorder.
Types of Bipolar Disorder
Older age bipolar disorder has two main categories: Bipolar I is episodes of major depression and of mania that can be severe enough to require hospitalization. Severe depression and hypomania characterize bipolar II (DSM–5-TR; American Psychiatric Association, 2022). Hypomania isn’t as intense as full mania.
Symptoms in Older Adults
If you’ve already been diagnosed with bipolar disorder, you know symptoms of depression include apathy, lethargy, hopelessness, withdrawal from normal activities, changes in appetite, and sleeping too much. Mania includes poor judgment, reduced need for sleep, agitation, and, in older adults, irritability rather than the euphoria experienced by younger adults with bipolar disorder (Dols et al., 2023).
Challenges in Diagnosing Older Age Bipolar Disorder
Dementia or side effects from medications for chronic conditions of aging such as cardiovascular disease, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease (COPD) can complicate a diagnosis of older age bipolar disorder by obscuring symptoms of bipolar disease or by requiring medications that may cause depression or dementia side effects themselves (Goldstein et al., 2009; Charles et al., 2016; Katz et al., 2017).
You may be underreporting bipolar symptoms due to memory issues or the stigma surrounding mental illness. You need to mention recurring symptoms to your doctor: Don’t be ashamed if you are experiencing emotional issues. Ask relatives or caregivers to help you write down questions for your medical appointments.
Diagnostic Differences: Apathy
If you have apathy, you are uninterested in hobbies and activities and are probably not socializing with friends or family members (Ishii et al., 2009). Some studies in the last ten years have shown that apathy in older adults who are showing no signs of dementia may be associated with decreased brain volume, as shown on MRI studies (Anderson-Hanley et al., 2018; Grool et al., 2014).
The decreased brain volume of gray matter—the brain’s and spinal cord’s information processing tissue—is present in some older adults. White matter is also reduced; it is the part of the central nervous system that connects and communicates with the areas of gray matter. Researchers have been unable to find a causal relationship between apathy and decreased brain volume (Grool et al., 2014).
Mild Cognitive Impairment (MCI)
The interval between normal forgetfulness resulting from aging and the development of early dementia is mild cognitive impairment (MCI) (Simjanoski et al., 2022; Teixeira et al., 2012). If you have MCI, you can be sluggish, lack motivation and have reduced emotional responses. MCI includes forgetfulness, slowed thinking and difficulty focusing or conversing with others. You may be moody, and even difficult and disruptive. Your bipolar depression may sometimes mimic apathy or MCI (Solé et al., 2017).
Studies in the past 10 to 12 years have shown that MCI, with its symptoms of poor concentration and reduced emotional response, leads to decreased social interaction, and this social isolation can lead to dementia or Alzheimer’s disease (Anderson, 2019). These studies could not prove cause and effect, but they most certainly show negative health outcomes. Researchers have shown that any kind of MCI is worrisome, especially if you have the additional diseases mentioned previously of aging (Charles et al., 2016; Goldstein et al., 2009). A clear diagnosis by the family doctor or a psychiatrist can ensure support and appropriate treatment.
Therapeutic Interventions
You need to maintain a routine when you have bipolar disorder at any age, but it is especially important when you have older age bipolar disorder (OABD). You should keep a rigid daily schedule to reduce confusion and counteract lack of motivation. If you follow a schedule for eating, sleeping, and engaging in routine activities, you will achieve effective mood management and decrease cognitive impairment. At home, do picture puzzles, crossword puzzles, word searches, or memory games to keep your mind engaged. Find activities that will challenge you.
You can reduce isolation by maintaining a social life, such as attending free classes or going to a neighborhood senior center on a regular basis. Participate in the arts by attending free concerts or art classes. Your local Parks and Recreation Department and many senior communities can provide a guide for activities such as these and more.
Physical activity is especially important to maintaining good mood and brain health. Gentle chair exercise, walking, yoga, or tai chi will improve brain fitness as well as physical fitness (Anderson-Hanley et al., 2018; Karssemeijer, et al., 2017; Gates et al., 2013).
Other Interventions
You should depend on your healthcare professional and family caregiver for regular medical evaluations and monitoring of your medications. There is also a type of modified cognitive behavioral therapy (CBT) adapted for older adults (Chand & Grossberg, 2013), if you feel you need counseling. Allow your family or caregiver to help you evaluate your moods on a regular basis.
It’s important that you recognize and respond to your bipolar disorder and its emotional, cognitive, and psychological aspects. Cultivate a network of compassionate family, friends, and caregivers for good mental health.
Resources
National Alliance for Mental Illlness Info HelpLine
- 800-950-NAMI (6264)
- Chat or text “helpline” to 62640
- In a crisis? Call or Text 988
National Institute of Mental Health
- Call toll free 866-615-NIMH (6464)
- MHA Crisis Text Line: 741741
Jill Hanika Stout has spent 38 years working in the medical and mental health professions and was diagnosed with bipolar disorder in 1984. In 2002, she founded a bipolar support group with Mental Health America in Wabash, Indiana, and from 2003 to 2014, she wrote a quarterly newsletter for individuals living with mental illness. After earning her BA in Psychology in 2011, she served as Executive Director of the nonprofit until 2014, before relocating to the Asheville, North Carolina area. She later worked as a direct support professional with developmentally disabled clients for Easter Seals UCP of NC and WV. In addition to her professional work, Jill has contributed to the blog for the Indianapolis-based TV show Great Day TV and, since retiring in 2024, she now writes full-time. For more information, email jhstout50@yahoo.com or call (828) 243-6013.
References
American Psychiatric Association (Ed.). (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR (5th edition, text revision). American Psychological Association Publishing.
Anderson, N. (2019). State of the science on mild cognitive impairment (MCI). CNS Spectrums 24(24): 78-87. Doi:10.1017/S109285291800347.
Anderson-Hanley, C., Barcelos, N., Zimmerman, E., Gillen, R., Dunham, M., Cohen, B., et al. (2018). The Aerobic and Cognitive Exercise Study (ACES) for Community-Dwelling Older Adults with or At-Risk for Mild Cognitive Impairment (MCI): Neuropsychological, Neurobiological and Neuroimaging Outcomes of a Randomized Clinical Trial. Frontiers in Aging Neuroscience 10(76). Doi: 10.3389/fnagi.2018.00076.
Brown, P., Devanand, D., Liu, X. & Caccappolo, E. (2011). Functional Impairment in Elderly Patients with Mild Cognitive Impairment and Mild Alzheimer Disease. Archives of General Psychiatry 68(6): 617-626.
Chand, S. & Grossberg, G. (2013). How to adapt cognitive-behavioral therapy for older adults. Current Psychiatry 12(3): 10-16. Retrieved 6-17-25 from https://www.researchgate.net/publication/281976181.
Charles, E., Lambert, C. & Kerner, B. (2016). Bipolar disorder and diabetes mellitus: evidence for disease-modifying effects and treatment implications. International Journal of Bipolar Disorders 4:13. DOI.10.1186/s40345-016-0054-4.
Dols, A., Sekhon, H., Rej, S., Klaus, F., Bodenstein, K. & Sajatovic, M. (2023). Bipolar Disorder Among Older Adults: Newer Evidence to Guide Clinical Practice. Focus; 21:4, Fall 2023.
Goldstein, B., Fagiolini, A., Houck, P. & Kupfer, D. (2009). Cardiovascular disease and Hypertension among adults with bipolar I disorder in the United States. Bipolar Disorders 11(6): 657-662. Retrieved 6-16-25 from https://doi.org/10.1111/j.1399-5618.2009.00735.x
Gates, N., Singh, M., Sachdev, P. & Valenzuela, M. (2013). The Effect of Exercise Training on Cognitive Function in Older Adults with Mild Cognitive Impairment: A Meta-analysis of Randomized Controlled Trials. The American Journal of Geriatric Psychiatry 21(11): 1086-1097. Doi.10.1016/.jagp.2013.02.018.
Grool, A., Geerlings, M., Sigurdsson, S., Eiriksdottir, G., Jonsson, P., Garcia, M., et al. (2014). Structural MRI correlates of apathy symptoms in older persons without dementia AGES-Reykjavik Study. Neurology 82(18): 1628-1635. Retrieved 6-12-25 from https://doi.org/10.1212/WNL.0000000000000378.
Ishii, S., Weintraub, N. & Mervis, J. (2009). Apathy: A Common Psychiatric Syndrome in the Elderly. Journal of the American Medical Directors Association 10(6): 381-393. Retrieved 6-12-25 from https://doi.org/10.1016/j.jamda.2009.03.007.
Karssemeijer, E., Aaronson, J., Bossers, W., Smits, T., Olde Rikkert, M. & Kessels, R. (2017). Positive effects of combined cognitive and physical exercise training on cognitive function in older adults with mild cognitive impairment or dementia: A meta-analysis. Ageing Research Reviews 40: 75-83. Doi.10.1016/j.arr.2007.09.003.
Katz., T., Georgakas, J., Motyl, C., Quayle, W. & Forester, B. (2017). Pharmacological Treatment of Bipolar Disorder in the Elderly. Current Treatment Options in Psychiatry (Opinion Statement) 4: 13-32.
Simjanoski, M., McIntyre, A., Kapczinski, F. & de Azevedo Cardoso, T. (2022). Cognitive impairment in bipolar disorder in comparison to mild cognitive impairment and dementia: a systematic review. Trends in Psychiatry and Psychotherapy 2022:44: e20210300. Retrieved 6-12-25 from https://dx.doi.org/10.47626/2237-6089-2021-0300.
Solé, B., Jiménez, E., Torrent, C., Reinares, M., del Mar Bonnin, C., Torres, I. et al. (2017). Cognitive Impairment in Bipolar Disorder: Treatment and Prevention Strategies. International Journal of Neuropsychopharmacology 20(8): 670-680. Doi:10.1093/ijnp/pysx032.
Teixeira, C., Gobbi, L., Corazza, D., Stella, F., Costa, J. & Gobbi, S. (2012). Non-pharmacological interventions on cognitive functions in older people with mild cognitive impairment (MCI). Archives of Gerontology and Geriatrics 54(1): 175-180. Retrieved 6-13-25 from https://doi.org/10.1016/j.archger.2011.02.014
