Some general themes emerge from available information concerning manic states and bipolar disorders in late life: heterogeneity of both clinical features of the manic episode and of antecedent illness course; late average age at illness onset; lower rate of affective illness in families of late-onset cases; association of medical and neurologic illness and drug treatments with late-onset cases; utility of lithium salts for acute, continuation, and maintenance treatment; changes in lithium pharmacokinetics associated with aging, disease, and drugs resulting in increased plasma concentration/dose ratios. Geriatric manic states and bipolar disorders present opportunities for research. Investigation may illuminate the nature of mood disorders across the age spectrum, lead to better diagnosis and management in the elderly, and suggest strategies for prevention based on insights into pathophysiologic and pathogenetic mechanisms. Strategies that can be pursued include: longitudinal studies to evaluate differences in affective, cognitive, and other outcomes in geriatric patients with late-onset compared with early-onset illness; studies of psychopathology, family history, and illness course in organic mood disorder, manic; retrospective categorization when cognitive impairment accompanies acute episodes; studies of mania occurring in the context of dementing illness; application of neuroimaging and other laboratory measures to geriatric manic states; contrast of clinical and laboratory findings in early-onset geriatric patients and young adult patients to assess effect of age; definition of lithium concentration-effect relationships in regard to efficacy and toxicity in patients with and without cognitive impairment/dementia.
