Santiago Apóstol Hospital, Vitoria, Spain.
Maturitas. 2011 Oct;70(2):160-3. doi: 10.1016/j.maturitas.2011.07.005. Epub 2011 Aug 26.
Bipolar disorder in elderly is probably heterogenous and the age of onset has been considered to be a potential clinical marker of heterogeneity for this disease. Early- and late-onset bipolar disorders share symptoms, but it is not clear whether they have different aetiologies and vulnerabilities. In bipolar disorder one of the most frequent neuroimaging finding is the white matter hyperintensities (WMHs). The disruption caused by WMHs in the connectivity between structures related to mood regulation and cognition in elderly may be responsible for the affective symptomatology seen in these patients. White matter hyperintensities are found both in late onset patients and in early age onset bipolar patients. It is likely that the aetiology of the white matter hyperintensities in late-onset bipolar disorder be multifactorial, although cardiovascular changes in particular seem to contribute to their physiopathology. In early life onset the aetiology of these lesions is less clear, although probably genetic factors are more important than cardiovascular factors. Understanding the aetiopathogenesis is of key importance when dealing with this disease.
老年双相情感障碍可能具有异质性，发病年龄被认为是该病异质性的一个潜在临床标志物。早发型和晚发型双相情感障碍有共同的症状，但尚不清楚它们是否具有不同的病因和易感性。在双相情感障碍中，最常见的神经影像学发现之一是脑白质高信号（WMH）。WMH 破坏了与情绪调节和认知相关结构之间的连接，这可能是导致这些患者出现情感症状的原因。晚发型和早发型双相情感障碍患者均存在脑白质高信号。虽然心血管变化似乎特别有助于其病理生理学，但晚发型双相情感障碍脑白质高信号的病因很可能是多因素的。在生命早期，这些病变的病因尚不清楚，尽管遗传因素可能比心血管因素更为重要。在处理这种疾病时，了解病因发病机制至关重要。
