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Frontal Signal Hyperintensities in Mania in Old Age

From the Department of Psychiatry, NY Presbyterian Hospital, Westchester Division, Weill Medical College of Cornell University, Westchester Division, White Plains, NY (JMdA, GSA, DNK, MH, RCY); and the Department of Psychiatry, Hillside Hospital, Psychiatric Division of Long Island Jewish Medical Center, Long Island Jewish Medical Center, Glen Oaks, NY (BSG, MA).

Objective: Signal hyperintensities (SH) on magnetic resonance (MR) imaging have been associated with increased age and with mood disorders. Frontal and subcortical neuropathology has been implicated in the pathophysiology of mania and bipolar disorders. The authors assessed frontal and subcortical SH in elderly bipolar manic patients and the comparison group, and hypothesized that SH scores would be greater in the patient group.

Method: MR imaging was performed in patients aged 60 years with bipolar disorder, mania, and in a same-aged community comparison group. SH were rated blindly using the Boyko system. Frontal deep white matter and basal ganglia SH were assessed in the left and right hemispheres.

Results: SH scores were significantly greater in patients (N = 40) than the comparison group (N = 15) in frontal deep white matter (left: p = 0.003; right: p = 0.023) based on Mann-Whitney two-sample exact tests. The SH scores in the subcortical gray regions overlapped in these groups. In patients, higher right frontal SH scores were associated with later age at onset of mania.

Conclusions: Frontal deep white matter SH may be increased in elders with bipolar disorder. Further study of the relationship of SH to age at onset in elders is warranted.

Key Words: Geriatric mania • signal hyperintensities • MRI • illness onset

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