ABSTRACT
Current understanding of bipolar disorder (BD) in late life builds on early clinical descriptions by European psychiatrists, and these descriptions emphasized links to brain pathology. Manic signs and symptoms were described in the context of brain lesions and disorders at least as early as the nineteenth century (1). Welt (2) described behavioral “disinhibition” in patients with lesions of the orbital surface of the frontal lobes. This was termed “Witzelsucht” by European psychiatrists (3), and “pseudopsychopathic syndrome” by neurologists (4). These observations set the stage for more recent investigations of brain pathology associated with mania and depression in old age. Early writings mention the association between brain vascular disease and mood disorder in late life (5). Kay et al. (6) and Post (7) proposed that mood disorder with onset in late life reflects in part age-associated brain changes.
