Homocysteine, rather than age of onset, is a better predictor for cognitive function in older adults with bipolar disorder

Pao-Huan Chen, Hsing-Cheng Liu, Mong-Liang Lu, Chun-Hsin Chen, Ching-Jui Chang, Wei-Che Chiu, I-Wen Sun, Shen-Ing Liu, Shang-Ying Tsai, Chih-Chiang Chiu, Robert Stewart

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Objectives: The association between older-age bipolar disorder and cognitive impairments may be mediated by vascular burden. The aim of the study was to examine the difference of cognitive function between older people with late-onset bipolar disorder (LOBD) and early-onset bipolar disorder (EOBD) by considering rigorous vascular risk burden evaluation, comprehensive cognitive tests, and relevant biochemistry data. Methods: We recruited 95 outpatients aged over 55 with a DSM-IV-TR diagnosis of bipolar I disorder. Fifty had LOBD, defined by age of onset after 40. Cognitive function was evaluated through a battery of tests assessing verbal memory, attention/speed, visuospatial function, verbal fluency, and cognitive flexibility. Vascular risk assessments included individual disorders, 10-year Framingham cardiovascular risk scores, and serum levels of homocysteine, vitamin B12, folate, and triiodothyronine. Results: No differences were observed between LOBD and EOBD on any cognitive test after adjusting for potential confounders. In addition to age and educational years, multiple linear regression analyses indicated significantly negative associations between serum homocysteine levels and cognitive performances in attention, psychomotor speed, verbal memory, and executive function. Conclusions: Among older people with bipolar disorder, LOBD is not associated with more cognitive dysfunction in this study. However, higher serum homocysteine levels were significantly associated with worse cognitive performance in this particular group. Clinicians therefore have to pay attention to the cognitive function in older bipolar patients with higher levels of homocysteine.

Original languageEnglish
Pages (from-to)1473-1480
Number of pages8
JournalInternational Journal of Geriatric Psychiatry
Issue number10
Early online dateMay 21 2019
Publication statusPublished - Oct 1 2019


  • Framingham risk score
  • age of onset
  • homocysteine
  • neurocognitive performance
  • older-age bipolar disorder

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health


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