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Neuroimaging in older-age bipolar disorder
Florindo Stella1,2, Rodolfo B Ladeira1, Orestes V Forlenza1
1Laboratory of Neuroscience (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP).
Current Opinion in Psychiatry
|June 19, 2026
Summary
Neuroimaging studies reveal brain changes in older adults with bipolar disorder (OABD), including cortical thinning and reduced gray matter. Research highlights a concerning "brain age gap" in these individuals.
Area of Science:
- Neuroimaging
- Geriatric Psychiatry
- Bipolar Disorder Research
Background:
- Older adults with bipolar disorder (OABD) present unique clinical challenges.
- Understanding neurobiological underpinnings is crucial for effective treatment.
Purpose of the Study:
- To review neuroimaging studies investigating brain alterations in OABD.
- To synthesize findings on cortical and subcortical changes.
Main Methods:
- Structural MRI
- Functional MRI (fMRI)
- Diffusion Tensor Imaging (DTI)
- Positron Emission Tomography (PET) including 18-F-FDG-PET, amyloid-PET, and tau-PET.
Main Results:
- Evidence suggests cortical thinning and reduced gray matter volume in OABD.
- Subcortical alterations and white-matter microstructural changes (decreased fractional anisotropy) are observed.
- A 'brain age gap,' where predicted brain age exceeds chronological age, is reported.
Conclusions:
- Neuroimaging research in OABD is limited by methodological inconsistencies.
- Heterogeneity in imaging protocols, disease severity, and treatment effects hinder generalizability.
- Further standardized research is needed to clarify brain changes in OABD.
Related Concept Videos
01:14Brain Imaging
Brain imaging technologies provide critical insights into both the structure and function of the human brain, enabling medical professionals and researchers to diagnose, study, and treat neurological disorders or psychiatric disorders more effectively.
These technologies include computerized axial tomography (CAT or CT scans), positron-emission tomography (PET scans), magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), and Transcranial Magnetic Stimulation (TMS).
These technologies include computerized axial tomography (CAT or CT scans), positron-emission tomography (PET scans), magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), and Transcranial Magnetic Stimulation (TMS).
01:30Bipolar Disorder
Bipolar disorder is a chronic mental health condition marked by significant mood fluctuations, including episodes of mania and depression. Elevated energy levels, heightened mood or irritability, impulsive behavior, reduced sleep needs, rapid speech, racing thoughts, inflated self-esteem, and distractibility characterize mania. Individuals with bipolar disorder often alternate between depressive and manic states, with periods of emotional stability lasting an average of six months to a year.