Title:Bipolar Disorder and Manic-Like Symptoms in Alzheimer’s, Vascular and
Frontotemporal Dementia: A Systematic Review
Volume: 21
Issue: 12
Author(s): Camilla Elefante, Giulio Emilio Brancati, Samuele Torrigiani, Salvatore Amadori, Sara Ricciardulli, Gabriele Pistolesi, Lorenzo Lattanzi and Giulio Perugi*
Affiliation:
- Department of Clinical and Experimental Medicine, University of Pisa, Psychiatry Unit, Pisa, Italy
- G. De Lisio Institute of Behavioral Sciences, Pisa, Italy
Keywords:
Mania, bipolar disorder, manic-like symptoms, dementia, mild cognitive impairment, Alzheimer, vascular dementia, frontotemporal dementia.
Abstract:
Background: An increased risk of manic episodes has been reported in patients with neurodegenerative
disorders, but the clinical features of bipolar disorder (BD) in different subtypes of
dementia have not been thoroughly investigated.
Objectives: The main aim of this study is to systematically review clinical and therapeutic evidence
about manic syndromes in patients with Alzheimer’s disease (AD), vascular dementia (VaD), and
frontotemporal dementia (FTD). Since manic-mixed episodes have been associated to negative outcomes
in patients with dementia and often require medical intervention, we also critically summarized
selected studies with relevance for the treatment of mania in patients with cognitive decline.
Methods: A systematic review of the literature was conducted according to PRISMA guidelines.
PubMed, Scopus, and Web of Science databases were searched up to February 2022. Sixty-one articles
on patients with AD, VaD, or FTD and BD or (hypo) mania have been included.
Results: Manic symptoms seem to be associated to disease progression in AD, have a greatly variable
temporal relationship with cognitive decline in VaD, and frequently coincide with or precede
cognitive impairment in FTD. Overall, mood stabilizers, and electroconvulsive therapy may be the
most effective treatments, while the benefits of short-term treatment with antipsychotic agents must
be balanced with the associated risks. Importantly, low-dose lithium salts may exert neuroprotective
activity in patients with AD.
Conclusion: Prevalence, course, and characteristics of manic syndromes in patients with dementia
may be differentially affected by the nature of the underlying neurodegenerative conditions.