Researchers do not yet understand the exact nature of the relationship between bipolar disorder and dementia. However, the two conditions share several features. Recent research suggests both are associated with progressive cognitive decline.

Bipolar disorder (BD) is a mood disorder. BD causes shifts in a person’s mood, energy, and behavior.

Dementia is an umbrella term describing various symptoms of cognitive decline. These are shared by a number of conditions associated with aging, such as Alzheimer’s disease.

Due to their shared features, some people with either late-onset BD or frontotemporal dementia symptoms will receive a diagnosis for the other condition.

This article explores the connection between BD and dementia. It looks at their similarities and differences and how to tell the difference between the two conditions.

Silhouette of a couple sitting closelyShare on Pinterest
Smile/Getty Images

The relationship between BD and dementia is complex. Research suggests that having either condition may place a person at higher risk of developing the other condition. However, more research is needed to determine the exact connection.

A 2018 meta-analysis found a significant association between a history of BD and an increased risk of dementia in older adults.

According to the authors, the literature reviewed robustly proves that mood disorders in general are associated with higher risks of dementia. Furthermore, for a certain sub-group of individuals, BD can be characterized as a progressive condition leading to cognitive impairment and dementia.

Historically, scientists have understood BD as a cyclic disease, with people recovering fully between mood episodes. However, according to a 2016 study, significant evidence has accumulated over the last decade supporting BD’s progressive features.

A 2020 meta-analysis concluded that those with BD are around three times more likely to develop dementia.

Late-onset BD and dementia share several features, which can make diagnosis difficult. Because of this, it is common for a considerable proportion of people with dementia to first receive a BD diagnosis.

Similarities

Similarities include:

  • disinhibition
  • cognitive alterations
  • depressive symptoms, including:
    • apathy
    • anhedonia
    • lack of motivation
    • lack of interest
    • lack of energy
    • impaired concentration
  • manic symptoms, such as:
    • irritability
    • pressured speech
    • impulsivity
    • psychomotor agitation
    • excessive jocularity or cheerfulness
    • inappropriate social conduct or sexual behavior

Differences

While they share many overlapping symptoms, BD and dementia also have some key differences.

BD

Depressive symptoms of BD that are not common with dementia include:

  • guilty ruminations
  • feeling of worthlessness
  • suicidal thoughts

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

  • Call or text the 988 Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
  • Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
  • Not in the United States? Find a helpline in your country with Befrienders Worldwide.
  • Call 911 or your local emergency services number if you feel safe to do so.

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you’re not in the same household, stay on the phone with them until help arrives.

Those living with dementia may act apathetic and emotionally withdrawn. However, they often lack the sadness that characterizes BD depression.

Manic symptoms of BD that are not typical with dementia include:

  • a sense of grandiosity and invulnerability
  • increased energy
  • decreased need for sleep
  • elevated mood with inflated self-esteem

Dementia

Symptoms of dementia not typical of BD include:

  • repetitive motor behavior
  • apparent loss of knowledge of social norms
  • lack of interest in sex

BD and dementia have a high number of shared features and subtle distinctions between their presentation of symptoms. As a result, it is essential to contact a healthcare professional if someone suspects they or a loved one may be living with BD or dementia.

A healthcare professional can speak with a person about their medical history and symptoms. They can also perform specific cognition and dementia tests to assess whether a person may have dementia.

The following are answers to some questions people frequently ask about BD and dementia.

Is memory loss common in bipolar disorder?

Yes. Cognitive impairment is a common feature of BD, including memory loss.

What does bipolar look like in the elderly?

Late-onset BD has a couple of key differences from early-onset BD, according to older research from 2011. Episodes may be more frequent and more persistently depressive, rather than manic. Older adults tend to have symptoms that score lower on the Manic State Rating Scale, including:

  • activity‐energy score
  • sexual interest
  • religiosity
  • initiating and creating plans

Does bipolar get worse with age?

Potentially, yes. BD can present differently in older adults. This can include more frequent episodes, less severe manic symptoms, and more severe depressive symptoms.

Bipolar disorder resources

Visit our dedicated hub for more research-backed information and in-depth resources on bipolar disorder.

BD and dementia share several features, which can make diagnosis difficult. People with BD may receive an initial diagnosis of frontotemporal dementia. Conversely, sometimes, people with frontotemporal dementia may initially receive a diagnosis of BD.

Researchers do not yet fully understand the connection between the two conditions. However, a growing body of research suggests that BD may be a progressive condition associated with worsening cognitive decline over time.