Affective disorders arising in the senium. I. Their association with organic cerebral degeneration.

1. The association of cerebral degeneration with affective disorder arising for the first time in the senium has been examined by comparing two groups of patients, ( a ) those who had fallen ill for the first time before 60, and ( b ) those in whom the first attack had occurred at the age of 60 or later. 2. The two groups showed a similar incidence of signs indicative of or liable to be attributed to cerebral disease. Nor is there any difference between the two groups in respect of mental test performance. Cases of affective disorder of both early and late onset are exposed to some risk of suffering from cerebrovascular disease in old age. A review of the relevant evidence suggests that this is probably no greater than the risk in the normal population; the slight excess of cases with cerebrovascular symptoms found in follow-up of the group with late onset is likely to be due to its greater mean age. But further investigations into a possible association between cerebrovascular disease and affective symptoms are indicated. 3. The pattern of outcome of the two groups is closely similar with high discharge and low mortality rates, which sharply differentiate them from the organic groups proper. But attention is drawn to a small group of “mixed” cases which carry a far worse prognosis. 4. There is reason to believe that the slightly greater mortality of the group of late onset represents a real difference though it is not significant. It is linked with the higher incidence of physical illness of this group; the aetiological role of this is examined in another paper. 5. The conclusion is reached that cerebral degeneration of the kind found in the senile and arteriosclerotic psychoses is unlikely to be an aetiological factor of any importance in the causation of affective psychosis in late life, whether or not this appeared in the senium for the first time. Depressive or manic psychosis of late onset may be regarded together with affective disorders of earlier life as forming a nosological entity distinct from psychoses with cerebral degeneration.