Table 1:

Studies included in the review examining nutrition in older adults with bipolar disorder

Study	Design	Sample, n, age, females	Nutrients	Main findings
Bell et al., 1990 USA	R	N=102 (BD=22), age = 60–100 years, females=84 (82%)	Folate, Vitamin B12	Folate levels correlated negatively with age at onset of psychiatric illness and length of hospitalization. Biochemically interrelated vitamins such as B12 and folate may exert both a separate and a concomitant influence on affect and cognition.
Bell et al., 1990 USA	R	N=60 (BD=8), mean age= 74.5 (SD= 5.9) years, females=45(75%)	Folate, Vitamin B12	There were strong positive correlations for B12 and cognitive measures within the psychotic depression, but not in other diagnostic categories including BD.
Forester et al., 2012 USA	RCT	N=10, (BD-All), age range ≥55 years, females=7(70%)	Coenzyme Q10	Reduction in depression symptom severity during treatment with high-dose CoEnzyme Q10 for OABD
Forester et al. 2015 USA	RCT	N=19, (BPD=All), age range 56–78 years, gender= females, 9(47.4%)	Coenzyme Q10	CoQ10 showed antidepressant effects in OABD suggesting that mitochondrial enhancing therapies may play a role in the treatment of affective illness. Specific symptom domains such as lassitude, apparent sadness and poor concentration may preferentially respond to such energy enhancing therapies.
Gronli et al., 2014 Norway	C	N=95 (BD= 10), age >64 years, females=63.2%	Vitamin D	Compared with controls, Vitamin D deficiency was associated with patient status, but did not differ significantly among across different psychiatric diagnoses
Isaac et al., 2015 India	R	N=60 (BD=3), age > 64 years, females=26(43.3%)	Vitamin B12	This study suggested Vitamin B12 deficiency could be associated with memory loss in diverse neuropsychiatric populations including OABD.
Keaton et al., 2009 USA	C	N=100 (BD=50), age ≥50 years (mean age 68.7 ±9.74 years), females=70(70.0%)	Herbal and Nutritional compounds	The use of herbal and nutritional compounds (HNC) was more common in elders with bipolar disorder compared to those with major depression. Most individuals did not discuss HNC use with their physicians.
Lachner et al., 2014 USA	R	N=374 (BD=50), age>50 years, females=194(51.9%)	Vitamin B12	No difference in Vitamin B12 level comparing cognitive disorders vs. noncognitive disorders, in older adult psychiatric inpatients.
Lapid et al., 2013 USA	R	N=171(BD=11), age≥65 years, females=86 (61%)	Vitamin D	Hypovitaminosis D was common among psychogeriatric patients but there was no association between Vitamin D level with diagnosis and global cognitive function.
Scott et al., 2004 USA	R	N=34 (BD=16%), mean age=75 years, female=15(44.1%)	Folate Homocysteine Vitamin B12	Low folate concentration was associated with decreased hippocampal and amygdala volume as well as with brain white matter disease. Elevated homocysteine level was also associated with brain white matter disease.

BD- bipolar disorders, BCAA- branched-chain amino acid, C-cross-sectional, CC-case control, MTHFR- Methylene tetrahydrofolate reductase, N-total number of sample, NR-not reported, OABD- Older adults with bipolar disorders, R-retrospective chart review, RCT-randomized controlled clinical trial, YMRS- Young Mania Rating Scale