ORESTES VICENTE FORLENZA

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Departamento de Psiquiatria, Faculdade de Medicina - Docente
LIM/27 - Laboratório de Neurociências, Hospital das Clínicas, Faculdade de Medicina

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  • conferenceObject
    Mixed mood states and optimizing generalizability: An update from the global aging & geriatric experiments in bipolar disorder database (GAGE-BD)
    (2021) SAJATOVIC, Martha; DOLS, Annemiek; REJ, Soham; BLUMBERG, Hilary; BRIGGS, Farren; FORESTER, Brent; FORLENZA, Orestes; GILDENGERS, Ariel; MULSANT, Benoit; SCHOUWS, Sigfried; SUTHERLAND, Ashley; TSAI, Shang-Ying; VIETA, Eduard; EYLER, Lisa
  • article 0 Citação(ões) na Scopus
    Bipolar symptoms, somatic burden and functioning in older-age bipolar disorder: A replication study from the global aging & geriatric experiments in bipolar disorder database (GAGE-BD) project
    (2024) SAJATOVIC, Martha; REJ, Soham; ALMEIDA, Osvaldo P.; ALTINBAS, Kursat; BALANZA-MARTINEZ, Vicent; BARBOSA, Izabela G.; BEUNDERS, Alexandra J. M.; BLUMBERG, Hilary P.; BRIGGS, Farren B. S.; DOLS, Annemiek; FORESTER, Brent P.; FORLENZA, Orestes V.; GILDENGERS, Ariel G.; JIMENEZ, Esther; KLAUS, Federica; LAFER, Beny; MULSANT, Benoit; MWANGI, Benson; NUNES, Paula Villela; OLAGUNJU, Andrew T.; OLUWANIYI, Stephen; ORHAN, Melis; PATRICK, Regan E.; RADUA, Joaquim; RAJJI, Tarek; SARNA, Kaylee; SCHOUWS, Sigfried; SIMHANDL, Christian; SEKHON, Harmehr; SOARES, Jair C.; SUTHERLAND, Ashley N.; TEIXEIRA, Antonio L.; TSAI, Shangying; VIDAL-RUBIO, Sonia; VIETA, Eduard; YALA, Joy; EYLER, Lisa T.
    Objectives: The Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) project pools archival datasets on older age bipolar disorder (OABD). An initial Wave 1 (W1; n = 1369) analysis found both manic and depressive symptoms reduced among older patients. To replicate this finding, we gathered an independent Wave 2 (W2; n = 1232, mean +/- standard deviation age 47.2 +/- 13.5, 65% women, 49% aged over 50) dataset. Design/Methods: Using mixed models with random effects for cohort, we examined associations between BD symptoms, somatic burden and age and the contribution of these to functioning in W2 and the combined W1 + W2 sample (n = 2601). Results: Compared to W1, the W2 sample was younger (p < 0.001), less educated (p < 0.001), more symptomatic (p < 0.001), lower functioning (p < 0.001) and had fewer somatic conditions (p < 0.001). In the full W2, older individuals had reduced manic symptom severity, but age was not associated with depression severity. Age was not associated with functioning in W2. More severe BD symptoms (mania p <= 0.001, depression p <= 0.001) were associated with worse functioning. Older age was significantly associated with higher somatic burden in the W2 and the W1 + W2 samples, but this burden was not associated with poorer functioning. Conclusions: In a large, independent sample, older age was associated with less severe mania and more somatic burden (consistent with previous findings), but there was no association of depression with age (different from previous findings). Similar to previous findings, worse BD symptom severity was associated with worse functioning, emphasizing the need for symptom relief in OABD to promote better functioning.
  • article 0 Citação(ões) na Scopus
    Sociodemographic and clinical characteristics of people with oldest older age bipolar disorder in a global sample: Results from the global aging and geriatric experiments in bipolar disorder project
    (2024) CHEN, Peijun; SAJATOVIC, Martha; BRIGGS, Farren B. S.; MULSANT, Benoit; DOLS, Annemiek A.; GILDENGERS, Ariel; YALA, Joy; BEUNDERS, Alexandra J. M.; BLUMBERG, Hilary P.; REJ, Soham; FORLENZA, Orestes V.; JIMENEZ, Esther; SCHOUWS, Sigfried; ORHAN, Melis; SUTHERLAND, Ashley N.; VIETA, Eduard; TSAI, Shangying; SARNA, Kaylee; EYLER, Lisa T.
    Objects: Studies of older age bipolar disorder (OABD) have mostly focused on ""younger old"" individuals. Little is known about the oldest OABD (OOABD) individuals aged >= 70 years old. The Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) project provides an opportunity to evaluate the OOABD group to understand their characteristics compared to younger groups. Methods: We conducted cross-sectional analyses of the GAGE-BD database, an integrated, harmonized dataset from 19 international studies. We compared the sociodemographic and clinical characteristics of those aged <50 (YABD, n = 184), 50-69 (OABD, n = 881), and >= 70 (OOABD, n = 304). To standardize the comparisons between age categories and all characteristics, we used multinomial logistic regression models with age category as the dependent variable, with each characteristic as the independent variable, and clustering of standard errors to account for the correlation between observations from each of the studies. Results: OOABD and OABD had lower severity of manic symptoms (Mean YMRS = 3.3, 3.8 respectively) than YABD (YMRS = 7.6), and lower depressive symptoms (% of absent = 65.4%, and 59.5% respectively) than YABD (18.3%). OOABD and OABD had higher physical burden than YABD, especially in the cardiovascular domain (prevalence = 65% in OOABD, 41% in OABD and 17% in YABD); OOABD had the highest prevalence (56%) in the musculoskeletal domain (significantly differed from 39% in OABD and 31% in YABD which didn't differ from each other). Overall, OOABD had significant cumulative physical burden in numbers of domains (mean = 4) compared to both OABD (mean = 2) and YABD (mean = 1). OOABD had the lowest rates of suicidal thoughts (10%), which significantly differed from YABD (26%) though didn't differ from OABD (21%). Functional status was higher in both OOABD (GAF = 63) and OABD (GAF = 64), though only OABD had significantly higher function than YABD (GAF = 59). Conclusions: OOABD have unique features, suggesting that (1) OOABD individuals may be easier to manage psychiatrically, but require more attention to comorbid physical conditions; (2) OOABD is a survivor cohort associated with resilience despite high medical burden, warranting both qualitative and quantitative methods to better understand how to advance clinical care and ways to age successfully with BD.
  • article 141 Citação(ões) na Scopus
    Physical Exercise in MCI Elderly Promotes Reduction of Pro-Inflammatory Cytokines and Improvements on Cognition and BDNF Peripheral Levels
    (2014) NASCIMENTO, Carla Manuela Crispim; PEREIRA, Jessica Rodrigues; ANDRADE, Larissa Pires de; GARUFFI, Marcelo; TALIB, Leda Leme; FORLENZA, Orestes Vicente; CANCELA, Jose Maria; COMINETTI, Marcia Regina; STELLA, Florindo
    The benefits of physical exercise to reduce low-grade inflammation and improve Brain-Derived Neurotrophic Factor (BDNF) levels and cognitive function became a growing field of interest. Low-grade inflammation is common during aging and seems to be linked to neurodegenerative process. Regular physical exercises can help to reduce pro-inflammatory cytokines levels and to improve BDNF peripheral concentrations. The main goal of this research was to analyze the effects of a 16-week multimodal physical exercise program on peripheral BDNF levels and on Tumor Necrosis-alpha (TNF-alpha) and Interleukin-6 (IL-6) as pro-inflammatory markers in cognitive healthy elderly individuals and in elderly with mild cognitive impairment (MCI). Cognitive functions were assessed by the Montreal Cognitive Assessment (MoCA) prior to and after the intervention. Thirty cognitively healthy participants and thirty-seven MCI participants were assigned to the control (CG) and trained (TG) groups. The TG participated in a multimodal physical training program for a 16-week period. The results showed a significant between-subjects interaction, which indicates the beneficial contribution of training on the reduction of TNF-alpha (p= 0.001) and IL-6 (p<0.001) and on the improvement of BDNF (p<0.001) peripheral concentrations. Cognitive functions also presented significant improvements for MCI trained group (p= 0.03). In conclusion, physical exercise was effective to reduce pro-inflammatory cytokines and to improve BDNF peripheral levels, with positive reflexes on cognition. To the best of our knowledge, this is the first study that evaluated longitudinally the effects of a multimodal physical exercises protocol on peripheral concentrations of pro-inflammatory cytokines and cognition performance in elderly MCI individuals.
  • article 2 Citação(ões) na Scopus
    Essential data dimensions for prospective international data collection in older age bipolar disorder (OABD): Recommendations from the GAGE-BD group
    (2023) LAVIN, Paola; REJ, Soham; OLAGUNJU, Andrew T.; TEIXEIRA, Antonio L.; DOLS, Annemieke; ALDA, Martin; ALMEIDA, Osvaldo P.; ALTINBAS, Kursat; BALANZA-MARTINEZ, Vicent; BARBOSA, Izabela G.; BLUMBERG, Hilary P.; BRIGGS, Farren; CALKIN, Cynthia; CASSIDY, Kristin; FORESTER, Brent P.; FORLENZA, Orestes V.; HAJEK, Tomas; HAARMAN, Barthomeus C. M.; JIMENEZ, Esther; LAFER, Beny; MULSANT, Benoit; OLUWANIYI, Stephen O.; PATRICK, Regan; RADUA, Joaquim; SCHOUWS, Sigfried; SEKHON, Harmehr; SIMHANDL, Christian; SOARES, Jair C.; TSAI, Shang-Ying; VIETA, Eduard; VILLA, Luca M.; SAJATOVIC, Martha; EYLER, Lisa T.
    BackgroundBy 2030, over 50% of individuals living with bipolar disorder (BD) are expected to be aged >= 50 years. However, older age bipolar disorder (OABD) remains understudied. There are limited large-scale prospectively collected data organized in key dimensions capable of addressing several fundamental questions about BD affecting this subgroup of patients. MethodsWe developed initial recommendations for the essential dimensions for OABD data collection, based on (1) a systematic review of measures used in OABD studies, (2) a Delphi consensus of international OABD experts, (3) experience with harmonizing OABD data in the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD, n >= 4500 participants), and (4) critical feedback from 34 global experts in geriatric mental health. ResultsWe identified 15 key dimensions and variables within each that are relevant for the investigation of OABD: (1) demographics, (2) core symptoms of depression and (3) mania, (4) cognition screening and subjective cognitive function, (5) elements for BD diagnosis, (6) descriptors of course of illness, (7) treatment, (8) suicidality, (9) current medication, (10) psychiatric comorbidity, (11) psychotic symptoms, (12) general medical comorbidities, (13) functioning, (14) family history, and (15) other. We also recommend particular instruments for capturing some of the dimensions and variables. ConclusionThe essential data dimensions we present should be of use to guide future international data collection in OABD and clinical practice. In the longer term, we aim to establish a prospective consortium using this core set of dimensions and associated variables to answer research questions relevant to OABD.
  • conferenceObject
    Clinical characteristics of the oldest older-age bipolar disorder (OOABD) patients: Results from the GAGE-BD project
    (2023) CHEN, Peijun; SAJATOVIC, Martha; EYLER, Lisa; MULSANT, Benoit; SARNA, Kaylee; DOLS, Annemiek; GILDENGERS, Ariel; BEUNDERS, Alexandra; BLUMBERG, Hilary; BRIGGS, Farren; REJ, Soham; FORLENZA, Orestes; JIMENEZ, Ester; SCHOUWS, Sigfried; ORHAN, Melis
  • conferenceObject
    Employment, education, and clinical characteristics in older-age bipolar disorder: Analysis from the GAGE-BD database project
    (2023) MALLU, Amulya; CHAN, Carol; EYLER, Lisa; DOLS, Annemiek; REJ, Soham; BLUMBERG, Hilary; SARNA, Kaylee; BRIGGS, Farren; FORESTER, Brent; PATRICK, Regan; FORLENZA, Orestes; JIMENEZ, Esther; VIETA, Eduard; SCHOUWS, Sigfried; PAANS, Nadine; SUTHERLAND, Ashley; YALA, Joy; SAJATOVIC, Martha
  • article 22 Citação(ões) na Scopus
    Bipolar symptoms, somatic burden, and functioning in older-age bipolar disorder: Analyses from the Global Aging & Geriatric Experiments in Bipolar Disorder Database project
    (2022) SAJATOVIC, Martha; DOLS, Annemiek; REJ, Soham; ALMEIDA, Osvaldo P.; BEUNDERS, Alexandra J. M.; BLUMBERG, Hilary P.; BRIGGS, Farren B. S.; FORESTER, Brent P.; PATRICK, Regan E.; FORLENZA, Orestes V.; GILDENGERS, Ariel; JIMENEZ, Esther; VIETA, Eduard; MULSANT, Benoit; SCHOUWS, Sigfried; PAANS, Nadine; STREJILEVICH, Sergio; SUTHERLAND, Ashley; TSAI, Shangying; WILSON, Betsy; EYLER, Lisa T.
    Objective Literature on older-age bipolar disorder (OABD) is limited. This first-ever analysis of the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) investigated associations among age, BD symptoms, comorbidity, and functioning. Methods This analysis used harmonized, baseline, cross-sectional data from 19 international studies (N = 1377). Standardized measures included the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS), and Global Assessment of Functioning (GAF). Results Mean sample age was 60.8 years (standard deviation [SD] 12.2 years), 55% female, 72% BD I. Mood symptom severity was low: mean total YMRS score of 4.3 (SD 5.4) and moderate-to-severe depression in only 22%. Controlled for sample effects, both manic and depressive symptom severity appeared lower among older individuals (p's < 0.0001). The negative relationship between older age and symptom severity was similar across sexes, but was stronger among those with lower education levels. GAF was mildly impaired (mean =62.0, SD = 13.3) and somatic burden was high (mean =2.42, SD = 1.97). Comorbidity burden was not associated with GAF. However, higher depressive (p < 0.0001) and manic (p < 0.0001) symptoms were associated with lower GAF, most strongly among older individuals. Conclusions Findings suggest an attenuation of BD symptoms in OABD, despite extensive somatic burden. Depressive symptom severity was strongly associated with worse functioning in older individuals, underscoring the need for effective treatments of BD depression in older people. This international collaboration lays a path for the development of a better understanding of aging in BD.
  • article 5 Citação(ões) na Scopus
    Clinical correlates of late-onset versus early-onset bipolar disorder in a global sample of older adults
    (2022) LAVIN, Paola; BUCK, Gabriella; ALMEIDA, Osvaldo P.; SU, Chien-Lin; EYLER, Lisa T.; DOLS, Annemieke; BLUMBERG, Hilary P.; FORESTER, Brent P.; V, Orestes Forlenza; GILDENGERS, Ariel; MULSANT, Benoit H.; TSAI, Shang-Ying; VIETA, Eduard; SCHOUWS, Sigfried; BRIGGS, Farren B. S.; SUTHERLAND, Ashley; SARNA, Kaylee; YALA, Joy; ORHAN, Melis; KORTEN, Nicole; SAJATOVIC, Martha; REJ, Soham
    Objectives: Late-onset bipolar disorder (LOBD) represents a significant subgroup of bipolar disorder (BD). However, knowledge for this group is mostly extrapolated from small studies in subjects with early/mixed age of illness onset. In this global sample of older adults with BD (OABD: >= 50 years old) we aim to characterize the sociodemographic and clinical presentation of LOBD (>= 40 years at BD onset) compared to early-onset BD (EOBD: <40 years at BD onset). Methods: The Global Aging and Geriatric Experiments in Bipolar Disorder consortium provided international data on 437 older age bipolar disorder participants. We compared LOBD versus EOBD on depression, mania, functionality, and physical comorbidities. Exploratory analyses were performed on participants with BD onset >= 50 years old. Results: LOBD (n = 105) did not differ from EOBD (n = 332) on depression, mania, global functioning, nor employment status (p > 0.05). Late-onset bipolar disorder was associated with higher endocrine comorbidities (odds ratio = 1.48, [95%CI = 1.0,12.1], p = 0.03). This difference did not remain significant when subjects with BD onset >= 50 years old were analyzed. Limitations: This study is limited by the retrospective nature of the variable age of onset and the differences in evaluation methods across studies (partially overcame by harmonization processes). Conclusion: The present analysis is in favor of the hypothesis that LOBD might represent a similar clinical phenotype as classic EOBD with respect to core BD symptomatology, functionality, and comorbid physical conditions. Large-scale global collaboration to improve our understanding of BD across the lifespan is needed.
  • article 170 Citação(ões) na Scopus
    Performance and complications of lumbar puncture in memory clinics: Results of the multicenter lumbar puncture feasibility study
    (2016) DUITS, Flora H.; MARTINEZ-LAGE, Pablo; PAQUET, Claire; ENGELBORGHS, Sebastiaan; LLEO, Alberto; HAUSNER, Lucrezia; MOLINUEVO, Jose L.; STOMRUD, Erik; FAROTTI, Lucia; RAMAKERS, Inez H. G. B.; TSOLAKI, Magda; SKARSGARD, Constance; ASTRAND, Ragnar; WALLIN, Anders; VYHNALEK, Martin; HOLMBER-CLAUSEN, Marie; FORLENZA, Orestes V.; GHEZZI, Laura; INGELSSON, Martin; HOFF, Erik I.; ROKS, Gerwin; MENDONCA, Alexandre de; PAPMA, Janne M.; IZAGIRRE, Andrea; TAGA, Mariko; STRUYFS, Hanne; ALCOLEA, Daniel A.; FROELICH, Lutz; BALASA, Mircea; MINTHON, Lennart; TWISK, Jos W. R.; PERSSON, Staffan; ZETTERBERG, Henrik; FLIER, Wiesje M. van der; TEUNISSEN, Charlotte E.; SCHELTENS, Philip; BLENNOW, Kaj
    Introduction: Lumbar puncture (LP) is increasingly performed in memory clinics. We investigated patient-acceptance of LP, incidence of and risk factors for post-LP complications in memory clinic populations. Methods: We prospectively enrolled 3868 patients (50% women, age 66 +/- 11 years, mini mental state examination 25 +/- 5) at 23 memory clinics. We used logistic regression analysis using generalized estimated equations to investigate risk factors for post-LP complications, such as typical postlumbar puncture headache (PLPH) and back pain. Results: A total of 1065 patients (31%) reported post-LP complaints; 589 patients (17%) reported back pain, 649 (19%) headache, of which 296 (9%) reported typical PLPH. Only few patients needed medical intervention: 11 (0.3%) received a blood patch, 23 (0.7%) were hospitalized. The most important risk factor for PLPH was medical history of headache. An atraumatic needle and age >65 years were preventive. Gender, rest after LP, or volume of cerebrospinal fluid had no effect. Discussions: The overall risk of complications is relatively low. If risk factors shown in this study are taken into account, LPs can be safely performed in memory clinics.