Among 14 elderly patients (mean age = 74.6 years) with first-episode mania who were followed for 3 to 10 years, men had a higher risk of mortality. Compared to 36 elderly patients with multiple episodes of mania, patients with first-episode mania were twice as likely to have a comorbid neurological disorder (71% [N = 10] versus 28% [N = 10]). Mania in the elderly appears to be a heterogeneous disorder.