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Late-onset-psychosis: cognition

Published online by Cambridge University Press:  22 March 2011

Caroline Girard ,
Martine Simard ,
Robert Noiseux ,
Louis Laplante ,
Michel Dugas ,
François Rousseau ,
Nadine Gagnon ,
François Primeau ,
Evelyn Keller  and
Patrick J. Bernier
Caroline Girard*
Affiliation:
École de psychologie, Université Laval, Québec, Canada Centre de Recherche Université Laval-Robert-Giffard (CRULRG), Québec, Canada Centre Hospitalier affilié universitaire l'Hôtel-Dieu de Lévis, Lévis, Québec, Canada
Martine Simard
Affiliation:
École de psychologie, Université Laval, Québec, Canada Centre de Recherche Université Laval-Robert-Giffard (CRULRG), Québec, Canada
Robert Noiseux
Affiliation:
Centre Hospitalier affilié universitaire l'Hôtel-Dieu de Lévis, Lévis, Québec, Canada
Louis Laplante
Affiliation:
École de psychologie, Université Laval, Québec, Canada
Michel Dugas
Affiliation:
Centre Hospitalier Université Laval (CHUL), Québec, Canada
François Rousseau
Affiliation:
Centre Hospitalier Robert-Giffard (CHRG), Québec, Canada
Nadine Gagnon
Affiliation:
Centre Hospitalier Robert-Giffard (CHRG), Québec, Canada
François Primeau
Affiliation:
Centre Hospitalier affilié universitaire l'Hôtel-Dieu de Lévis, Lévis, Québec, Canada
Evelyn Keller
Affiliation:
Centre Hospitalier Robert-Giffard (CHRG), Québec, Canada
Patrick J. Bernier
Affiliation:
Services gériatriques spécialisés de christ-Roi, Centre de santé et des services sociaux de la Vieille-Capitale, Québec, Canada
*
Correspondence should be addressed to: Caroline Girard, Ph.D., School of psychology, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Laval University, Québec, Canada, G1V 0A6. Phone: +1 418 656 2131; Fax: +1 418 656 3646. Email: caroline.girard.6@ulaval.ca.
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Abstract

Background: The objectives of the study were to characterize and compare the cognitive profile and natural evolution of patients presenting late-onset psychotic symptoms (LOPS: onset ≥50 years old) to those of elderly patients (≥50 years old) with life-long/early-onset schizophrenia (EOS: onset <40 years old).

Methods: Neuropsychological profiles of 15 LOPS patients were compared to those of 17 elderly EOS patients and to those of two control groups (n = 11/group). The evolution of the two patient groups was compared using an independent diagnostic consensual procedure involving a geriatric psychiatry physician/clinician and a neuropsychologist blinded to the initial psychiatric diagnosis.

Results: EOS presented significant memory and executive impairments when compared to controls but there was no significant difference between LOPS and their controls when age and education were taken into account. However, a detailed inspection of normative data suggests more executive impairments in LOPS than in EOS. The clinical judgment of experts was in favour of significant cognitive deficits with or without dementia in most LOPS (82.3%–94.1%) and EOS (80.0%–93.3%) patients. Regarding evolution, mild cognitive impairment (MCI) and vascular cognitive impairment (VCI) were the most common clinical diagnoses made by geriatric psychiatry physicians/clinicians for the LOPS (40%). In addition, 20% of LOPS versus 5.9% of EOS patients met the diagnostic criteria for dementia by consensus of the experts. Cerebral abnormalities were confirmed (CT scan; SPECT) in 73.3% of LOPS patients.

Conclusion: The present results suggest cognitive deficits (mostly of executive functions) and vascular and neurodegenerative vulnerability in LOPS. Further studies with larger samples are needed to confirm the present findings.

Keywords

psychotic symptomsschizophrenialate-onsetneuropsychologycognitionprognosis
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 8 , October 2011 , pp. 1301 - 1316
Copyright
Copyright © International Psychogeriatric Association 2011

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References

Andreasen, N. C. (1983). Scale for the Assessment of Negative Symptoms (SANS). Iowa City: University of Iowa.Google Scholar
Andreasen, N. C. (1984). Scale for the Assessment of Positive Symptoms (SAPS). Iowa City: University of Iowa.Google Scholar
Bondi, M. W. et al. (1994). Preclinical cognitive markers of dementia of the Alzheimer's type. Neuropsychology, 8, 374–384.CrossRefGoogle Scholar
Bowler, J. V. and Hachinski, V. (eds.) (2003). Vascular Cognitive Impairment: Preventable Dementia. Oxford: Oxford University Press.CrossRefGoogle Scholar
Bozikas, V. P., Kovari, E., Bouras, C. and Karavatos, A. (2002). Neurofibrillary tangles in elderly patients with late onset schizophrenia. Neuroscience Letters, 324, 109–112.CrossRefGoogle ScholarPubMed
Brodaty, H., Sachdev, P., Koschera, A., Monk, D. and Cullen, B. (2003). Long-term outcome of late-onset schizophrenia: 5-year follow-up study. British Journal of Psychiatry, 183, 213–219.CrossRefGoogle ScholarPubMed
Cahn, D. A. et al. (1995). Detection of dementia of the Alzheimer type in a population-based sample: neuropsychological test performance. Journal of the International Neuropsychological Society, 1, 252–260.CrossRefGoogle Scholar
Canadian Study of Health and Aging Working Group (1994) Canadian Study of Health and Aging: study methods and prevalence of dementia. Canadian Medical Association Journal, 150, 899–912.Google Scholar
Casanova, M. F., Stevens, J. R., Brown, R., Royston, C. and Bruton, C. (2002). Distangling the pathology of schizophrenia and paraphrenia. Acta Neuropathologica, 103, 313–320.CrossRefGoogle Scholar
Chui, H. C., Victoroff, J. I., Margolin, D., Jaqust, W., Shankle, R. and Katzman, R. (1992). Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer's Disease Diagnostic and Treatment Center. Neurology, 42, 473–480.CrossRefGoogle Scholar
Cohen, J. (1992). Statistical power analysis. Current Directions in Psychological Sciences, 1, 98–101.CrossRefGoogle Scholar
Canadian Pharmacists Association (2010). Compendium of Pharmaceuticals and Specialties: The Canadian Drug Reference for Health Professionals. Ottawa: Canadian Pharmacists Association.Google Scholar
Delis, D. C., Kramer, J. H., Kaplan, E. and Ober, B. A. (2000). California Verbal Learning Test–II, Second Edition. San Antonio, TX: The Psychological Corporation.Google Scholar
Delis, D. C., Kaplan, E. and Kramer, J. H. (2001). Delis Kaplan Executive System. San Antonio, TX: The Psychological Corporation.Google Scholar
Erkinjuntti, T. and Gauthier, S. (2009). The concept of vascular cognitive impairment. Frontiers of Neurology and Neurosciences, 24, 79–85.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatry Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Girard, C. and Simard, M. (2008). Clinical characterization of late- and very-late-onset first psychotic episode in psychiatric inpatients. American Journal of Geriatric Psychiatry, 16, 478–487.CrossRefGoogle ScholarPubMed
Gold, J. M., Randolph, C., Carpenter, C. J., Goldberg, T. E. and Weinberger, D. R. (1992). Forms of memory failure in schizophrenia. Journal of Abnormal Psychology, 101, 487–494.CrossRefGoogle ScholarPubMed
Graham, J. E. et al. (1997). Prevalence and severity of cognitive impairment with and without dementia in an elderly population. Lancet, 349, 1793–1796.CrossRefGoogle Scholar
Heaton, R. K., Gladsjo, J. A., Palmer, B. W., Kuck, J., Marcotte, T. D. and Jeste, D. V. (2001). Stability and course of neuropsychological deficits in schizophrenia. Archives of General Psychiatry, 58, 24–32.CrossRefGoogle ScholarPubMed
Heaton, R. et al. (1994). Neuropsychological deficits in schizophrenics: relationship to age, chronicity and dementia, Archives of General Psychiatry, 51, 469–476.CrossRefGoogle ScholarPubMed
Heinrichs, R. W. and Zarkanis, K. K. (1998). Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology, 12, 426–445.CrossRefGoogle ScholarPubMed
Hoff, A. L. et al. (1996). A neuropsychological study of early onset schizophrenia. Schizophrenia Research, 20, 21–28.CrossRefGoogle ScholarPubMed
Hopkins, B. and Roth, M. (1953). Psychological test performance in patients over sixty. II. Paraphrenia, arteriosclerotic psychosis and acute confusion. Journal of Mental Sciences, 99, 451–463.CrossRefGoogle ScholarPubMed
Howard, R., Rabins, P. V.Seeman, M. V.Jeste, D. V., and the International Late-Onset Schizophrenia Group (2000). Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus. American Journal of Psychiatry, 157, 172–178.CrossRefGoogle ScholarPubMed
Howard, R. (2001). Late-onset schizophrenia and very late-onset schizophrenia-like psychosis. Review in Clinical Gerontology, 11, 337–352.CrossRefGoogle Scholar
Huang, C. and Zhang, Y. (2009). Clinical differences between late-onset and early-onset chronically hospitalized elderly schizophrenic patients in Taiwan. International Journal of Geriatric Psychiatry, 24, 1166–1172.CrossRefGoogle ScholarPubMed
Hung, G.B.K. (2007). A comparison of two methods for calculating total antipsychotic dose. Hong Kong Journal of Psychiatry, 17, 87–90.Google Scholar
Jeste, D. V. et al. (1995). Clinical and neuropsychological characteristics of patients with late-onset schizophrenia. American Journal of Psychiatry, 152, 722–730.Google ScholarPubMed
Jeste, D. V. et al. (1998). Relationship of neuropsychological and MRI measures to age of onset of schizophrenia. Acta Psychiatrica Scandinavica, 98, 156–164.CrossRefGoogle ScholarPubMed
Kerssens, C. J., Pijnenburg, Y. A., Schouws, S., Eikelenboom, P. and van Tilburg, W. (2006). [Late-onset schizophrenia: is it a dementia nonpraecox? Review article with advice on differential diagnosis]. Tijdschrift voor Psychiatrie, 48, 717–727.Google ScholarPubMed
Kohler, S., van Os, J., de Graaf, R., Vollebergh, W., Verhey, F. and Krabbendam, L. (2007). Psychosis risk as a function of age at onset: a comparison between early- and late-onset psychosis in a general population sample. Social Psychiatry and Psychiatric Epidemiology, 42, 288–294.CrossRefGoogle Scholar
Korner, A., Lopez, A. G., Lauritzen, L., Andersen, P. K. and Kessing, L. V. (2008). Delusional disorder in old age and the risk of developing dementia: a nationwide register-based study. Aging and Mental Health, 12, 625–629.CrossRefGoogle ScholarPubMed
Korner, A., Lopez, A. G., Lauritzen, L., Andersen, P. K. and Kessing, L. V. (2009a). Acute and transient psychosis in old age and the subsequent risk of dementia: a nationwide register-based study. Geriatrics and Gerontology International, 9, 62–68.CrossRefGoogle ScholarPubMed
Korner, A., Lopez, A. G., Lauritzen, L., Andersen, P. K. and Kessing, L. V. (2009b). Late and very-late first-contact schizophrenia and the risk of dementia: a nationwide register based study. International Journal of Geriatric Psychiatry, 24, 61–67.CrossRefGoogle ScholarPubMed
Lagodka, A. and Robert, P. (2009). [Is late-onset schizophrenia related to neurodegenerative processes? A review of literature]. L'Encephale, 35, 386–393.CrossRefGoogle ScholarPubMed
Lopez, O. L., Becker, J. T. and Sweet, R. A. (2005). Non-cognitive symptoms in mild cognitive impairment subjects. Neurocase, 11, 65–71.CrossRefGoogle ScholarPubMed
Masur, D. M., Sliwinski, M., Lipton, R. B. and Blau, A. D. (1994). Neuropsychological prediction of dementia and the absence of dementia in healthy elderly persons. Neurology, 44, 1427–1432.CrossRefGoogle ScholarPubMed
Mattis, S. (2001). Dementia Rating Scale–2. Lutz, FL: Psychological Assessment Resources Inc.Google Scholar
McKeith, I. G. et al. (2005). Diagnosis and management of dementia with Lewy bodies: Third Report of the DLB Consortium. Neurology, 27, 1863–1872.CrossRefGoogle Scholar
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
Mesulam, M. M. and Weintraub, S. (1992). Spectrum of primary progressive aphasia. Ballieres Clinical Neurology, 1, 583–609.Google ScholarPubMed
Mishara, A. L. and Goldberg, T. E. (2004). A meta-analysis and critical review of the effects of conventional neuroleptic treatment on cognition in schizophrenia: opening a closed book. Biological Psychiatry, 15, 1013–1022.CrossRefGoogle Scholar
Nabalamba, A. and Patten, S. B. (2010). Prevalence of mental disorders in a Canadian household population with dementia. Canadian Journal of Neurological Sciences, 37, 186–194.CrossRefGoogle Scholar
Neary, D. et al. (1998). Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology, 51, 1546–1554.CrossRefGoogle ScholarPubMed
Paulsen, J. S. et al. (1995). The nature of learning and memory impairments in schizophrenia. Journal of the International Neuropsychological Society, 1, 88–99.CrossRefGoogle ScholarPubMed
Petersen, R. C. (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256, 183–194.CrossRefGoogle ScholarPubMed
Rabins, P. V. and Lavrisha, M. (2003). Long-term follow-up and phenomenologic differences distinguish among late-onset schizophrenia, late-life depression, and progressive dementia. American Journal of Geriatric Psychiatry 11, 589–594.CrossRefGoogle ScholarPubMed
Rajji, T. K., Ismail, Z. and Mulsant, B. H. (2009). Age at onset and cognition in schizophrenia: meta-analysis. British Journal of Psychiatry, 195, 286–293.CrossRefGoogle ScholarPubMed
Reeves, R. R. and Brister, J. C. (2008). Psychosis in late life: emerging issues. Journal of Psychosocial Nursing and Mental Health Services, 46, 45–52.CrossRefGoogle ScholarPubMed
Román, G. C. et al. (1993). Vascular dementia diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology, 43, 250–260.CrossRefGoogle ScholarPubMed
Rouleau, I., Salmon, D. P., Butters, N., Kennedy, C. and McGuire, K. (1992). Quantitative and qualitative analyses of clock drawings in Alzheimer's and Hungtington's disease. Brain and Cognition, 18, 70–87.CrossRefGoogle Scholar
Sachdev, P., Brodaty, H., Rose, N. and Cathcart, S. (1999). Schizophrenia with onset after age 50 years. 2: Neurological, neuropsychological and MRI investigation. British Journal of Psychiatry, 175, 416–421.CrossRefGoogle ScholarPubMed
Saykin, A. J., Gur, R. E., Mozley, P. D., Resnick, S. M., Kester, D. B. and Stafiniak, P. (1991). Neuropsychological function in schizophrenia: selective impairment in memory and learning. Archives of General Psychiatry, 48, 618–624.CrossRefGoogle ScholarPubMed
Shay, K. A. et al. (1991). The clinical validity of the Mattis Dementia Rating Scale in staging Alzheimer's dementia. Journal of Geriatric Psychiatry and Neurology, 4, 18–25.CrossRefGoogle ScholarPubMed
Simard, M. and Grandmaison, E. (2006). Les déficits des fonctions visuospatiales dans la schizophrénie: l'hypothèse d'une dysfonction fronto-temporale peut-elle tout expliquer? Revue de Neuropsychologie, 16, 79–115.Google Scholar
Stip, E. (2006). Cognition, schizophrenia and the effects of antipsychotics. L'Encephale, 32, 341–350.CrossRefGoogle ScholarPubMed
Teng, E. L. and Chui, H. C. (1987). The Modified Mini-Mental State (3MS) examination. Journal of Clinical Psychiatry, 48, 314–318.Google ScholarPubMed
Tierney, M. C., Szalai, J. P., Snow, W. G. and Fisher, R. H. (1996). The prediction of Alzheimer disease: the role of patient and informant perceptions of cognitive deficits. Archives of Neurology, 53, 423–427.CrossRefGoogle ScholarPubMed
Tuulio-Henriksson, A., Partonen, T., Suvisaari, J., Haukka, J. and Lönqvist, J. (2004). Age at onset and cognitive functioning in schizophrenia. British Journal of Psychiatry, 185, 215–219.CrossRefGoogle ScholarPubMed
Wechsler, D. (1997). Wechsler Adult Intelligence Test – Third Edition. San Antonio, TX: The Psychological Corporation.Google Scholar
Wynn Owen, P. A. and Castle, D. J. (1999). Late-onset schizophrenia: epidemiology, diagnosis, management and outcomes. Drugs and Aging, 15, 81–89.CrossRefGoogle Scholar
Zakzanis, K. K., Andrikopoulos, J., Young, D. A., Campbell, Z. and Sethian, T. (2003). Neuropsychological differentiation of late-onset schizophrenia and dementia of the Alzheimer's type. Applied Neuropsychology, 10, 105–114.CrossRefGoogle ScholarPubMed