Abstract
This study aimed to review the evidence base regarding cognitive impairment and the development of dementia in patients with very late-onset schizophrenia-like psychosis (VLOSLP). We conducted a systematic literature search of PubMed, PsycINFO and Web of Science according to Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Two reviewers independently screened records first by title and abstract and then by full text, resolving differences after each stage. Selected studies were assessed for quality using the GRADE system, and data on study design, participants, cognitive ability and rates of developing dementia were extracted and synthesised. Seventeen publications were identified for review. They were generally poor in quality and heterogenous in design. VLOSLP patients were found to have impaired global cognition compared to non-psychotic controls, but no difference was found between VLOSLP patients and aged early-onset schizophrenia (EOS) patients. No single cognitive domain was consistently affected. Patients with VLOSLP demonstrated significantly higher rates of dementia diagnosis (ranging from 4.4% over 3 years to 44.4% over 15 years) than controls, but no difference was found between VLOSLP patients and aged EOS patients. VLOSLP may not necessarily predict cognitive decline, but few studies have adequately investigated cohorts on a longitudinal basis. Heterogeneity between and within cohorts and varying selection criteria compromise the clinical generalisability of studies investigating the association between VLOSLP and neurodegenerative disease. Further studies on the clinical presentation, cognitive profile and neuropathology of VLOSLP with comparison to EOS/late-onset schizophrenia (LOS) and neurodegenerative disease are needed to better inform the diagnosis and management of VLOSLP.
Highlights
Schizophrenia commonly presents in late adolescent or early adulthood, a small proportion of patients first present with symptoms later in life (Howard et al 2000)
Three studies investigated the course of cognition over a follow-up period using cognitive assessment tools (Hymas et al 1989; Howard et al 1995) or carer impressions (Mazeh et al 2005), and one study compared rates of mortality from dementia in very late-onset schizophrenia-like psychosis (VLOSLP) patients with that of early-onset schizophrenia (EOS)/late-onset schizophrenia (LOS) patients (Talaslahti et al 2015)
There were no significant differences in performance between VLOP, LOP and early onset psychosis (EOP) on the WAIS/Raven IQ, GWLT, or CPT reaction time
Summary
Schizophrenia commonly presents in late adolescent or early adulthood, a small proportion of patients first present with symptoms later in life (Howard et al 2000). An international consensus defined very late-onset schizophrenia-like psychosis (VLOSLP) as an onset of psychotic symptoms at the age of 60 years or above, which cannot be attributed to a primary affective disorder or structural brain abnormalities (Howard et al 2000). VLOSLP typically presents with multimodal hallucinations, partition and paranoid delusions (Hanssen et al 2015) in the absence of formal thought disorder and negative symptoms seen in early-onset schizophrenia (EOS). The presentation of VLOSLP diverges from that of late-onset schizophrenia (LOS), defined as a primary onset of psychotic symptoms at the age of 40 years or above, being associated with a stronger female predominance, brain abnormalities on imaging and overall neuropsychological decline. Compared to VLOSLP, LOS has been observed to be more commonly associated with positive family history and presenting with negative symptoms (Palmer et al 2001)
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