Factors Associated with Cognitive Decline in Patients with Late-Onset Schizophrenia

Abstract

Background: it is believed that very-late onset (after 60 years) of schizophrenia-like psychosis is associated with the impact of neurodegeneration. We hypothesized that patients with late-onset schizophrenia and cognitive decline have more factors related to organic brain pathology.Objectives: to identify factors (clinical features of psychosis, anamnesis data and neuroimaging parameters) associated with cognitive decline in patients with late-onset schizophrenia.Patients and methods: the sample made up 28 patients with ICD-10 diagnosis of late-onset schizophrenia with illness duration 10 years and less. Patients were examined by admission and 4 weeks later using PANSS and HDRS-17, at the second time-point cognitive functions were assessed (MMSE, MoCA, FAB, TMT-A, TMT-B, 10 words and 5  gures memorization tests). Ranged scores of atrophy and vascular changes on CT/MRI were used. The control group included 24 subjects aged 45 and older without depressive and psychotic disorders. Nonparametric statistics and cluster analysis were used.Results: patients were divided into two clusters: Cluster 1 (with cognitive impairment) included 20 patients, Cluster 2 (without marked decline) — 8 patients. Patients of Cluster 1 had more negative symptoms, higher atrophic СТ-scores and leukoaraiosis on CT rate, as well as more frequent history of brain injury. Patients of Cluster 2 had more premorbid severe grief reactions. Patients of both clusters had more anxiety symptoms before manifestation of psychosis. Conclusions: cognitive decline in patients is associated with neurodegenerative factors that are not decisive pathogenesis cause of late-onset schizophrenia since numerous patients had speci c personality traits long before the psychosis onset.