Abstract
As established in a wealth of studies subtle motor and sensory neurological abnormalities or neurological soft signs (NSS) are frequently found in patients with schizophrenia at any stage of their illness. However, the potential impact of chronicity and age on NSS was scarcely investigated. Therefore, we assessed NSS in 90 patients with subchronic (n = 22) or chronic (n = 68) schizophrenia and in 60 healthy controls who were assigned to three age groups (18–29, 30–49, and +50 years). NSS were measured on the Heidelberg Scale, psychopathological symptoms including apathy were rated on established instruments. As demonstrated by analysis of variance, NSS scores in patients were significantly (p < 0.05) increased relative to healthy controls. Significant age effects arose in all NSS subscores, with older subjects scoring well above the younger ones. These age effects were more pronounced in patients than controls, indicating that NSS in chronic schizophrenia exceed age-associated changes. Moreover, the NSS scores in patients were significantly associated with duration of illness, thought disturbance, positive symptoms, and apathy. These results were confirmed after age/duration of illness and years of education were partialed out and via regression analyses. Our findings conform to the hypothesis that NSS are associated with chronicity of the disorder as indicated by the correlations of NSS with both, duration of illness and apathy. The correlations between NSS and positive symptoms/thought disturbance correspond to the fluctuation of positive symptoms during the course of the disorder. The significantly more pronounced age effects on NSS in patients may either point to ongoing cerebral changes or to a greater susceptibility of patients toward physiological age effects, which may be mediated among other factors by a lower cognitive reserve.
Highlights
Neurological soft signs (NSS)—i.e., subtle motor and sensory deficits—are frequently found in patients with schizophrenia when compared with healthy controls and patients with other psychiatric conditions such as affective disorders [for a overview see Ref. (1, 2)]
Post hoc tests revealed that young subjects differed significantly from old (p = 0.002) and middle-aged subjects (p = 0.023)
This study yielded two major findings: (i) while NSS increase with age in both, patients with schizophrenia and healthy controls, this effect is more pronounced in the patients group and (ii) increased NSS scores in patients with chronic schizophrenia are associated with duration of illness, positive symptoms/thought disorder, and apathy
Summary
Neurological soft signs (NSS)—i.e., subtle motor and sensory deficits—are frequently found in patients with schizophrenia when compared with healthy controls and patients with other psychiatric conditions such as affective disorders [for a overview see Ref. (1, 2)]. As established in previous studies, NSS decrease in the course of acute psychosis paralleling psychopathological symptoms, but NSS in Chronic Schizophrenia do not normalize to the level typically found in healthy controls (3, 4). These findings were confirmed and extended in a recent meta-analysis (5), which demonstrated that this decrease mainly applies to patients with a remitting course. One may expect NSS scores to increase with persistence of psychopathological symptoms in chronic schizophrenia This hypothesis is supported by Bachmann et al (3), who found stable or increasing NSS scores to be associated with an unfavorable outcome in 39 first-episode patients investigated upon first hospitalization and after 14 months. Further longitudinal studies that investigated NSS over similar periods of time are not available (5)
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