Elderly Schizophrenia Research Articles

Neurological Soft Signs in Schizophrenia Patients With Obsessive-Compulsive Disorder

Neurological Soft Signs in Schizophrenia Patients With Obsessive-Compulsive Disorder

Neurocognitive Deterioration in Elderly Chronic Schizophrenia Patients With and Without PTSD

Neurocognitive deficits are associated with chronic schizophrenia and aging. We investigated whether elderly chronic schizophrenia inpatients who also suffer from posttraumatic stress disorder (PTSD) have more severe cognitive impairment than elderly schizophrenia inpatients that do not. Fourteen schizophrenia inpatients that are Holocaust survivors and suffer from PTSD (survivor group) were compared with schizophrenia inpatients not exposed to the holocaust and without PTSD (comparison group) using neurocognitive assessments and psychiatric evaluation instruments. The survivors performed significantly worse on measures of processing speed and visual scanning, recognition memory, and general mental status, than the comparison group. Though nonsignificantly, the comparison group revealed better performance on tests that measured visuospatial perception, visuospatial planning and strategies, organizational and constructional skills. The survivor group displayed a greater severity of antipsychotic-induced side effects that were not associated with differences in cognitive performance. Comorbid PTSD may contribute to the severity of neurocognitive impairment in elderly chronic schizophrenia patients.

The Human Homolog of the QKI Gene Affected in the Severe Dysmyelination “Quaking” Mouse Phenotype: Downregulated in Multiple Brain Regions in Schizophrenia

The authors sought to understand the origins of oligodendrocyte/myelin gene expression abnormalities in the brains of persons with schizophrenia. Twelve cortical regions (Brodmann's areas 8, 10, 44, 46, 23/31, 24/32, 20, 21, 22, 36/28, 7, and 17) and three noncortical regions (caudate, hippocampus, and putamen) of 16 elderly schizophrenia patients and 14 matched comparison subjects were examined using 450 separate microarrays. The mRNA levels of QKI and its isoforms were then measured in a larger cohort by using quantitative real-time polymerase chain reaction (qPCR) in the cingulate cortex of schizophrenia subjects and matched comparison subjects. Expression of QKI mRNA was decreased in seven cortical regions and the hippocampus in the schizophrenia subjects. QKI gene expression deficits detected by microarray were validated by qPCR in the cingulate cortex, where the expression of isoforms QKI-5, QKI-6, and QKI-7 were profoundly perturbed in schizophrenia. Since QKI plays a fundamental role in oligodendrocyte differentiation and in myelination, its underexpression may be pivotal to, and upstream of, other myelin-associated gene expression abnormalities in schizophrenia. Given the role of QKI in determination of oligodendrocyte fate, these results not only confirm oligodendrocyte-related gene expression abnormalities in schizophrenia but suggest that the physiology of glial progenitor cells may be altered in schizophrenia.

Myelin-associated mRNA and protein expression deficits in the anterior cingulate cortex and hippocampus in elderly schizophrenia patients

Microarray and other studies have reported oligodendrocyte and myelin-related (OMR) deficits in schizophrenia. Here, we employed a quantitative approach to determine the magnitude of OMR gene expression deficits and their brain-region specificity. In addition, we examined how expression levels among the studied OMR genes are interrelated. mRNA of MAG, CNP, SOX10, CLDN11, and PMP22, but not MBP and MOBP, was reduced in the hippocampus and anterior cingulate cortex but not in the putamen of patients with schizophrenia. Expression of the only protein examined (CNP) was decreased in the hippocampus but not in the putamen. Correlation and factor analyses revealed that mRNA levels for genes that did exhibit differential expression in schizophrenia (MAG, CNP, SOX10, CLDN11, and PMP2), as opposed to those that did not (MOBP and MBP), loaded on separate factors. Thus, OMR gene and protein expression deficits in schizophrenia are brain-region specific, and the affected components may share regulatory elements.

Obsessive–compulsive disorder in elderly schizophrenia patients

Obsessive–compulsive disorder (OCD) has been identified in a substantial proportion of adult schizophrenia patients. Although symptoms of both disorders may persist into senescence, the prevalence of OCD in elderly schizophrenia patients has not yet been explicitly evaluated. We evaluated the prevalence of OCD in 50 elderly patients consecutively hospitalized for acute exacerbation of DSM-IV schizophrenia or schizoaffective disorder. The severity of schizophrenia and OCD symptoms was assessed using appropriate clinical rating scales. Eight (16%) of the 50 participants also met DSM-IV criteria for OCD. Schizophrenia patients with and without OCD did not differ significantly in demographic and clinical variables. In half of the schizophrenia–OCD group late onset OCD was observed, while in the remaining schizophrenia–OCD patients, early-onset OCD persisted into senescence, suggesting distinct mechanisms of occurrence. We conclude that OCD is not rare in elderly schizophrenia patients. Identification of this potentially treatable condition is imperative to provide adequate care.

Patients With Very-Late-Onset Schizophrenia-Like Psychosis: A Follow-Up Study

The topic of course and outcome of very-late-onset schizophrenia-like psychosis (VLOSLP) has not received the research attention it deserves. The aim of this study was to evaluate the course of clinical symptoms and functional status of patients with VLOSLP in comparison with patients with life-long schizophrenia. Telephone interviews were conducted on primary caregivers of 21 patients with VLOSLP who had recently been released from inpatient care. Their treating staff evaluated 21 schizophrenia inpatients according to the same criteria. The majority of patients with VLOSLP did not present cognitive and functional deterioration. On the other hand, 8 of the 19 patients in the elderly schizophrenia group had some functional decline; 3 of those 8 patients seemed to have some cognitive decline, as well. The results suggest that the VLOSLP patients present stable cognitive and everyday functioning, as compared with chronically institutionalized elderly patients with schizophrenia.

Patients With Very-Late-Onset Schizophrenia-Like Psychosis: A Follow-Up Study

<h3>Objective</h3> The topic of course and outcome of very-late-onset schizophrenia-like psychosis (VLOSLP) has not received the research attention it deserves. The aim of this study was to evaluate the course of clinical symptoms and functional status of patients with VLOSLP in comparison with patients with life-long schizophrenia. <h3>Methods</h3> Telephone interviews were conducted on primary caregivers of 21 patients with VLOSLP who had recently been released from inpatient care. Their treating staff evaluated 21 schizophrenia inpatients according to the same criteria. <h3>Results</h3> The majority of patients with VLOSLP did not present cognitive and functional deterioration. On the other hand, 8 of the 19 patients in the elderly schizophrenia group had some functional decline; 3 of those 8 patients seemed to have some cognitive decline, as well. <h3>Conclusions</h3> The results suggest that the VLOSLP patients present stable cognitive and everyday functioning, as compared with chronically institutionalized elderly patients with schizophrenia.

MRNA expression of AMPA receptors and AMPA receptor binding proteins in the cerebral cortex of elderly schizophrenics

L-alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptors (AMPARs) mediate the majority of the fast excitatory transmission in the CNS. To determine whether gene expression of AMPARs and/or AMPAR binding proteins, which control response/sensitivity of AMPAR-bearing neurons to glutamate, are altered in schizophrenia, mRNA expression and abundance of AMPAR subunits (GluR1-4) and several AMPAR binding proteins (SAP97, PICK1, GRIP, ABP) were measured in the dorsolateral prefrontal cortex (DLPFC) and the occipital cortex of elderly schizophrenia patients (n = 36) and matched normal controls (n = 26) by quantitative real-time PCR. The mRNA expression of GluR1, GluR4, and GRIP in the DLPFC and expression of the GluR4, GRIP, and ABP in the occipital cortex were significantly elevated in schizophrenics. GluR1 and ABP mRNA expression in the occipital cortex and GluR2, GluR3, SAP97, and PICK1 expression in either cortical area were not significantly altered. The data also demonstrated significant differences in the abundances of mRNAs encoding GluR1-4 subunits (GluR2 > GluR3 > GluR1 > GluR4) and of AMPAR binding proteins (SAP97 > PICK1 > GRIP > ABP) in both diagnostic groups. GluR2 (58-64%) and GluR3 (24-29%) were the major components of the AMPAR mRNA in both cortical areas, implying that the major AMPAR complexes in the human cortex are probably those containing GluR2 and GluR3 subunits. Small but significant differences in the amounts of GluR2, GluR3, and GRIP mRNAs were detected between the two cortical areas: more GluR3 and GRIP but less GluR2 were detected in the DLPFC than in the occipital cortex.

Suicide attempts amongst elderly schizophrenia patients: a 10-year case-control study

Background: Suicide is frequent amongst the elderly. Schizophrenia is one of the disorders in which suicide attempts and death by suicide are pronounced. However, there is paucity of data regarding suicide attempts by elderly schizophrenia patients. The aim of the present study was to characterize elderly schizophrenia patients who had attempted suicide (AS). Method: Over a 10-year period, all computerized records of admissions of schizophrenia patients 60 years or older were examined. Patients who had attempted suicide were defined as the index group and the comparison group was comprised of the next two admissions suffering from schizophrenia who did not attempt suicide prior to hospitalization. Results: 1066 admissions of patients 60 years or older suffering from schizophrenia were examined. There were 392 women and 300 men, mean age for the group 67.4 years. Forty-nine suicide attempts were documented comprising 4.6% of the admissions. Attempts were carried out by 30 patients of whom 10 had had attempted suicide more than once. There was an almost significant difference on gender composition with more males in the suicidal group. No other variables tested were positively associated with suicidality. Conclusions: The present study is unique in its scope and targeting elderly schizophrenia patients. Despite the lack of identified risk factors, further studies focusing on aging schizophrenia patients are needed as low base rate of suicide exists in this group.

Very late-onset schizophrenia-like psychosis: clinical and imaging characteristics in comparison with elderly patients with schizophrenia.

Studies of late-onset schizophrenia began in the early 1940s with work by M. Bleuler. Despite this fact, the emphasis on age of onset in young adulthood distracted researchers of schizophrenia from accumulating data on the subgroup of patients whose disease onset is in late life. Recently, the diagnostic entity of very late-onset schizophrenia-like psychosis (VLOSLP) was proposed for patients with disease onset after age 60 years, and it may have validity and clinical utility. The present study aims to prospectively identify patients suffering from VLOSLP over a 2-year period and to compare them with elderly schizophrenia patients on measures of brain structure, demographics, and treatment response, so that distinct features, if any, can be identified. Twenty-one VLOSLP patients (15 women, 6 men; mean age, 78.1 years) were enrolled and compared with 21 age- and gender-matched elderly schizophrenia patients. All had undergone brain CT scan, and all were treated with risperidone. The VLOSLP group was characterized by more education, higher percentage being married, more pronounced cerebellar atrophy, and better response to treatment. The authors suggest that VLOSLP is a valid diagnostic entity and that its features imply that involvement of neurodegenerative process may be etiologically relevant to psychosis with onset in late life.

Aggression in Elderly Schizophrenia Patients: A Comparison of Nursing Home and State Hospital Residents

Aggression in Elderly Schizophrenia Patients: A Comparison of Nursing Home and State Hospital Residents

Hippocampus and amygdala volumes in elderly schizophrenic patients as assessed by magnetic resonance imaging

Reduced size of the hippocampus and amygdala has been one of the more consistent morphological findings in schizophrenia, but the question of medial temporal abnormalities in elderly schizophrenia patients has been inadequately addressed. We examined 20 elderly subjects with a DSM-III-R diagnosis of schizophrenia, five of whom had a late-onset schizophrenia (LOS), and compared them with 20 healthy volunteers on magnetic resonance imaging (MRI) and neuropsychological parameters. Hippocampus and amygdala volumes were obtained by manual tracing on T1-weighted 1.5 mm thick contiguous coronal slices perpendicular to the long axis of the hippocampus. Patients had smaller left hippocampal and right amygdala volumes than comparison subjects, the mean differences being 9.7 and 11.1%, respectively, but the right amygdala volumes were not significantly different after Bonferroni correction. The hippocampus-amygdala volumes together were smaller in the schizophrenia group bilaterally. In a pilot analysis, the LOS subjects had non-significantly smaller hippocampus-amygdala volumes than did the early-onset schizophrenia (EOS) subjects. For the schizophrenia group, there were significant correlations between amygdala and hippocampus volumes and some neuropsychological performance indices. The findings are consistent with those reported in younger schizophrenics, and are of the same order of magnitude, suggesting that they are not likely to be progressive. This pilot analysis in LOS subjects argues against the condition being secondary to Alzheimer's disease.

Self-perceived interpersonal competence in older schizophrenia patients: the role of patient characteristics and psychosocial factors.

This study compared older schizophrenia patients with normal subjects in terms of their perceived interpersonal competence. A total of 95 middle-aged and elderly schizophrenia patients and 85 age-matched normal subjects completed the Interpersonal Competence Questionnaire. Patients scored significantly lower than normal subjects on initiation, provision of emotional support, and conflict management. Severity of psychiatric symptoms and other patient characteristics were examined as predictors of interpersonal competence among patients. Negative symptoms were inversely related to interpersonal competence, whereas emotional support from others and a positive appraisal coping style both yielded positive associations. These findings suggest the need for clinical interventions designed to enhance the interpersonal skills of older schizophrenia patients, particularly those with marked negative symptoms.

Application of cognitive scales to medical records of schizophrenia inpatients

The Scales of Cognitive Impairment Rated From Institutional Records (SCIRFIR), a battery based on commonly used dementia rating instruments, was tested on the records of 26 chronically institutionalized, elderly schizophrenia patients, for the purpose of retrospectively evaluating the long-term course of cognitive change in schizophrenia and relating it to available autopsy materials. The inter-rater reliability of the component scales was high (Intraclass Correlations=0.78–0.96), the final item scores were comparable to ratings on living subjects, and Alzheimer-type neuropathological changes were associated with a markedly deteriorating course. The substantial potential of this method is discussed.

Validity of specific subscales of the positive and negative symptom scales in older schizophrenia outpatients

We investigated the construct validity of subscales of the Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS) along with other measures of psychopathology in 109 schizophrenia outpatients aged 45–84 years. Scores on subscales of the SAPS, SANS and Brief Psychiatries Rating Scale (BPRS) and on the Hamilton Depression Scale (HAM-D) were subjected to a principal components analysis and orthogonal rotation followed by an extension analysis. In both analyses three of four SAPS subscales had their highest loading on the positive symptom factor and four of five SANS subscales had their highest factor loading on the negative symptom factor. The SAPS bizarre behavior subscale, however, had a much higher loading on the depressive symptom factor than on the positive symptom factor, and the SANS avolition apathy subscale had moderate loadings on both the negative symptom factor and the depressive symptom factor. The use of SAPS and SANS subscales to represent two constructs was largely (but not entirely) validated among middle-aged and elderly schizophrenia outpatients. The SAPS bizarre behavior subscale and, to a lesser extent, the SANS avolition—apathy subscale appear to represent in this older population a separate construct which may be related to depressive symptoms.

Clock drawing test in elderly schizophrenia patients.

Clock drawing has been studies in Alzheimer's disease but not in elderly schizophrenics. We examined clock drawing ability in elderly schizophrenia patients and sought possible correlations with demographic, clinical and cognitive variables. Retrospective analysis of the clock drawing item from the Cambridge Cognitive Examination (CAMCOG) presented to three independent raters. Long-stay 'open' departments of a public psychiatric hospital in Israel. Thirty-one physically well psychiatric inpatients suffering from schizophrenia (DSM-III-R, APA), between ages 60 and 76 years. The Clock Drawing Interpretation Scale (CDIS). The mean CDIS score was 14.4 (out of 20), and 61-84% of patients scored beneath the normal range (> 18). Interrater reliability was high (0.91-0.96). A moderate but significant correlation was found between CDIS and duration of illness as well as total scores on the Manchester Scale, the CAMCOG and the Mini-Mental State Examination, but not with the other variables studies. Clock drawing skills of a significant portion of long-term institutionalized elderly schizophrenics are impaired. When this test is used as a screening device for Alzheimer's disease in these patients, the results should be interpreted cautiously. Clock drawing abilities in these patients seem to be related to cognitive and non-cognitive (psychiatric state) factors, as well as to illness duration.

Schizophrenia, Alzheimer's disease, and anti-inflammatory agents.

Some recent postmortem reports raise the possibility that Alzheimer-type pathology may be 6 to 12 times higher in elderly schizophrenia patients than in general population. One study indicates that neuroleptic treatment may be an important contributor. Other reports, however, suggest that cognitive impairment in elderly schizophrenia patients is seldom due to Alzheimer-type pathology, indicating that more detailed follow-up studies are needed. Since multiple epidemiological studies show that Alzheimer's disease is less prevalent in patients with medical conditions requiring anti-inflammatory drugs than in the general population, anti-inflammatory medication might be considered as an adjuvant to chronic neuroleptic treatment in elderly schizophrenia patients showing early signs of Alzheimer-type memory deficits.

Spect imaging of cognitive decline in elderly schizophrenia

Spect imaging of cognitive decline in elderly schizophrenia

A topographical study of senile plaques and neurofibrillary tangles in the hippocampi of patients with Alzheimer's disease and cognitively impaired patients with schizophrenia

Neuropsychological testing of elderly schizophrenia patients reveals that a significant portion of this population exhibit varying degress of cognitive impairment. Since Alzheimer's disease is the most common cause of dementia in geriatric patients, we investigated whether the cognitive decline observed in schizophrenia is the result of degenerative changes analogous to those characteristic of Alzheimer's disease. For this purpose, the number and distribution of senile plaques and neurofibrillary tangles were mapped in the hippocampi of 10 cognitively impaired schizophrenia patients, 10 patients with Alzheimer's diseas, and 10 patients with dementia not attributed to either schizophrenia or Alzheimer's disease. In Alzheimer's disease, degenerative changes invariably predominated in the CA1 subfield, subiculum, and proisocortex. By contrast, findings characteristic of Alzheimer's disease were virtually never observed in the hippocampi of schizophrenic and other cognitively impaired patients. In some patients with Alzheimer's disease, the presence of senile plaques in the molecular layer of the dentate gyrus suggested the existence of an underlying entorhinal cortex lesion. Similar dentate gyrus pathology was never found in any of the other patients. The authors conclude that cognitive impairment in schizophrenia is not the result of degenerative changes analogous to those found in Alzheimer's disease.

Schizophrenia in late life: elderly patients admitted to an acute care psychiatric hospital.

Although a considerable body of biological and clinical data has been accumulated on the mood disorders and organic disorders of late life, only a handful of studies have focused on aging schizophrenia patients. Using the results of a comprehensive evaluation of all elderly patients admitted over a 30-month period to a 26-bed acute care geriatric unit, we compared the demographic, social, and clinical characteristics of schizophrenia patients, patients with recurrent major depression with and without psychotic features, and patients with primary degenerative dementia of the Alzheimer's type with and without delusions. The main findings of this study are that elderly schizophrenia patients were younger, more often African-American, more often single, and poorer than the other groups. A concomitant history of substance abuse and institutionalization as an outcome were more frequent among schizophrenia patients. Like the older depressed and demented patients, schizophrenia patients were predominantly female and commonly presented with several medical disorders. The potential significance of these findings is discussed in the context of the literature on the long-term outcome of schizophrenia.