Elderly Schizophrenic Patients Research Articles

Study on clinical characteristics of event-related potential P300 in elderly schizophrenics and associated risk factors.

To investigate the clinical characteristics of event-related potential P300 in elderly schizophrenics with different levels of violence and the risk factors of severe violence. A total of 138 elderly schizophrenic patients from January 2020 to December 2021 in the First Hospital of Hebei Medical University were enrolled in this retrospective analysis. Based on the violence risk assessment, 61, 102, and 145 patients were divided into high-risk, medium-risk, and low-risk groups, respectively. Clinical characteristics, P300 latency, and P300 amplitude were compared among the three groups followed by a logistic regression analysis of elderly schizophrenics with severe violence. The latency of P300 in the high-risk group was higher than that in the low-risk group (p<.05). The P300 amplitude of patients in the high-risk group was significantly lower than that in the low-risk group (p<.05). Univariate logistic regression analysis showed that previous history of violence, delusion of persecution, P300 latency, and amplitude were independent influencing factors of severe violence in elderly schizophrenics (odds ratio [OR]: 0.022, 95% confidence interval [CI]: 0.007-0.067, p<.001; OR: 0.118, 95% CI: 0.043-1.763, p=.037; OR: 1.289, 95% CI: 1.142-1.673, p<.001; and OR: 0.049, 95% CI: 0.021-0.067, p<0.001, respectively). After adjusting gender, age, and other confounding factors, multivariate logistic regression analysis showed that delusion of persecution, P300 latency, and P300 amplitude were associated with severe violence in elderly schizophrenics (OR: 2.211, 95% CI: 0.061-4.067, p<.001; OR: 2.006, 95% CI: 1.421-2.721, p=.017; and OR: 0.067, 95% CI: 0.037-0.276; p<.001; respectively). The latency and amplitude of P300 can be used as effective neuroelectrophysiological indicators to evaluate the violence level of elderly schizophrenics. Delusion of persecution, P300 latency, and P300 amplitude were independent influencing factors of severe violence in elderly schizophrenics.

Community-based psychosocial rehabilitation model for people with schizophrenia

Schizophrenia is a mental disorder that triggers the occurrence of impaired function in the human brain, behavior, cognitive, and emotional functions. This disorder has become a problem in the study of mental health, which must be treated comprehensively by using empirical treatment combined with rehabilitation. Hopefully, increasing the maximum level of healing and reducing recurrence rates can improve social function and quality of life. Thus, this review aims to narrate the model and effective community-based psychosocial rehabilitation center. The articles of the studies published from 2017-2021 were collected and analyzed in this literature review. The keywords used were community-based rehabilitation for schizophrenia. The results show that in addition to pharmacological therapy, six community-based psychosocial non-pharmacological therapy methods are considered effective for intervention in patients with schizophrenia. The methods are club methods in elderly schizophrenic patients, community-based methods, direct patient decision-making methods, case and club management methods, psychoeducational and social skills methods, and community care unit methods. All of the above methods analyzed showed significant effectiveness in community-based psychosocial rehabilitation treatment in developing countries.

Evaluation of Abnormal Movements among Senior Schizophrenics: A Local Study with Reference to Tardive Dyskinesia

Introduction: Tardive dyskinesia (TD) includes involuntary choreiform or athetoid movements of the jaw, lower face, tongue, and extremities, developing in association with the use of an antipsychotic medication, and may develop in about 20 to 40 percent of patients who require long-lasting hospitalization. In the present study, the prevalence of this condition has been measured among an elderly group of schizophrenic patients. Methods: One hundred and one elderly schizophrenic patients, who were hospitalized in the chronic section of a community psychiatric hospital, were selected for the present cross-sectional study. Abnormal Involuntary Movement Scale (AIMS) was employed to screen for patients with schizophrenia who also had TD. Scale for Assessment of Positive Symptoms, Scale for Assessment of Negative Symptoms, Schedule for Assessment of Insight, and Clinical Global Impressions – Severity of illness, as well, had been used as ancillary scales for evaluation of severity of general psychopathology of schizophrenia, and comparing the TD patients with the group of patients without TD, for probing the intervening parameters. Results: While abnormal movements were clear in 38.61% (n=39) of elderly schizophrenic patients, only seven of them (6.93 %) could be diagnosed as TD, based on the above-mentioned criteria. All of them were using conventional antipsychotic medications, accompanied with anticholinergic medications. Among TD patients, three cases had only abnormal facial and oral movements, one patient had atypical facial and oral movements as well as anomalous extremity movements, one patient had irregular facial and oral movements in addition to unusual trunk movements, and lastly, two patients had nonstandard extremity movements. In addition, around 71% of patients with TD were aware of their unusual movements. Between-group analysis did not show any significant difference between patients with TD and patients without TD in age, duration of illness, positive symptoms, negative symptoms, insight, and general psychopathology. Conclusion: According to the findings of the present study, the prevalence of Tardive Dyskinesia among elderly schizophrenic patients, who were using typical antipsychotic medications, is very lower than what has been indicated thus far.

APOE E4 is associated with hyperlipidemia and obesity in elderly schizophrenic patients

Obesity is a critical issue in patients with schizophrenia, which is considered to be brought about by both environmental and genetic factors. Apolipoprotein E (APOE) gene polymorphisms might be involved in the pathogenesis of schizophrenia, however, the effect of APOE gene polymorphism on obesity has never been investigated in Chinese aging with schizophrenia. This cross-sectional study was to investigate the effect of obesity on cognitive and psychiatric symptoms in elderly participants with schizophrenia. At the same time, we also discussed the inner link between APOE E4 and obesity. 301 elderly participants with schizophrenia and 156 normal controls were included in the study. Their cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), psychiatric symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS), and APOE gene polymorphism was determined by polymerase chain reaction (PCR). The prevalence of obesity in elderly schizophrenic patients and healthy controls accounted for 15.9% (48/301) and 10.3% (16/156), respectively, with no statistically significant difference. By using stepwise linear regression analysis, we found that elevated fasting blood glucose, hypertension, and hyperlipidemia were risk factors for obesity in elderly schizophrenic patients. Although there was no direct correlation between APOE E4 and obesity in patients with schizophrenia, it was significantly correlated with hyperlipemia(r = − 0.154, p = 0.008), suggesting that APOE E4 may induce obesity in elderly patients with schizophrenia through hyperlipemia, However, the above conclusions do not apply to the normal elderly. What’s more, we did not find a link between obesity and cognitive function or mental symptoms for both patients with schizophrenia and normal controls. APOE E4 is associated with hyperlipidemia in elderly schizophrenic patients, which may be a risk factor for obesity, however, the above conclusion does not apply to the normal elderly.

Medical Comorbidity in Elderly Schizophrenic Patients: A Preliminary Study in Iran

Background: While comorbidity between mental disorders and physical illnesses is the rule rather than an exception, appraising the impact of comorbidity is challenging due to lack of consensus about how to define and measure the concept of comorbidity. Objective: The aim of the present evaluation was to appraise the prevalence and features of medical comorbidities among a group of native elderly schizophrenic patients. Methods: Geriatric unit of Razi psychiatric hospital was selected as the field of investigation and 168 elderly schizophrenic patients (≥65 years old), including 101 males and 67 females, who have been hospitalized there as chronic cases, were chosen as an accessible sample, and were surveyed with respect to existing comorbid medical disorders. Psychiatric diagnosis was based on ‘Diagnostic and Statistical Manual of Mental Disorders’, 5th edition (DSM-5), and the medical diagnosis was based on ‘International Classification of Diseases’, 10th edition. Results: As shown by the results, 89% (n=151) of elderly schizophrenic patients had some kind of registered physical co-morbidity, which was more significant than the frequency of medical comorbidities among native senior citizens. Amongst the listed co-morbidities, falls, hypertension and osteoarthritis were the most prevalent comorbidities with a frequency of around 48.8%, 44.6% and 39.2%, respectively. Hypertension, renal disease and malnutrition were significantly more prevalent among male patients (p&lt;0.0000, p&lt;0.0045 and p&lt; 0.0018, respectively) and hyponatremia, aspiration/ asphyxiation and seizure were meaningfully more prevalent among female patients (p&lt;0.0075, p&lt;0.0000 and p&lt;0.0009, respectively). As stated by the findings and in comparison with the native seniors, while diabetes, renal diseases and malnutrition were significantly more frequent, coronary artery disease, gastrointestinal disorder and osteoarthritis were significantly less frequent in the existing sample of elderly schizophrenic patients. Conclusion: In comparison with the native senior people, the rate of medical comorbidities, particularly diabetes, renal diseases and malnutrition, was significantly higher in elderly schizophrenic patients, a significant difference, was observed regarding physical comorbidities between male and female patients, which demands further methodical and gender-based studies for defining more appropriate care.

Clinical Profile of Mortality among Chronic Schizophrenic Patients: A Local Pilot Survey in Iran

Background: Many scholars believe that mental disorders may increase the risk of mortality among psychiatric patients in comparison with ordinary people. Unfortunately, since there is no systematic psychiatric case register system in Iran, a precise study of the rate of mortality of psychiatric patients in Iran is not easy. Objective: The objective of the current study included estimation of the rate of mortality and clinical profile of the died patients in a group of non-western aged schizophrenic patients. Methods: Senior section of Razi psychiatric hospital was selected as the specific field of investigation, and all elderly schizophrenic patients (≥65 years old), who had been hospitalized there, were nominated as the accessible sample and estimated with respect to the objectives of the present assessment. For survey, all deaths in the said district, which had occurred throughout the last sixty months (April of 2014-August 2019), had been listed by the supervisor of the mortality committee of the hospital. The clinical diagnosis was based on ‘Diagnostic and Statistical Manual of Mental Disorders’, 5th edition, criteria. Results: Among 840 chronic elderly schizophrenic patients, 69 deaths were registered by the mortality committee of the hospital. As evident by the results, the annual rate of mortality among elderly schizophrenic patients in the present assessment was around 0.015 (0.15 per 1,000 individuals per year) and 0.017 (0.17 per 1,000 individuals per year) among male and female aged patients, respectively, which was significantly lower than the native crude death rate. While the average age of the expired female patients was significantly longer than male cases, the life expectancy of both male and female patients was significantly shorter than the life expectancy of native people. Besides, while among the present sample of old schizophrenics cardiac disease was the main leading cause of death, other causes, like violence, suicide, road traffic accidents, falls, fires, drug use, tuberculosis, drowning, epilepsy, and Parkinson’s disease were not liable at all. Conclusion: While the rate of mortality among aged schizophrenics was significantly lower than the native crude death rate, the age of the expired female patients was significantly longer than the male cases and the life expectancy of both male and female patients was significantly shorter than the life expectancy of native people. Cardiac disorder was the leading cause of death among the present sample of aged schizophrenics.

Clinicopathological investigation of the background of cognitive decline in elderly schizophrenia.

We have often observed dementia symptoms or severe neurocognitive decline in the long-term course of schizophrenia. While there are epidemiological reports that patients with schizophrenia are at an increased risk of developing dementia, there are also neuropathological reports that the prevalence of Alzheimer's disease (AD) in schizophrenia is similar to that in normal controls. It is difficult to distinguish, based solely on the clinical symptoms, whether the remarkable dementia symptoms and cognitive decline seen in elderly schizophrenia are due to the course of the disease itself or a concomitant neurocognitive disease. Neuropathological observation is needed for discrimination. We conducted a neuropathological search on three cases of schizophrenia that developed cognitive decline or dementia symptoms after a long illness course of schizophrenia. The clinical symptoms of total disease course were confirmed retrospectively in the medical record. We have evaluated neuropathological diagnosis based on not only Hematoxylin-Eosin and Klüver-Barrera staining specimens but also immunohistochemical stained specimens including tau, β-amyloid, pTDP-43 and α-synuclein protein throughout clinicopathological conference with multiple neuropathologists and psychiatrists. The three cases showed no significant pathological findings or preclinical degenerative findings, and poor findings consistent with symptoms of dementia were noted. Although the biological background of dementia symptoms in elderly schizophrenic patients is still unclear, regarding the brain capacity/cognitive reserve ability, preclinical neurodegeneration changes in combination with certain brain vulnerabilities due to schizophrenia itself are thought to induce dementia syndrome and severe cognitive decline.

The Clinical Profile of Death Among Aged Iranian Schizophrenic Patients: A Local Pilot Evaluation

Comorbidity between mental disorders and physical illnesses is the rule rather than the exception. Approaches to study the impact of comorbidity become challenging also due to lack of consensus about how to define and measure the concept of comorbidity. The aim of the present study was to evaluate the clinical profile of medical comorbidity among a group of local chronic elderly schizophrenic patients to see their prevalence and physiognomies.

Incidence and Clinical Outline of Medical Comorbidities Among Old Schizophrenic Patients: An Initial Local Review

Comorbidity between mental disorders and physical illnesses is the rule rather than the exception. Approaches to study the impact of comorbidity become challenging also due to lack of consensus about how to define and measure the concept of comorbidity. The aim of the present study was to evaluate the clinical profile of medical comorbidity among a group of local chronic elderly schizophrenic patients to see their prevalence and physiognomies.

Local Estimation of Rate and Clinical Outline of Mortality in Old Schizophrenics

Introduction: Researchers have consistently reported that people with mental disorders have elevated mortality compared with the general population. In Iran there are not systematic psychiatric case registers that could allow us to study precisely the mortality of psychiatric patients. The aim of the current study was to determine the mortality rate and clinical profile of death in a group of non-western chronic elderly schizophrenic patients. Methods: chronic geriatric subdivision of Razi Psychiatric hospital with a capacity around 220 beds (110 for each of male and female elderly patients) had been selected as the specific arena of investigation. For the present retrospective survey, all recorded deceases during the last sixty months (April of 2014-August 2019) in the said senior wards had been included in the current study. Clinical diagnosis, too, was essentially based on ‘Diagnostic and Statistical Manual of Mental Disorders’, 5th edition (DSM-5). Results: Among eight-hundreds and frothy chronic elderly schizophrenic patients, sixty-nine deceases had been registered by the mortality committee of the hospital. As said by results, the annual rate of mortality among elderly schizophrenic patients in the present assessment was around 0.015 (0.15 per 1,000 individuals per year) and 0.017 (0.17 per 1,000 individuals per year) among male and female aged patients, respectively, which were significantly lower than current native crude death rate (p&lt;0.000). While the age of the expired female patients was significantly more than the died male schizophrenics (p &lt; 0.001), the life expectancy of both male and female expired patients was significantly shorter than the public’s life expectancy (p&lt; 0.000). Besides, in the present evaluation, while cardiac illness was the main leading cause of death among old schizophrenics, reasons like suicide, falls, drug use or tuberculosis, were not applicable at all. Conclusion: While the rate of mortality among elderly schizophrenics was significantly lower than public’s crude death rate, age of the deceased female patients was significantly longer than the male expired patients and life expectancy of both male and female died patients was significantly lower than native public’s life expectancy. Cardiac disorder, as well, was the main leading cause of death among aged schizophrenic patients.

Clinical Figure and Rate of Mortality Among Chronic Schizophrenics: A Local Assessment

Introduction: Researchers have consistently reported that people with mental disorders have elevated mortality compared with the general population. In Iran there are not systematic psychiatric case registers that could allow us to study precisely the mortality of psychiatric patients. The aim of the current study was to determine the mortality rate and clinical profile of death in a group of non-western chronic elderly schizophrenic patients. Methods: chronic geriatric subdivision of Razi Psychiatric hospital with a capacity around 220 beds (110 for each of male and female elderly patients) had been selected as the specific arena of investigation. For the present retrospective survey, all recorded deceases during the last sixty months (April of 2014-August 2019) in the said senior wards had been included in the current study. Clinical diagnosis, too, was essentially based on ‘Diagnostic and Statistical Manual of Mental Disorders’, 5th edition (DSM-5). Results: Among eight-hundreds and frothy chronic elderly schizophrenic patients, sixty-nine deceases had been registered by the mortality committee of the hospital. As said by results, the annual rate of mortality among elderly schizophrenic patients in the present assessment was around 0.015 (0.15 per 1,000 individuals per year) and 0.017 (0.17 per 1,000 individuals per year) among male and female aged patients, respectively, which were significantly lower than current native crude death rate (p&lt;0.000). While the age of the expired female patients was significantly more than the died male schizophrenics (p &lt; 0.001), the life expectancy of both male and female expired patients was significantly shorter than the public’s life expectancy (p&lt; 0.000). Besides, in the present evaluation, while cardiac illness was the main leading cause of death among old schizophrenics, reasons like suicide, falls, drug use or tuberculosis, were not applicable at all. Conclusion: While the rate of mortality among elderly schizophrenics was significantly lower than public’s crude death rate, age of the deceased female patients was significantly longer than the male expired patients and life expectancy of both male and female died patients was significantly lower than native public’s life expectancy. Cardiac disorder, as well, was the main leading cause of death among aged schizophrenic patients.

Paroxetine combined with olanzapine in the treatment of schizophrenia.

Objective:To investigate the clinical efficacy of paroxetine combined with olanzapine in the treatment of senile schizophrenia with depression.Methods:Eighty-four elderly schizophrenic patients with depression who were admitted to our hospital from August 2016 to February 2018 were selected as research subjects and randomly divided into observation group and control group using random number table, 42 cases in each group. The control group was treated with olanzapine orally, while the observation group was treated with olanzapine and paroxetine orally. The level of homocysteine (Hcy) in the two groups was analyzed before and after treatment. The efficacy was evaluated by the Positive and Negative Symptoms Scale (PANSS) score and Hamilton Depression Scale (HAMD) score. The adverse reactions of the two groups were compared.Results:After treatment, the level of serum Hcy in the observation group was significantly lower than that in the control group (P<0.05), and it was close to the normal level. There was no significant difference in PANSS score between the two groups before treatment (P>0.05). After treatment, the negative factor score and PANSS score in the observation group were significantly lower than those in the control group, and the differences were statistically significant (P<0.05). The HAMD score of the two groups had no significant difference before treatment (P>0.05). After treatment, the HAMD score of the observation group was significantly lower than that of the control group (P<0.05). The difference of incidence of adverse reactions between the two groups had no statistical significance (P>0.05).Conclusion:Paroxetine combined with olanzapine has a definite clinical effect in the treatment of senile schizophrenia with depression. It can effectively reduce the level of serum Hcy, relieve the symptoms of schizophrenia, and alleviate the depressive symptoms of patients, with high safety. It is worth promoting.

Osteopenia and the physical function in Japanese patients with schizophrenia

SummaryWe evaluated the state of osteopenia and the physical function in 121 schizophrenic patients. These factors were worse in the inpatient group than in the outpatient group. The age, sex, body mass index (BMI), and physical function were correlated to the state of osteopenia. Physicians should consider the risk of osteopenia in elderly female psychiatric patients with low BMI.PurposeInformation about the actual state of osteopenia in patients with schizophrenia is limited. In the present study, we evaluated the factors related to osteopenia and patient’s physical function and compared these factors between inpatients and outpatients.MethodsA total of 121 schizophrenic patients were included in the present study. We divided the patients into two groups according to the therapeutic form. We collected data on their age, sex, body mass index (BMI), bone mineral density (BMD) in the lumbar spine and proximal femur, serum bone metabolic markers, risk of fracture, and physical function.ResultsThe number of fractured vertebrae, risk of fracture, serum concentration of tartrate-resistant acid phosphatase 5b (TRACP-5b), and score of locomo25 were significantly higher and the BMI and BMD in the lumbar spine and proximal femur significantly lower in the inpatient group than in the outpatient group. A multiple regression analysis showed that the age, sex, BMI, the number of fractured vertebrae, and score of locomo 25 were correlated with the BMD in the lumbar spine and proximal femur. Neither the therapeutic form nor any bone metabolic markers were correlated with the BMD. The inpatient group had a lower average BMI, BMD, and physical function than the outpatient group. However, a multiple regression analysis showed that the therapeutic form was not correlated with the BMD.ConclusionThese findings suggest that physicians should consider elderly female schizophrenic patients with a low BMI to be at risk of developing osteopenia.

P.3.b.031 - Elderly schizophrenic patients – clinical and social correlations

P.3.b.031 - Elderly schizophrenic patients – clinical and social correlations

Schizophrénie et vieillissement

Despite a progressive increase in mean lifespan of people suffering from schizophrenia, there is a need to improve the care of elderly schizophrenic patients, to offer adapted nursing homes, and to improve prevention and early detection of somatic diseases, in particular regarding primary care access. Schizophrenia is still associated with a rate of premature mortality that is two to three times higher than that in the general population. Suicide is the leading cause of premature death in patients with schizophrenia, but there is also an over mortality caused by natural death, especially due to cardiovascular diseases and cancer. Nevertheless, there have been few studies of clinical and functional characteristics of older schizophrenic patients. This gap in knowledge must be filled in order to develop the most appropriate alternative structures and best meet this true public health challenge.

Clozapine in Elderly Schizophrenic Patients: Addressing New Behaviors

Introduction: Antipsychotics are widely used in geriatric patients with various psychiatric disorders. A growing number of atypical anti-psychotics are currently available with various side effect profiles. These agents, while expanding clinical options, also raise concern. Many questions about the use of anti-psychotics in older patients remain unanswered by available clinical literature. Among the second generation anti-psychotics, clozapine is often one that is avoided the most due to its adverse side effect profile which includes agranulocytosis, requiring monthly monitoring of cell counts. However, in patients with refractory positive symptoms of schizophrenia, clozapine can be the drug of last resort. Such was the case with one of our patients.

Symptomatic remission and associated factors in a catchment area based population of older patients with schizophrenia

Background Symptomatic remission and its associated factors have been evaluated in several studies of younger schizophrenic patients. Although the number of older individuals with schizophrenia is rapidly growing, evaluations of remission in elderly patients are scarce and limited to samples of convenience, questioning their generalizability to unselected patient populations. Methods We assessed the rate of symptomatic remission in a cohort of older Dutch schizophrenic patients within a psychiatric catchment area. In addition, we examined the association of symptomatic remission with measures of mental health treatment, social functioning, cognition, mood, and quality of life. Results With a rate of 29.4%, symptomatic remission in this catchment area based cohort of older schizophrenic patients (mean age 68 years) was markedly lower than the rates reported for convenience samples. Remission was more frequent in schizoaffective patients, compared to patients with schizophrenia. Remitted patients were more adherent to psychiatric services and scored higher on measures of social functioning. No association with symptomatic remission could be demonstrated for cognition, mood, and quality of life. Conclusion The modest rate of symptomatic remission in this treated sample of elderly schizophrenic patients questions the notion that old age is associated with high levels of symptomatic remission. The concurrent validity of the remission concept in elderly patients merits further investigation, given the limited number of demonstrated associations.

Familles et patient souffrant de schizophrénie : questions liées à l’avancée en âge ?

The management of elderly schizophrenic patients is a medical and a political issue with regard to life expectation. There is a paucity of global research. This matter concerns patients, sanitary and social workers, family, care teams, and also decision makers and elective representatives as they all have to work together. A psychiatric patient remains a psychiatric patient throughout his/her life, he/she does not become a geriatric patient. Assuring a continuity of care, of housing, of financial autonomy and of support in a social network is indispensable. Family and care teams are of capital importance (as in all long-lasting diseases). Training in the management of care is essential. One question: can a schizophrenic patient also be an elderly person?

Clinical differences between late‐onset and early‐onset chronically hospitalized elderly schizophrenic patients in Taiwan

To examine the clinical differences between late-onset schizophrenia (LOS) and early-onset schizophrenia (EOS) in Taiwanese elderly chronic hospitalized schizophrenic patients. By using a cross-sectional study method, we investigated all the hospitalized elderly schizophrenic patients in a general hospital's psychiatric ward during July-September 2007. All the subjects matched DSM-IV-TR diagnostic criteria and were aged 60 years or above. A total of 52 subjects were enrolled (LOS = 23, EOS = 29). Demographic data, illness history, and antipsychotic treatment record were documented; the positive and negative syndrome scale (PANSS), Center for Epidemiological Studies Depression scale (CES-D), mini-mental status examination (MMSE), activities of daily living rating scale for psychiatric patients (ADLRS), community self-sufficiency test (CST), clinical global impression (CGI), and general assessment of functioning scale (GAF) were administered. In our samples, a lower educational level was found to be more common in late-onset patients. In LOS, there was no significant increase in the severity of PANSS psychopathology except for greater thought disorder symptoms. Both LOS and EOS patients had similar cognitive and functioning impairment with poor global outcomes. There was a trend of low antipsychotic drug use in LOS. In Taiwan, elderly chronic inpatients LOS had greater thought disorders compared to findings in Western studies. Further large-scale longitudinal studies are needed to understand the factors related to these findings.

The Neuropsychiatry and Neuropsychology Of Lipoid Proteinosis

The Neuropsychiatry and Neuropsychology Of Lipoid Proteinosis