Background: Controversy exists about the clinical, cognitive, and functional characteristics of older patients with schizophrenia. Whereas some recent investigations, especially those including chronically hospitalized patients, have found a high prevalence of dementia in older schizophrenia patients, several longitudinal follow-up studies have provided evidence that marked cognitive and functional deterioration is uncommon in elderly patients. Methods: The authors studied a group of 74 community-dwelling elderly patients (age 60–85) with early onset (<age 45) schizophrenia or schizoaffective disorders and compared them to 92 healthy elderly individuals and 118 younger (age 40–59) patients with early onset schizophrenia or schizoaffective disorders. Comparisons were made on demographic, clinical, functional, and broad cognitive measures using standardized instruments. Results: For all clinical, cognitive, and functional variables, both older and younger patient groups were impaired relative to the healthy elderly subjects. Older patients were similar to younger patients in age of onset of illness, highest and longest occupation, marital status, living situation, neuroleptic and anticholinergic medication status, anticholinergic dose, depressive symptoms, extrapyramidal symptoms, quality of life, and daily functioning. Older patients, however, had less severe overall symptomatology and were on lower daily doses of neuroleptics. In addition, negative symptoms were more prominent (or equivalent) in the older group, and positive symptoms were less prominent (or equivalent) in the older group, depending on the measure used. The older group scored more poorly than the younger group only on severity of dyskinesia and on two measures of global cognitive function, although the mean scores did not reach levels associated with dementia. Comment: This cross-sectional study revealed that older community-dwelling patients with schizophrenia or schizoaffective disorder were impaired relative to healthy elderly individuals on many clinical, cognitive, and functional variables but were generally quite similar to younger patients in the degree of impairment. Where differences did exist between younger and older patient groups, the older patients tended to have a more favorable clinical profile but slightly greater levels of cognitive impairment. These findings support a stable or even somewhat favorable long-term course of schizophrenia in old age. P20