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Psychiatric Quarterly

, Volume 83, Issue 2, pp 127–144 | Cite as

Is There Evidence for Late Cognitive Decline in Chronic Schizophrenia?

  • Jharna N. Shah
  • Salah U. Qureshi
  • Ali Jawaid
  • Paul E. Schulz
Original Paper

Abstract

Schizophrenia (SZP) has been historically referred to as “dementia praecox” because of the recognition that its onset is associated with deficits in memory, attention and visuospatial orientation. We wondered whether there is evidence for additional cognitive decline late in the course of chronic SZP. This review examined the evidence (1) for cognitive decline late in the course of chronic SZP, (2) for how often the late cognitive decline occurs, and (3) whether the cognitive decline in late-life SZP is related to pathophysiology of SZP versus the superimposition of another type of dementia. A PUBMED search was performed combining the MESH terms schizophrenia and dementia, cognitive decline, cognitive impairment and cognitive deficits. A manual search of article bibliographies was also performed. We included longitudinal clinical studies employing standard tests of cognition. Cross-sectional studies and those that did not test cognition through standard cognitive tests were excluded. The initial search produced 3898 studies. Employing selection criteria yielded twenty-three studies. Our data extraction tool included the number of patients in the study, whether a control group was present, the age of patients at baseline and follow-up, the study setting (inpatients versus outpatients), the cognitive tests employed, study duration, and results. Only three longitudinal studies tested for dementia using Diagnostic and statistical manual of mental disorder (DSM) or International classification of disease (ICD) criteria and compared them to controls: two studies demonstrated an increase in the prevalence of dementia and one did not. Twenty longitudinal studies tested for one or more cognitive domains without employing standard criteria for dementia: twelve studies demonstrated a heterogeneous pattern of cognitive decline and eight did not. Studies generally did not control for known risk factors for cognitive impairment such as education, vascular risk factors, apolipoprotein (ApoE) genotype and family history. The evidence for late cognitive decline in SZP is mixed, but, slightly more studies suggest that it occurs. If it occurs, it is unclear whether it is related to SZP or other risks for cognitive impairment. Hence, prospective, longitudinal, controlled studies are needed to confirm that there is progressive cognitive decline in chronic SZP which occurs independent of other risk factors for cognitive impairment.

Keywords

Schizophrenia Dementia Cognitive decline Cognitive impairment Cognitive deficits 

Notes

Conflict of interest

None.

References

  1. 1.
    Schizophrenia-U.S. Department of Health and Human Services, National Institutes of Health National Institute of Mental Health NIH Publication No. 09-3517 Revised 2009Google Scholar
  2. 2.
    Barbato A: Schizophrenia and Public health. Nations for Mental Health. WHO/MSA/NAM/97.6, 1998Google Scholar
  3. 3.
    Asarnow RF: Neurocognitive impairments in schizophrenia: A piece of the epigenetic puzzle. European Child & Adolescent Psychiatry 8(Suppl 1):I5–8, 1999PubMedCrossRefGoogle Scholar
  4. 4.
    Ciompi L: Catamnestic long-term study on the course of life and aging of schizophrenics. Schizophrenia Bulletin 6(4):606–618, 1980PubMedGoogle Scholar
  5. 5.
    de Vries PJ, Honer WG, Kemp PM et al.: Dementia as a complication of schizophrenia. Journal of Neurology, Neurosurgery & Psychiatry 70(5):588–596, 2001PubMedCrossRefGoogle Scholar
  6. 6.
    Banaschewski T, Schulz E, Martin M, Remschmidt H: Cognitive functions and psychopathological symptoms in early-onset schizophrenia. European Child & Adolescent Psychiatry 9(1):11–20, 2000PubMedCrossRefGoogle Scholar
  7. 7.
    Kørner A, Lopez AG, Lauritzen L et al.: Late and very-late first-contact schizophrenia and the risk of dementia—a nationwide register based study. International Journal of Geriatric Psychiatry 24:61–67, 2009PubMedCrossRefGoogle Scholar
  8. 8.
    Brodaty H, Sachdev P, Koschera A, et al.: Long-term outcome of late-onset schizophrenia: 5-year follow-up study. The British Journal of Psychiatry 183:213–219, 2003PubMedCrossRefGoogle Scholar
  9. 9.
    Rabins PV, Lavrisha M: Long-term follow-up and phenomenologic differences distinguish among late-onset schizophrenia, late-life depression, and progressive dementia. American Journal of Geriatric Psychiatry 11:6, 2003.Google Scholar
  10. 10.
    Goldberg TE, Hyde TM, Kleinman JE, et al.: Course of schizophrenia: neuropsychological evidence for a static encephalopathy. Schizophrenia Bulletin 19:797–804, 1993PubMedGoogle Scholar
  11. 11.
    Lieberman JA: Is schizophrenia a neurodegenerative disorder? A clinical and neurobiological perspective. Biological Psychiatry 46(6):729–739, 1999PubMedCrossRefGoogle Scholar
  12. 12.
    Farmer ME, Kittner SJ, Rae DS, et al.: Education and change in cognitive function. The Epidemiologic Catchment Area Study. Annals of Epidemiology 5:1–7, 1995PubMedCrossRefGoogle Scholar
  13. 13.
    Corral M, Rodríguez M, Amenedo E et al. Cognitive reserve, age, and neuropsychological performance in healthy participants. Developmental Neuropsychology 29(3):479–491, 2006PubMedCrossRefGoogle Scholar
  14. 14.
    Cohn T, Prud’homme D, Streiner D et al.: Characterizing coronary heart disease risk in chronic schizophrenia: High prevalence of the metabolic syndrome. Canadian Journal of Psychiatry 49(11):753–660, 2004PubMedGoogle Scholar
  15. 15.
    Stahl SM, Mignon L, Meyer JM: Which comes first: Atypical antipsychotic treatment or cardioembolic risk? Acta Psychiatrica Scandinavica. 119(3):171–179, 2009PubMedCrossRefGoogle Scholar
  16. 16.
    Lin HC, Hsiao FH, Pfeiffer S, et al.: An increased risk of stroke among young schizophrenia patients. Schizophrenia Research 101(1–3):234–241, 2008PubMedCrossRefGoogle Scholar
  17. 17.
    Malaspina D, Goetz RR, Friedman JH, et al.: Traumatic brain injury and schizophrenia in members of schizophrenia and bipolar disorder pedigrees. The American Journal of Psychiatry 158:440–446, 2001PubMedCrossRefGoogle Scholar
  18. 18.
    Dean B, Laws SM, Hone E, et al.: Increased levels of apolipoprotein E in the frontal cortex of subjects with schizophrenia. Biological Psychiatry 54(6):616–622, 2003PubMedCrossRefGoogle Scholar
  19. 19.
    Schürhoff F, Krebs MO, Szöke A, et al.: Apolipoprotein E in schizophrenia: A French association study and meta-analysis. American Journal of Medical Genetics B: Neuropsychiatric Genetics 119B (1):18–23, 2003PubMedCrossRefGoogle Scholar
  20. 20.
    Hata T, Kunugi H, Nanko S, et al.: Possible effect of the APOE epsilon 4 allele on the hippocampal volume and asymmetry in schizophrenia. American Journal of Medical Genetics 114(6):641–642, 2002PubMedCrossRefGoogle Scholar
  21. 21.
    Jeste DV, Gladsjo JA, Lindamer LA, et al.: Medical comorbidities in Schizophrenia. Schizophrenia Bulletin 22(3):413–430, 1996PubMedCrossRefGoogle Scholar
  22. 22.
    Niizato K, Genda K, Nakamura R, et al.: Cognitive decline in schizophrenics with AD a mini-review of neuropsychological and neuropathological studies. Progress in Neuro-Psychopharmacology & Biological Psychiatry 25:1359–1366, 2001CrossRefGoogle Scholar
  23. 23.
    Ortakov V, Mancevski B, Keilp J, et al.: Application of cognitive scales to medical records of schizophrenia inpatients. Schizophrenia Research 35(2):131–140, 1999PubMedCrossRefGoogle Scholar
  24. 24.
    CERAD: CERAD 1986–1996, Documentation and Data. Archive Rev 1.0, March 1996. Durham, NC, 1996Google Scholar
  25. 25.
    Friedman JI, Harvey PD, Coleman T, et al.: Six-year follow-up study of cognitive and functional status across the lifespan in schizophrenia: A comparison with Alzheimer’s disease and normal aging. The American Journal of Psychiatry 158(9):1441–1448, 2001PubMedCrossRefGoogle Scholar
  26. 26.
    Raven JC: Standard Progressive Matrices. London, Lewis, 1958aGoogle Scholar
  27. 27.
    Raven JC: The Mill Hill Vocabulary Scale. London, Lewis, 1958bGoogle Scholar
  28. 28.
    Morrison G, O’Carroll R, McCreadie R: Long-term course of cognitive impairment in schizophrenia. The British Journal of Psychiatry 189:556–557, 2006PubMedCrossRefGoogle Scholar
  29. 29.
    Waddington JL, Youssef HA: Cognitive dysfunction in chronic schizophrenia followed prospectively over 10 years and its longitudinal relationship to the emergence of tardive dyskinesia. Psychological Medicine 26(4):681–688, 1996PubMedCrossRefGoogle Scholar
  30. 30.
    Harvey PD, Silverman JM, Mohs RC, et al.: Cognitive decline in late-life schizophrenia: A longitudinal study of geriatric chronically hospitalized patients. Biological Psychiatry 45(1):32–40, 1999PubMedCrossRefGoogle Scholar
  31. 31.
    Harvey PD, Parrella M, White L, et al.: Convergence of cognitive and adaptive decline in late-life schizophrenia. Schizophrenia Research 35(1):77–84, 1999PubMedCrossRefGoogle Scholar
  32. 32.
    Friedman JI, Harvey PD, McGurk SR, et al.: Correlates of change in functional status of institutionalized geriatric schizophrenic patients: Focus on medical comorbidity. The American Journal of Psychiatry 159(8):1388–1394, 2002PubMedCrossRefGoogle Scholar
  33. 33.
    Harvey PD, Bertisch H, Friedman JI, et al.: The course of functional decline in geriatric patients with schizophrenia: Cognitive-functional and clinical symptoms as determinants of change. American Journal of Geriatric Psychiatry 11(6):610–619, 2003PubMedGoogle Scholar
  34. 34.
    Meagher DJ, Quinn JF, Bourke S, et al.: Longitudinal assessment of psychopathological domains over late-stage schizophrenia in relation to duration of initially untreated psychosis: 3-year prospective study in a long-term inpatient population. Psychiatry Research 126(3):217–227, 2004PubMedCrossRefGoogle Scholar
  35. 35.
    Chemerinski E, Reichenberg A, Kirkpatrick B, et al.: Three dimensions of clinical symptoms in elderly patients with schizophrenia: prediction of six-year cognitive and functional status. Schizophrenia Research 85(1–3):12–19, 2006PubMedCrossRefGoogle Scholar
  36. 36.
    White L, Friedman JI, Bowie CR, et al.: Long-term outcomes in chronically hospitalized geriatric patients with schizophrenia: Retrospective comparison of first generation and second generation antipsychotics. Schizophrenia Research 88(1–3):127–134, 2006PubMedCrossRefGoogle Scholar
  37. 37.
    Nayak Savla G, Moore DJ, Roesch SC, et al.: An evaluation of longitudinal neurocognitive performance among middle-aged and older schizophrenia patients: Use of mixed-model analyses. Schizophrenia Research 83(2–3):215–223, 2006PubMedCrossRefGoogle Scholar
  38. 38.
    Harvey PD, White L, Parrella M, et al.: The longitudinal stability of cognitive impairment in schizophrenia. Mini-mental state scores at one- and two-year follow-ups in geriatric in-patients. The British Journal of Psychiatry 166(5):630–633, 1995PubMedCrossRefGoogle Scholar
  39. 39.
    Harvey PD, Lombardi J, Leibman M, et al.: Cognitive impairment and negative symptoms in geriatric chronic schizophrenic patients: A follow-up study. Schizophrenia Research 22(3):223–231, 1996PubMedCrossRefGoogle Scholar
  40. 40.
    Harvey PD, Lombardi J, Leibman M, et al.: Performance of chronic schizophrenia patients on cognitive neuropsychological measures sensitive to dementia. International Journal of Geriatric Psychiatry 11:621–627, 1996CrossRefGoogle Scholar
  41. 41.
    McGurk SR, Moriarty PJ, Harvey PD, et al.: The longitudinal relationship of clinical symptoms, cognitive functioning, and adaptive life in geriatric schizophrenia. Schizophrenia Research 42(1):47–55, 2000PubMedCrossRefGoogle Scholar
  42. 42.
    Laks J, Fontenelle LF, Chalita A, et al.: Absence of dementia in late-onset schizophrenia: A one year follow-up of a Brazilian case series. Arq Neuropsiquiatr 64(4):946–949, 2006PubMedCrossRefGoogle Scholar
  43. 43.
    Heaton RK, Gladsjo JA, Palmer BW, et al.: Stability and course of neuropsychological deficits in schizophrenia. Archives of General Psychiatry 58(1):24–32, 2001PubMedCrossRefGoogle Scholar
  44. 44.
    Palmer BW, Bondi MW, Twamley EW, et al.: Are late-onset schizophrenia spectrum disorders neurodegenerative conditions? Annual rates of change on two dementia measures. The Journal of Neuropsychiatry and Clinical Neurosciences 15(1):45–52, 2003PubMedCrossRefGoogle Scholar
  45. 45.
    Lewis R: Should cognitive deficit be a diagnostic criterion for schizophrenia? Journal of Psychiatry & Neuroscience 29(2):102–113, 2004PubMedGoogle Scholar
  46. 46.
    Waddington JL, Youssef HA, Dolphin C, et al.: Cognitive dysfunction, negative symptoms and tardive dyskinesia in schizophrenia. Archives of General Psychiatry 44(10):907–912, 1987PubMedCrossRefGoogle Scholar
  47. 47.
    Liddle PF, Crow TJ.: Age disorientation in chronic schizophrenia is associated with global intellectual impairment. The British Journal of Psychiatry 144:193–199, 1984PubMedCrossRefGoogle Scholar
  48. 48.
    Spohn HE, Strauss ME: Relation of neuroleptic and anticholinergic medication to cognitive functions in schizophrenia. Journal of Abnormal Psychology 98(4):367–380, 1989PubMedCrossRefGoogle Scholar
  49. 49.
    Goldberg TE, Weinberger DR: Effects of neuroleptic medications on the cognition of patients with schizophrenia: A review of recent studies. Journal of Clinical Psychiatry 57(Suppl 9):62–65, 1996PubMedGoogle Scholar
  50. 50.
    Galderisi S, Davidson M, Kahn RS, et al.: Correlates of cognitive impairment in first episode schizophrenia: The EUFEST study. Schizophrenia Research, 2009Google Scholar
  51. 51.
    Chen EY, Lam LC, Chen RY, et al.: Negative symptoms, neurological signs and neuropsychological impairments in 204 Hong Kong Chinese patients with schizophrenia. The British Journal of Psychiatry 168:227–233, 1996PubMedCrossRefGoogle Scholar
  52. 52.
    Norman RM, Malla AK, Morrison-Stewart SL, et al.: Neuropsychological correlates of syndromes in schizophrenia. The British Journal of Psychiatry 170:134–139, 1997PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Jharna N. Shah
    • 1
  • Salah U. Qureshi
    • 2
    • 3
  • Ali Jawaid
    • 4
  • Paul E. Schulz
    • 5
  1. 1.Department of NeurologyBaylor College of MedicineHoustonUSA
  2. 2.Menninger Department of Psychiatry & Behavioral SciencesBaylor College of MedicineHoustonUSA
  3. 3.Health Services Research and Development CoE, Michael E. DeBakey VA Medical CenterHoustonUSA
  4. 4.Institute of NeuropathologyUniversity Hospital ZurichZurichSwitzerland
  5. 5.Department of NeurologyThe University of Texas Health Science Center at Houston, Medical SchoolHoustonUSA

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