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Late-Onset Schizophrenia

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Handbook on the Neuropsychology of Aging and Dementia

Part of the book series: Clinical Handbooks in Neuropsychology ((CHNEURO))

Abstract

Given that psychotic symptoms are relatively common in the older adults and can accompany a variety of conditions, correctly identifying the etiology of psychosis in older patients is essential for developing the most effective treatment plan. Here we focus on the identification and management of late-onset schizophrenia and schizophrenia-like psychosis.

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References

  1. Ostling S, Skoog I. Psychotic symptoms and paranoid ideation in a nondemented population-based sample of the very old. Arch Gen Psychiatry. 2002;59(1):53–9.

    Article  Google Scholar 

  2. Champagne LL, et al. Psychosis in geropsychiatric inpatients with and without dementia. Int J Geriatr Psychiatry. 1996;11(6):523–7.

    Article  Google Scholar 

  3. Burke WJ, Roccaforte WH, Wengel SP. Characteristics of elderly patients admitted for the first time to a psychiatric facility. J Geriatr Psychiatry Neurol. 1988;1(3):159–62.

    Article  Google Scholar 

  4. Howard R, Rabins PV, Castle DJ. Late onset schizophrenia. Philadelphia: Wrightson Biomedical; 1999. p. 278.

    Google Scholar 

  5. Bleuler M. Die spatschizophrenen Krankheitsbilder. Fortschr Neurol Psychiatr. 1943;15:259–90.

    Google Scholar 

  6. Roth M, Morrissey JD. Problems in the diagnosis and classification of mental disorder in old age; with a study of case material. J Ment Sci. 1952;98(410):66–80.

    Article  Google Scholar 

  7. Kay DW, Roth M. Environmental and hereditary factors in the schizophrenias of age (“late paraphrenia”) and their bearing on the general problem of causation in schizophrenia. J Ment Sci. 1961;107:649–86.

    Article  Google Scholar 

  8. Howard R, et al. Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus. The International Late-Onset Schizophrenia Group. Am J Psychiatry. 2000;157(2):172–8.

    Article  Google Scholar 

  9. Keith SJ, Regier AM, Rae DS. Schizophrenic disorders. In: Robins LN, Regier DA, editors. Psychiatric disorders in America: the epidemiologic catchment area study. New York: Free Press; 1991. p. 449.

    Google Scholar 

  10. Meesters PD, et al. Schizophrenia spectrum disorders in later life: prevalence and distribution of age at onset and sex in a dutch catchment area. Am J Geriatr Psychiatry. 2012;20(1):18–28.

    Article  Google Scholar 

  11. Harris MJ, Jeste DV. Late-onset schizophrenia: an overview. Schizophr Bull. 1988;14(1):39–55.

    Article  Google Scholar 

  12. Copeland JR, et al. Alzheimer’s disease, other dementias, depression and pseudodementia: prevalence, incidence and three-year outcome in Liverpool. Br J Psychiatry. 1992;161:230–9.

    Article  Google Scholar 

  13. Copeland JR, et al. Schizophrenia and delusional disorder in older age: community prevalence, incidence, comorbidity, and outcome. Schizophr Bull. 1998;24(1):153–61.

    Article  Google Scholar 

  14. Castle DJ, Murray RM. The epidemiology of late-onset schizophrenia. Schizophr Bull. 1993;19(4):691–700.

    Article  Google Scholar 

  15. Holden NL. Late paraphrenia or the paraphrenias? A descriptive study with a 10-year follow-up. Br J Psychiatry. 1987;150:635–9.

    Article  Google Scholar 

  16. van Os J, et al. Increasing age is a risk factor for psychosis in the elderly. Soc Psychiatry Psychiatr Epidemiol. 1995;30(4):161–4.

    Article  Google Scholar 

  17. Cervantes AN, Rabins PV, Slavney PR. Onset of schizophrenia at age 100. Psychosomatics. 2006;47(4):356–9.

    Article  Google Scholar 

  18. Reeves RR, Brister JC. Psychosis in late life: emerging issues. J Psychosoc Nurs Ment Health Serv. 2008;46(11):45–52.

    Article  Google Scholar 

  19. Palmer BW, McClure FS, Jeste DV. Schizophrenia in late life: findings challenge traditional concepts. Harv Rev Psychiatry. 2001;9(2):51–8.

    Article  Google Scholar 

  20. Pearlson GD, et al. A chart review study of late-onset and early-onset schizophrenia. Am J Psychiatry. 1989;146(12):1568–74.

    Article  Google Scholar 

  21. Jeste DV, et al. Clinical and neuropsychological characteristics of patients with late-onset schizophrenia. Am J Psychiatry. 1995;152(5):722–30.

    Article  Google Scholar 

  22. Howard R, et al. A comparative study of 470 cases of early-onset and late-onset schizophrenia. Br J Psychiatry. 1993;163:352–7.

    Article  Google Scholar 

  23. Almeida OP, et al. Psychotic states arising in late life (late paraphrenia) psychopathology and nosology. Br J Psychiatry. 1995;166(2):205–14.

    Article  Google Scholar 

  24. Vahia IV, et al. Is late-onset schizophrenia a subtype of schizophrenia? Acta Psychiatr Scand. 2010;122(5):414–26.

    Article  Google Scholar 

  25. Mason O, Stott J, Sweeting R. Dimensions of positive symptoms in late versus early onset psychosis. Int Psychogeriatr. 2013;25(2):320–7.

    Article  Google Scholar 

  26. Huber G, Gross G, Schuttler R. Late schizophrenia (author’s transl). Arch Psychiatr Nervenkr. 1975;221(1):53–66.

    Article  Google Scholar 

  27. Rabins PV, Lavrisha M. Long-term follow-up and phenomenologic differences distinguish among late-onset schizophrenia, late-life depression, and progressive dementia. Am J Geriatr Psychiatry. 2003;11(6):589–94.

    Article  Google Scholar 

  28. Cooper AF. Deafness and psychiatric illness. Br J Psychiatry. 1976;129:216–26.

    Article  Google Scholar 

  29. Howard R, Almeida O, Levy R. Phenomenology, demography and diagnosis in late paraphrenia. Psychol Med. 1994;24(2):397–410.

    Article  Google Scholar 

  30. Herbert ME, Jacobson S. Late paraphrenia. Br J Psychiatry. 1967;113(498):461–9.

    Article  Google Scholar 

  31. Howard R, et al. Permeable walls, floors, ceilings and doors. Partition delusions in late paraphrenia. Int J Geriatr Psychiatry. 1992;7(10):719–24.

    Article  Google Scholar 

  32. Rabins P, Pauker S, Thomas J. Can schizophrenia begin after age 44? Compr Psychiatry. 1984;25(3):290–3.

    Article  Google Scholar 

  33. Howard R, Levy R. Charles Bonnet syndrome plus: complex visual hallucinations of Charles Bonnet syndrome type in late paraphrenia. Int J Geriatr Psychiatry. 1994;9(5):399–404.

    Article  Google Scholar 

  34. Angermeyer MC, Kuhn L. Gender differences in age at onset of schizophrenia. An overview. Eur Arch Psychiatry Neurol Sci. 1988;237(6):351–64.

    Article  Google Scholar 

  35. Hambrecht M, et al. Transnational stability of gender differences in schizophrenia? An analysis based on the WHO study on determinants of outcome of severe mental disorders. Eur Arch Psychiatry Clin Neurosci. 1992;242(1):6–12.

    Article  Google Scholar 

  36. Lohr JB, et al. Minor physical anomalies in older patients with late-onset schizophrenia, early-onset schizophrenia, depression, and Alzheimer’s disease. Am J Geriatr Psychiatry. 1997;5(4):318–23.

    Article  Google Scholar 

  37. Castle DJ, et al. Schizophrenia with onset at the extremes of adult life. Int J Geriatr Psychiatry. 1997;12(7):712–7.

    Article  Google Scholar 

  38. Barak Y, et al. Very late-onset schizophrenia-like psychosis: clinical and imaging characteristics in comparison with elderly patients with schizophrenia. J Nerv Ment Dis. 2002;190(11):733–6.

    Article  Google Scholar 

  39. Howard RJ, et al. A controlled family study of late-onset non-affective psychosis (late paraphrenia). Br J Psychiatry. 1997;170:511–4.

    Article  Google Scholar 

  40. Howard R, et al. Apolipoprotein e genotype and late paraphrenia. Int J Geriatr Psychiatry. 1995;10(2):147–50.

    Article  Google Scholar 

  41. Purohit DP, et al. Alzheimer disease and related neurodegenerative diseases in elderly patients with schizophrenia: a postmortem neuropathologic study of 100 cases. Arch Gen Psychiatry. 1998;55(3):205–11.

    Article  Google Scholar 

  42. Essali A, Ali G. Antipsychotic drug treatment for elderly people with late-onset schizophrenia. Cochrane Database Syst Rev. 2012;15(2):CD004162.

    Google Scholar 

  43. Sin Fai Lam CC, et al. Service and treatment engagement of people with very late-onset schizophrenia-like psychosis. BJPsych Bull. 2016;40(4):185–6.

    Article  Google Scholar 

  44. Jeste DV, et al. Relationship of neuropsychological and MRI measures to age of onset of schizophrenia. Acta Psychiatr Scand. 1998;98(2):156–64.

    Article  Google Scholar 

  45. Pearlson GD, et al. Quantitative D2 dopamine receptor PET and structural MRI changes in late-onset schizophrenia. Schizophr Bull. 1993;19(4):783–95.

    Article  Google Scholar 

  46. Corey-Bloom J, et al. Quantitative magnetic resonance imaging of the brain in late-life schizophrenia. Am J Psychiatry. 1995;152(3):447–9.

    Article  Google Scholar 

  47. Rabins PV, et al. MRI findings differentiate between late-onset schizophrenia and late-life mood disorder. Int J Geriatr Psychiatry. 2000;15(10):954–60.

    Article  Google Scholar 

  48. Howard R, et al. Magnetic resonance imaging volumetric measurements of the superior temporal gyrus, hippocampus, parahippocampal gyrus, frontal and temporal lobes in late paraphrenia. Psychol Med. 1995;25(3):495–503.

    Article  Google Scholar 

  49. Tonkonogy JM, Geller JL. Late-onset paranoid psychosis as a distinct clinicopathologic entity: magnetic resonance imaging data in elderly patients with paranoid psychosis of late onset and schizophrenia of early onset. Neuropsychiatry Neuropsychol Behav Neurol. 1999;12(4):230–5.

    Google Scholar 

  50. Howard R, et al. White matter signal hyperintensities in the brains of patients with late paraphrenia and the normal, community-living elderly. Biol Psychiatry. 1995;38(2):86–91.

    Article  Google Scholar 

  51. Symonds LL, et al. Lack of clinically significant gross structural abnormalities in MRIs of older patients with schizophrenia and related psychoses. J Neuropsychiatry Clin Neurosci. 1997;9(2):251–8.

    Article  Google Scholar 

  52. Jones DK, et al. A diffusion tensor magnetic resonance imaging study of frontal cortex connections in very-late-onset schizophrenia-like psychosis. Am J Geriatr Psychiatry. 2005;13(12):1092–9.

    Article  Google Scholar 

  53. Sachdev P, et al. Regional cerebral blood flow in late-onset schizophrenia: a SPECT study using 99mTc-HMPAO. Schizophr Res. 1997;27(2–3):105–17.

    Article  Google Scholar 

  54. Wake R, et al. Regional cerebral blood flow in late-onset schizophrenia: a SPECT study using 99mTc-ECD. Eur Arch Psychiatry Clin Neurosci. 2016;266(1):3–12.

    Article  Google Scholar 

  55. Wium-Andersen MK, Ørsted DD, Nordestgaard BG. Elevated C-reactive protein associated with late- and very-late-onset schizophrenia in the general population: a prospective study. Schizophr Bull. 2014;40(5):1117–27.

    Article  Google Scholar 

  56. Heaton R, et al. Neuropsychological deficits in schizophrenics. Relationship to age, chronicity, and dementia. Arch Gen Psychiatry. 1994;51(6):469–76.

    Article  Google Scholar 

  57. Heaton RK, et al. Stability and course of neuropsychological deficits in schizophrenia. Arch Gen Psychiatry. 2001;58(1):24–32.

    Article  Google Scholar 

  58. Brodaty H, et al. Long-term outcome of late-onset schizophrenia: 5-year follow-up study. Br J Psychiatry. 2003;183:213–9.

    Article  Google Scholar 

  59. Schretlen DJ, et al. Neuropsychological functioning in bipolar disorder and schizophrenia. Biol Psychiatry. 2007;62(2):179–86.

    Article  Google Scholar 

  60. Heinrichs RW, Zakzanis KK. Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology. 1998;12(3):426–45.

    Article  Google Scholar 

  61. Brichant-Petitjean C, et al. Memory deficits in late-onset schizophrenia. Schizophr Res. 2013;151(1–3):85–90.

    Article  Google Scholar 

  62. Hanssen M, et al. Comparative study of clinical and neuropsychological characteristics between early-, late and very-late-onset schizophrenia-spectrum disorders. Am J Geriatr Psychiatry. 2015;23(8):852–62.

    Article  Google Scholar 

  63. Miller BL, et al. Brain lesions and cognitive function in late-life psychosis. Br J Psychiatry. 1991;158:76–82.

    Article  Google Scholar 

  64. Almeida OP, et al. Cognitive features of psychotic states arising in late life (late paraphrenia). Psychol Med. 1995;25(4):685–98.

    Article  Google Scholar 

  65. Laks J, et al. Absence of dementia in late-onset schizophrenia: a one year follow-up of a Brazilian case series. Arq Neuropsiquiatr. 2006;64(4):946–9.

    Article  Google Scholar 

  66. Rajji TK, Mulsant BH. Nature and course of cognitive function in late-life schizophrenia: a systematic review. Schizophr Res. 2008;102(1–3):122–40.

    Article  Google Scholar 

  67. Shah JN, et al. Is there evidence for late cognitive decline in chronic schizophrenia? Psychiatry Q. 2012;83(2):127–44.

    Article  Google Scholar 

  68. Palmer BW, et al. Are late-onset schizophrenia spectrum disorders neurodegenerative conditions? Annual rates of change on two dementia measures. J Neuropsychiatry Clin Neurosci. 2003;15(1):45–52.

    Article  Google Scholar 

  69. Kørner A, et al. Late and very-late first-contact schizophrenia and the risk of dementia--a nationwide register based study. Int J Geriatr Psychiatry. 2009;24(1):61–7.

    Article  Google Scholar 

  70. Andreasen NC, et al. Correlational studies of the scale for the assessment of negative symptoms and the scale for the assessment of positive symptoms: an overview and update. Psychopathology. 1995;28(1):7–17.

    Article  Google Scholar 

  71. Sheikh JI, Yesavage JA. Geriatric depression scale (GDS): recent evidence and development of a shorter version. Clin Gerontol. 1986;5(1–2):165–73.

    Google Scholar 

  72. Almeida OP, Almeida SA. Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int J Geriatr Psychiatry. 1999;14(10):858–65.

    Article  Google Scholar 

  73. Mitchell AJ, et al. Which version of the geriatric depression scale is most useful in medical settings and nursing homes? Diagnostic validity meta-analysis. Am J Geriatr Psychiatry. 2010;18(12):1066–77.

    Article  Google Scholar 

  74. Fieldstone SC, et al. Validation of the 15-item geriatric depression scale for clinical use with young and middle-aged adults. J Int Neuropsychol Soc. 2010;16(S1):41.

    Google Scholar 

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Correspondence to Tracy D. Vannorsdall .

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Vannorsdall, T.D., Schretlen, D.J. (2019). Late-Onset Schizophrenia. In: Ravdin, L.D., Katzen, H.L. (eds) Handbook on the Neuropsychology of Aging and Dementia. Clinical Handbooks in Neuropsychology. Springer, Cham. https://doi.org/10.1007/978-3-319-93497-6_42

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