Age-Associated Differences in Cognitive Performance in Older Patients With Schizophrenia: A Comparison With Healthy Older Adults

Loewenstein, David; Czaja, Sara J.; Bowie, Christopher R.; Harvey, Philip D.

doi:10.1097/jgp.0b013e31823bc08c

Cited by 69 publications

(58 citation statements)

References 30 publications

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“…A number of recent studies have suggested that these elderly survivors are now facing aging associated health problems in addition to their mental illness including cognitive decline (15, 16, 18–24). One study reported that the greatest expenditures of Medicare/Medicaid were in elderly patients with schizophrenia primarily due to nursing home costs (25).…”

Section: Objectivementioning

confidence: 99%

Comorbidity Profile and Healthcare Utilization in Elderly Patients with Serious Mental Illnesses

Hendrie¹,

Lindgren²,

Hay³

et al. 2013

The American Journal of Geriatric Psychiatry

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Objectives Patients with serious mental illness are living longer. Yet there remain few studies that focus on health care utilization and its relationship to comorbidities in these elderly mentally ill patients. Design Comparative study. Information on demographics, comorbidities and health care utilization were taken from an electronic medical record system. Setting Wishard Health Services senior care and community mental health clinics. Participants Patients age 65 years and over-255 patients with serious mental illness (schizophrenia, major recurrent depression and bipolar illness) attending a mental health clinic and a representative sample of 533 non-demented patients without serious mental illness attending primary care clinics. Results Patients having serious mental illness had significantly higher rates of medical emergency room visits (p=0.0027) and significantly longer lengths of medical hospitalizations (p<0.0001) than did the primary care control group. The frequency of medical comorbidities such as diabetes, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, thyroid disease, and cancer were not significantly different between the groups. Hypertension was lower in the mentally ill group (p<0.0001). Reported falls (p<0.0001), diagnoses of substance abuse (p=0.02), and alcoholism (p=0.0016) were higher in the seriously mentally ill. The differences in health care utilization between the groups remained significant after adjusting for comorbidity levels, lifestyle factors, and attending primary care. Conclusions Our findings of higher rates of emergency care, longer hospitalizations, and increased frequency of falls, substance abuse, and alcoholism suggest the elderly seriously mentally ill remain a vulnerable population requiring an integrated model of health care.

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Section: Objectivementioning

confidence: 99%

Comorbidity Profile and Healthcare Utilization in Elderly Patients with Serious Mental Illnesses

Hendrie¹,

Lindgren²,

Hay³

et al. 2013

The American Journal of Geriatric Psychiatry

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“…However, they may also experience accelerated cognitive decline in verbal memory and processing speed when they reach their 70s. 17 Such acceleration in cognitive decline has also been reported among a subgroup of older patients with schizophrenia who were chronically institutionalized. It was estimated that these patients-who represent a minority among older patients with schizophrenia-decline cognitively after the age of 65 by 1 point/year on the MMSE, 18 compared with 3 points/year for patients with Alzheimer disease.…”

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confidence: 90%

Cognition, Function, and Disability in Patients with Schizophrenia: A Review of Longitudinal Studies

2014

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This paper aims to review longitudinal studies assessing the impact of cognition on function in patients with schizophrenia. PubMed and Scholars Portal were searched using search terms related to schizophrenia, cognition, function, and longitudinal studies. Some functional abilities have been studied more than others. Some studies suggest that the impact of cognition on function depends on the severity of baseline cognitive deficits. Other studies suggest that the impact of cognition on function depend on what phase of the illness the patient is in or what stage in that particular function the patient is involved in. Finally, few studies assessed interactions between cognition and other aspects of schizophrenia in predicting function, such as functional capacity, insight, motivation, and negative symptoms. More longitudinal and comprehensive studies are needed. A focus on community living is of high public significance as patients with schizophrenia continue to grow old. Future studies should also focus on the longitudinal interactions between cognition and other dimensions of schizophrenia as well as on the biological factors that underlie these interactions. W W W Cognition, fonction et incapacité chez des patients souffrant de schizophrénie : une revue des études longitudinalesCet article vise à examiner les études longitudinales évaluant l'effet de la cognition sur la fonction des patients souffrant de schizophrénie. Des recherches ont été effectuées dans PubMed et Scholars Portal à l'aide de mots clés liés à la schizophrénie, la cognition, la fonction, et les études longitudinales. Certaines capacités fonctionnelles ont été étudiées plus que d'autres. Des études suggèrent que l'effet de la cognition sur la fonction dépend de la gravité des déficits cognitifs au départ. D'autres études font valoir que l'effet de la cognition sur la fonction dépend de la phase de la maladie ou du stade de cette fonction où se situe le patient. Enfin, peu d'études ont évalué les interactions entre cognition et autres aspects de la schizophrénie pour prédire la fonction, comme la capacité fonctionnelle, l'intuition, la motivation, et les symptômes négatifs. Il faut plus d'études longitudinales et exhaustives. Mettre l'accent sur la vie dans la communauté est d'une grande importance publique car les patients souffrant de schizophrénie continuent de vieillir. Les futures études devraient aussi se pencher sur les interactions longitudinales entre la cognition et d'autres dimensions de la schizophrénie, ainsi que sur les facteurs biologiques qui sous-tendent ces interactions.S chizophrenia affects more than 24 million adults, worldwide, and about a quarter of a million in Canada.

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“…Cognitive impairments have been shown to exert a general influence on functioning (Evans et al, 2003), with minimal evidence of differential correlations with different functional domains. Cognitive impairments are evident at the onset of illness (Speidman et al, 2010), are stable over the lifetime for the majority of patients (Heaton et al, 2001), appear to worsen only in the “oldest-old” patients (Loewenstein et al, in press) and can be affected by treatments (Kurtz et al, 2009). …”

Section: Introductionmentioning

confidence: 99%

The course and correlates of everyday functioning in schizophrenia

Reichenberg

Feo

Prestía

et al. 2014

Schizophrenia Research: Cognition

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Previously institutionalized older patients with schizophrenia show changes in cognitive and functional capacity over time. This study examined changes in real-world functioning in a sample of people with schizophrenia who varied in their history of long-term institutionalization and related changes in real world functioning to changes in cognition and functional capacity over the follow-up period. Older patients with schizophrenia (n=111) were examined with assessments of cognitive functioning, functional capacity, clinical symptoms, and everyday functioning. They were then followed up to 45 months and examined up to two times. Mixed-model regression was used to examine changes in real-world functioning in social, everyday living, and vocational domains over the follow-up period and identify potential predictors of change. Everyday functioning worsened over time in all three domains. Although length of longest hospitalization predicted worsening, this influence was eliminated when the course of functional capacity was used to predict the course of everyday functioning. For both vocational and everyday living domains, as well as the composite score on functional status, worsening in performance based measures of everyday functioning and social competence predicted worsening in real world functioning. Changes in negative symptoms further predicted worsening in the everyday living domain. Worsening in everyday functioning is found in people with schizophrenia and those with a history of greater chronicity and severity of illness seem more affected. These influences seem to be expressed through worsening in the ability to perform everyday functional skills. Potential causes of these changes and implications for reducing these impairments are discussed.

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Age-Associated Differences in Cognitive Performance in Older Patients With Schizophrenia: A Comparison With Healthy Older Adults

Cited by 69 publications

References 30 publications

Comorbidity Profile and Healthcare Utilization in Elderly Patients with Serious Mental Illnesses

Comorbidity Profile and Healthcare Utilization in Elderly Patients with Serious Mental Illnesses

Cognition, Function, and Disability in Patients with Schizophrenia: A Review of Longitudinal Studies

The course and correlates of everyday functioning in schizophrenia

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