Dementia as a complication of schizophrenia

Abstract

Objectives-Cognitive impairment is known to occur in schizophrenia, and may be marked in institutionalised patients. The aim of this study was to determine whether it ever warrants an additional diagnosis of dementia. Methods-A population of chronic schizophrenic patients who were aged 65 or younger and showed no organic risk factors for dementia were screened for presence of disorientation. Any showing this underwent neuropsychological testing, physical investigations, and structural and functional neuroimaging. Information about day to day cognitive function was also obtained from carers. Results-Eight patients aged 28 to 64 were identified who showed disorientation; in all cases this was accompanied by general intellectual impairment and objective evidence of a dementia syndrome. The patients' schizophrenic symptoms were unexceptional and did not seem suYcient to account for their cognitive impairment. Neuropsychological testing disclosed relative sparing of visual and visuospatial function and language syntax, but pervasive deficits in memory and executive function. Brain CT demonstrated only minor abnormalities but most of the patients showed frontal or temporal hypoperfusion on SPECT. Conclusions-Dementia in schizophrenia seems to be a real entity with a neuropsychological signature similar to that of frontotemporal dementia. Functional but not structural imaging abnormalities may also be characteristic. (J Neurol Neurosurg Psychiatry 2001;70:588-596)

Functional brain imaging applications to differential diagnosis in the dementias

“…Frontotemporal hypoperfusion has been reported in patients with bulbar onset motor neuron disease when they present with cognitive impairment [62]. In keeping with the heterogeneity of the syndrome, dementia in schizophrenic patients has been characterized by memory and executive dysfunction and by lowered frontotemporal CBF [63]. Hypoperfusion in the frontal, anterior cingulate and temporal cortex and in the caudate nucleus has been shown on mean single-photon emission computed tomography images of patients with FTD standardized in a common stereotactical space [64 . ], as already reported for PET data [65].…”

Prise en soins de la schizophrénie chez la personne âgée

“…En fait, les neuroleptiques peuvent avoir des effets néga-tifs sur la performance cognitive de volontaires normaux, n otamment en ce qui concerne les neuroleptiques classiques à effet anticholinergique (effet direct sur la mémoire) ou a ntihistaminique (effet induit par la sédation) ou encore via un effet antidopaminergique (D1). La capacité cognitive de 510 patients schizophrènes chroniquement hospitalisés avec un âge moyen de 60 ans a été investiguée [32]. Aucune r elation entre la durée d'exposition aux neuroleptiques et les scores à des tests d'intelligence n'a été trouvée.…”

“…Aucune r elation entre la durée d'exposition aux neuroleptiques et les scores à des tests d'intelligence n'a été trouvée. Par ailleurs, des déficits cognitifs majeurs chez les schizophrènes ont été décrits chez des patients qui n'ont jamais eu de médica-ments neuroleptiques [33] et bien avant l'ère des neuroleptiques [32]. La dénomination originale de la schizophrénie proposée par Kraepelin, à savoir la «dementia praecox» en témoigne.…”

Clozapine for the treatment of neurogenic bladder

“…Urodynam. 26:537-539, 2007. ß 2007 Wiley-Liss, Inc.Key words: bladder; clozapine; neurogenic; urge incontinence Neurogenic bladder leading to urinary incontinence has been reported in patients of stroke, Alzheimer's disease, multiinfarct dementia, other dementias, and Parkinson's disease possibly due to impaired higher cortical inhibition of the urinary bladder.1 Detrusor hyperreflexia and urinary urge incontinence has also been reported in some patients of schizophrenia, notably in cognitively impaired patients as the brain abnormalities in this subgroup of patients are similar to neurological patients with urinary incontinence.2, 3 We report a case of schizophrenia with cognitive impairment and urinary urge incontinence, where the urinary incontinence responded to treatment with clozapine.Mr. A, 31-year old right-handed male, became symptomatic initially about 10 years ago.…”