Right-hemisphere encephalopathy in elderly subjects with schizophrenia: evidence from neuropsychological and brain imaging studies

Gabrovska-Johnson, V. S.; Scott, Marietta; Jeffries, Suzanne; Thacker, Neil A.; Baldwin, Robert C.; Burns, Alistair; Lewis, Shôn; Deakin, Bill

doi:10.1007/s00213-003-1524-9

Cited by 9 publications

(7 citation statements)

References 41 publications

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“…Temporal lobe volume at onset was predictive of unremitting positive symptomatology as an outcome measure at fiveyear follow-up (Milev et al, 2003) while cerebellar, but not temporal or ventricular, volumes were predictive of psychosocial and clinical outcome at seven-year follow-up (Wassink, Andreasen, Nopoulos, & Flaum, 1999). Some of the findings were suggestive of a relationship between the larger lateral ventricular size and cognitive impairment in institutionalized (Gabrovska-Johnson et al, 2003;Johnstone et al, 1976;Owens et al, 1985) and noninstitutionalized chronic patients (Goldberg et al, 1988;Keilp et al, 1988;Lawson, Waldman, & Weinberger, 1988;Roccatagliatta, Gandolfo, Ruffinengo, Scotto, & Bacigalupo, 1986). Longitudinal outcome measures were employed only in some of these studies that assessed the overtly Kraepelinian schizophrenia subtype (Davis et al, 1998;Johnstone et al, 1976Johnstone et al, , 1989Losonczy et al, 1986;Owens et al, 1985;Staal et al, 2001).…”

Section: Ventricular Systemmentioning

confidence: 89%

“…Elderly institutionalized patients with poor outcomes, regardless of gender (Moriarty et al, 2001) or treatment location (Harvey, Leff, Trieman, Anderson, & Davidson, 1997a;Harvey et al, 1998), display an array of severe adaptive and cognitive deficits (e.g. in Mini-Mental State examination, clock-drawing test as a nonspecific measure of global cognitive and visual-analytic functioning, as well as on the phonemic tests of verbal fluency) that are not grossly dissimilar to those seen in Alzheimer's disease (Arnold et al, 1995a;Bozikas et al, 2002;Gabrovska-Johnson et al, 2003;Heinik, Lahav, Drummer, Vainer-Benaiah, & Lin, 2000;Kosmidis et al, 2005;Lowery et al, 2003;McBride et al, 2002;Owens & Johnstone, 1980). Recognition memory has been reported a single most impaired domain of cognitive functioning in this patient group (Harvey et al, 2000a).…”

Section: Longitudinal Course Of the Illnessmentioning

confidence: 99%

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Very poor outcome schizophrenia: Clinical and neuroimaging aspects

Mitelman

Buchsbaum

2007

International Review of Psychiatry

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In spite of significant advances in treatment of patients with schizophrenia and continued efforts towards their deinstitutionalization, a considerable group of patients remain chronically hospitalized or otherwise dependent on others for basic necessities of life. It has been proposed that these patients belong to a distinct etiopathological subgroup, termed Kraepelinian, whose course of illness may be progressive and resistant to treatment. Indeed, longitudinal studies appear to show that elderly Kraepelinian patients follow a course of rapid cognitive and functional deterioration, commensurate with a dementing process, and that their poor functional status is closely correlated with the cognitive deterioration. Recent neuroimaging studies described a pattern of posteriorization of grey and white matter deficits with poor outcome in schizophrenia, and produced a constellation of findings implicating primary processing of visual and auditory information as central to the impaired functional status in this patient group. These studies are summarized in detail in this review and future directions for neuroimaging assessment of very poor outcome patients with schizophrenia are suggested.

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Section: Ventricular Systemmentioning

confidence: 89%

Section: Longitudinal Course Of the Illnessmentioning

confidence: 99%

Very poor outcome schizophrenia: Clinical and neuroimaging aspects

Mitelman

Buchsbaum

2007

International Review of Psychiatry

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“…Specific deficits such as those of executive functioning (Shallice, Burgess & Frith, 1991), use of language (Faber, Abrams & Taylor, 1983), and memory functions (Saykin, Shtasel & Gur, 1994) have been reported. In a comparative study of cognitively impaired older patients of schizophrenia with equally impaired patients of Alzheimer's disease (AD), Gabrovska-Johnson et al (2003) found that the schizophrenia group was more impaired on visuospatial tasks but less impaired on corresponding verbal tasks despite similar overall cognitive impairment and a peculiar profile of cognitive impairment suggestive of underlying right hemisphere impairment and supported by the findings on Magnetic Resonance Imaging (MRI). These findings clearly differ from the pattern of cognitive deficits seen in AD, which presents with a more global deterioration of cognitive functions and follows a declining course.…”

Section: Cognitive Deficitsmentioning

confidence: 98%

Older people with chronic schizophrenia

Karim

Overshott

Burns

2005

Aging & Mental Health

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Older people with chronic schizophrenia are a numerically small but important group with complex clinical and service needs. Along with a reduction in positive schizophrenic symptoms with increasing age, a majority suffer from negative symptoms, cognitive deficits, depression, side effects due to long-term use of antipsychotics and co-morbid medical problems. They may have social disabilities making them vulnerable to poverty, isolation and poor quality of life. Evidence suggests that judicious use of antipsychotics combined with psychotherapy and psychosocial interventions are effective. There are shortcomings in the standard of both hospital and community care, and the cost implications of providing adequate services are high.

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“…Cutting (1992) proposed that schizophrenic patients with a preponderance of negative symptoms display right-hemisphere dysfunction. In schizophrenic patients, the right hemisphere is no more dominant in the functions it usually controls in normal subjects: perception of facial emotions (Borod et al 1993), visuospatial task performance (Gabrovska-Johnson et al 2003), attention (Kucharska-Pietura et al 2002), and ability to grasp global forms (Ferman et al 1999).…”

Section: The Ontogeny and Asymmetry Of The Highest Brain Skills And Tmentioning

confidence: 99%

An evolutionary theory of schizophrenia: Cortical connectivity, metarepresentation, and the social brain

2004

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Schizophrenia is a worldwide, prevalent disorder with a multifactorial but highly genetic aetiology. A constant prevalence rate in the face of reduced fecundity has caused some to argue that an evolutionary advantage exists in unaffected relatives. Here, I critique this adaptationist approach, and review – and find wanting – Crow's “speciation” hypothesis. In keeping with available biological and psychological evidence, I propose an alternative theory of the origins of this disorder. Schizophrenia is a disorder of the social brain, and it exists as a costly trade-off in the evolution of complex social cognition. Paleoanthropological and comparative primate research suggests that hominids evolved complex cortical interconnectivity (in particular, frontotemporal and frontoparietal circuits) to regulate social cognition and the intellectual demands of group living. I suggest that the ontogenetic mechanism underlying this cerebral adaptation was sequential hypermorphosis and that it rendered the hominid brain vulnerable to genetic and environmental insults. I argue that changes in genes regulating the timing of neurodevelopment occurred prior to the migration of Homo sapiens out of Africa 100,000–150,000 years ago, giving rise to the schizotypal spectrum. While some individuals within this spectrum may have exhibited unusual creativity and iconoclasm, this phenotype was not necessarily adaptive in reproductive terms. However, because the disorder shared a common genetic basis with the evolving circuitry of the social brain, it persisted. Thus schizophrenia emerged as a costly trade-off in the evolution of complex social cognition.

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Right-hemisphere encephalopathy in elderly subjects with schizophrenia: evidence from neuropsychological and brain imaging studies

Abstract: The results suggest that right hemisphere impairment underlies the specific profile of cognitive impairment in elderly patients with schizophrenia.

Cited by 9 publications

References 41 publications

Very poor outcome schizophrenia: Clinical and neuroimaging aspects

Very poor outcome schizophrenia: Clinical and neuroimaging aspects

Older people with chronic schizophrenia

An evolutionary theory of schizophrenia: Cortical connectivity, metarepresentation, and the social brain

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