The Course of Functional Decline in Geriatric Patients With Schizophrenia: Cognitive-Functional and Clinical Symptoms as Determinants of Change

Harvey, Philip D.; Bertisch, Hillary; Friedman, Joseph I.; Marcus, Sue M.; Parrella, Michael; White, Leonard; Davis, Kenneth L.

doi:10.1176/appi.ajgp.11.6.610

Cited by 48 publications

(42 citation statements)

References 30 publications

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“…While our data do not support the hypothesis that there is a global neurodegenerative course associated with patients with lower levels of functional deficits at baseline (57), long-stay institutionalized patients were not the focus of our investigation. The current study was also limited by the presence of some outliers in our data who may have been representative of more impaired individuals.…”

Section: Discussioncontrasting

confidence: 81%

Computerized Neurocognitive Test Performance in Schizophrenia: A Lifespan Analysis

Irani

Brensinger

Richard

et al. 2012

The American Journal of Geriatric Psychiatry

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Objective Computerized neurocognitive batteries based on advanced behavioral neuroscience methods are increasingly used in large-scale clinical and genomic studies. Favorable construct validity in younger schizophrenia patients has been reported, but not in older patients. New variables afforded by computerized assessments were used to clarify age-associated cognitive impairment across the lifespan. Methods 624 patients with schizophrenia and 624 healthy comparison (HC) subjects aged 16–75 completed a 1–2 hour computerized neurocognitive battery (CNB) that assessed abstraction and mental flexibility, attention, working memory, recognition memory (verbal, facial, spatial), language, visuospatial and emotion processing. Linear mixed effects models tested for group differences in accuracy, response time, and efficiency scores. Contrasts were stratified by age. Results 91% of older (45+) and 94% of younger (<45) groups provided “good” data quality. After controlling for parental education and project, there were significant three-way interactions for diagnosis x domain x age group on all three outcome variables. Patients performed worse than HC across all neurocognitive domains, except in the oldest group of 60+ patients. Age-stratified analyses did not show differences between younger (16–45) and older patients (45–60, 60+), except for the attention domain. Older patients’ reduced working memory efficiency was due to worse speed, not accuracy. Older patients were quicker than younger patients in processing emotions. Conclusions Computerized assessments are feasible in large cohorts of schizophrenia patients. There is stable and generalized neurocognitive dysfunction across the lifespan in schizophrenia, albeit with fewer differences in some domains between older patients and HC after age 60. Speed-accuracy tradeoff strategies suggest deceleration of some frontal networks and improvements in speed of emotional processing.

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Section: Discussioncontrasting

confidence: 81%

Computerized Neurocognitive Test Performance in Schizophrenia: A Lifespan Analysis

Irani

Brensinger

Richard

et al. 2012

The American Journal of Geriatric Psychiatry

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“…Olanzapine has also been shown to reduce positive and negative symptoms in elderly patients with chronic schizophrenia whilst inducing less extra pyramidal symptoms (Barak, Shamir & Zemishlani, 2002;Sajatovic, Perez, Brescan & Ramirez, 1998). Low doses of olanzapine and risperidone can also improve cognitive function in elderly patients with schizophrenia (Harvey, Bertisch & Friedman, 2003). This is consistent with research in younger people with schizophrenia where the improvement occurs in areas of cognitive functioning related to functional outcome.…”

Section: Medicationsupporting

confidence: 68%

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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“…However, the historical reasons for extended institutional stays, including treatment resistance and aggressive behavior (White et al, 1997b), have not been resolved as clinical issues. Later research should determine whether treatment resistance, which is associated with longitudinal ventricular enlargement (Davis et al, 1998) is the operative factor in the functional declines seen and whether patients with persistently severe psychotic symptoms evidence functional decline as previous data has suggested (Harvey et al, 2003). …”

Section: Discussionmentioning

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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The Course of Functional Decline in Geriatric Patients With Schizophrenia: Cognitive-Functional and Clinical Symptoms as Determinants of Change

Cited by 48 publications

References 30 publications

Computerized Neurocognitive Test Performance in Schizophrenia: A Lifespan Analysis

Computerized Neurocognitive Test Performance in Schizophrenia: A Lifespan Analysis

Older people with chronic schizophrenia

The course and correlates of everyday functioning in schizophrenia

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