Very Late-Onset Schizophrenia-Like Psychosis: Clinical and Imaging Characteristics in Comparison With Elderly Patients With Schizophrenia

Abstract

Studies of late-onset schizophrenia began in the early 1940s with work by M. Bleuler. Despite this fact, the emphasis on age of onset in young adulthood distracted researchers of schizophrenia from accumulating data on the subgroup of patients whose disease onset is in late life. Recently, the diagnostic entity of very late-onset schizophrenia-like psychosis (VLOSLP) was proposed for patients with disease onset after age 60 years, and it may have validity and clinical utility. The present study aims to prospectively identify patients suffering from VLOSLP over a 2-year period and to compare them with elderly schizophrenia patients on measures of brain structure, demographics, and treatment response, so that distinct features, if any, can be identified. Twenty-one VLOSLP patients (15 women, 6 men; mean age, 78.1 years) were enrolled and compared with 21 age- and gender-matched elderly schizophrenia patients. All had undergone brain CT scan, and all were treated with risperidone. The VLOSLP group was characterized by more education, higher percentage being married, more pronounced cerebellar atrophy, and better response to treatment. The authors suggest that VLOSLP is a valid diagnostic entity and that its features imply that involvement of neurodegenerative process may be etiologically relevant to psychosis with onset in late life.

Cerebellum and psychiatric disorders

“…23 Magnetic resonance imaging (MRI) analyses using quantitative anthropometric techniques have yielded more consistent reports of cerebellar atrophy in schizophrenia, 22,24 with some authors attempting to delineate a subset of patients with reduced or atrophied cerebellum. Global reduction of cerebellum in patients with schizophrenia seems to be associated in some cases with perinatal brain insults, 25 in others with male gender, 26 childhood-onset, 27 verylate-onset, 28 chronic course, 29 and positive psychotic symptoms. 30 Other authors have noted atrophy limited to the vermis.…”

Elderly patients with very late-onset schizophrenia-like psychosis and early-onset schizophrenia: Cross-sectional and retrospective clinical findings

“…However, in most studies, negative symptoms were absent in VLOSLP [14,20] while they were present in EOS and to a lesser extent in LOS [14]. Negative symptoms were not at all or barely mentioned in several studies on VLOSLP [18,21,24,26].…”

“…Good response to antipsychotics [24,26,34,35], even better than in LOS [24] and elderly EOS patients [24,26], was often registered in VLOSLP patients. VLOSLP individuals, especially inpatients [35], responded well to atypical antipsychotics [20,35], and in particular to amisulpride [34].…”

“…Studies on VLOSLP alone [18][19][20][21][22][23], as well as studies comparing the profile of patients with VLOSLP with that of patients with LOS [14,24,25], elderly EOS [14,24,[26][27][28][29] and healthy controls [30,31] were also realized to better differentially characterize the demographics, clinical symptoms and evolution [14,20,29] of VLOSLP patients.…”

“…In terms of positive symptoms, mild paranoid delusions [14,26] mostly persecutory [18,20,21,24,25], auditory [18,21,25,26] and visual hallucinations [18,21,25], as well as all the Scale for the Assessment of Positive Symptoms (SAPS) [32] behavioral disturbances except for psychomotor abnormalities [25] were described in VLOSLP. These symptoms were sometimes as common as in LOS [25].…”