Cognitive decline in late-life schizophrenia: A longitudinal study of geriatric chronically hospitalized patients

Background: Geriatric schizophrenic patients with a chronic course of insti tutionalization manifest cognitive and functional impairments that implicat e decline at some time point after the onset of illness. The rate of change in cognitive and functional status in these patients has not yet been iden tified with a longitudinal study. Methods: Three hundred and twenty-six schizophrenic patients entered a 30-m onth follow-up study with two separate assessments of the patients. Overall functional and cognitive status was indexed with the Clinical Dementia Rat ing (CDR). Survival analysis was used to examine changes in cognitive and f unctional status, including worsening for the less impaired patients and im provements on the part of more impaired patients. Results: Approximately 30% of the patients who had baseline scores in the l ess impaired range manifested a worsening of their CDR ratings to a score o f 2.0 (moderate) or mope severe, whereas only 7% of the sample with lower s cores at baseline appeared to improve in their functioning. Several charact eristics of the patients at baseline assessment predicted increased risk fo r cognitive and functional decline, including lower levels of education, ol der age, and more severe positive symptoms. Conclusions: Cognitive and functional decline can be detected in a short-te rm follow-up in a subset of geriatric long-stay patients with schizophrenia . This decline appears distributed across patients and not due to the prese nce of progressive degenerative dementing conditions. Later research will h ave to identify the causes of this decline, possibly on the basis of the ri sk factors identified in this study. Biol Psychiatry 1999;45:32-40 (C) 1999 Society of Biological Psychiatry.