Schizophrenia in late life: Findings challenge traditional concepts

Two notions about schizophrenia have persisted: (1) it is characterized by onset in adolescence or early adulthood. and (2) it has a progressively det eriorating course. Recent studies focusing on early-adulthood- and middle-a ge-onset schizophrenia challenge these views. Patients with early-onset sch izophrenia and middle-age-onset schizophrenia (MAOS) are similar in terms o f family history of schizophrenia, presence of minor physical anomalies, ea rly childhood maladjustment, severity of positive symptoms, presence of gro ss structural abnormalities on cerebral magnetic resonance imaging, overall pattern of neuropsychologic deficits, and qualitative response to neurolep tic medications. Differences include a higher proportion of women among MAO S patients, and the tendency for MAOS patients to have less severe negative symptoms, better neuropsychologic performance (particularly in learning an d abstraction/cognitive flexibility), and possibly larger thalamic volume a nd to respond to lower doses of neuroleptic medications. While onset of sch izophrenia-like symptoms in very late life may reflect an acquired conditio n that is not "true schizophrenia," and that may be labeled "very-late-onse t schizophrenia-like psychosis," findings suggest that true schizophrenia c an arise after early adulthood. Middle-age-onset schizophrenia is predomina ntly neurodevelopmental, but it is also a distinct neurobiological subtype of schizophrenia. Our studies also demonstrate that neuropsychologic functi oning remains stable in chronic schizophrenia outpatients, even when observ ed over several years and in the presence of significant fluctuations in th e severity of clinical symptoms.