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Long-term outcome of late-onset schizophrenia: 5-year follow-up study

School of Psychiatry, University of New South Wales, Sydney, Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, Australia

PERMINDER SACHDEV, MD, PhD, FRANZCP

School of Psychiatry, University of New South Wales, Sydney, Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia

ANNETTE KOSCHERA, PhD, DOROTHY MONK, MB BS, MD and BREDA CULLEN, BA, MSc

Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, Australia

Correspondence: Professor Henry Brodaty, Academic Department for Old Age Psychiatry, Euroa Centre, Prince of Wales Hospital, Avoca St, Randwick, NSW 2031, Australia. Tel: 2 9382 3759; fax: 2 9382 3762; e-mail: hbrodaty{at}unsw.edu.au

Declaration of interest None.

Background There is controversy about whether late-onset schizophrenia is a precursor of cognitive decline.

Aims To examine the long-term outcome of a group of patients with late-onset schizophrenia.

Method Patients with onset of DSM–III–R schizophrenia at age 50 years or over, but without dementia, and a healthy control group were assessed at baseline (n=27 andn=34, respectively), after 1 year and after 5 years (n=19 and n=24, respectively) on measures of psychopathology, cognition and general functioning, and compared on rates of decline and incidence of dementia.

Results Nine patients with late-onset schizophrenia and none of the control group were found to have dementia (5 Alzheimer type, 1 vascular, 3 dementia of unknown type) at 5-year follow-up. There appeared to be a subgroup of late-onset schizophrenia patients without signs of dementia at baseline or at 1 year follow-up who subsequently declined.

Conclusions Late-onset schizophrenia may be a prodrome of Alzheimer-type dementia. More longitudinal studies are required to determine its nosological status.

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