Introduction

Since the early 1970s, the application of successive advances in brain imaging techniques to schizophrenia has contributed more than any other area of investigation to the current view that abnormalities of brain structure and function underpin the illness. Until the late 1950s all psychoses arising in later life were regarded as manifestations of organic brain pathology, so it is ironic that brain imaging studies of such patients have had a tendency to appear in the literature at least five years after those involving younger subjects with schizophrenia. Despite these delays and the relative paucity of studies, what appears to be emerging from the literature is that the brain imaging findings from populations of patients with an onset of schizophrenia, or a paranoid state, in late life parallel those from younger-onset cases. This chapter reviews the findings of those structural and functional brain imaging studies that have examined patients with schizophrenic or paranoid symptomatology that has onset in old age.

The classification of paranoid and schizophrenic disorders of late life remains controversial. Undoubtedly disagreement over nosology has hindered research, including neuroimaging studies of these conditions. It also makes direct comparison between the studies that do exist difficult, as not all researchers have used the same diagnostic groupings. The following terms have been proposed and, as they will be used in this chapter, brief definitions are provided here.

Late onset schizophrenia

This refers to patients who satisfy diagnostic criteria for schizophrenia but who have an illness onset after a certain age, though the age cut-off chosen does vary.