Skip to main content Accessibility help

Late-onset-psychosis: cognition

  • Caroline Girard (a1) (a2) (a3), Martine Simard (a1) (a2), Robert Noiseux (a3), Louis Laplante (a1), Michel Dugas (a4), François Rousseau (a5), Nadine Gagnon (a5), François Primeau (a3), Evelyn Keller (a5) and Patrick J. Bernier (a6)...


Background: The objectives of the study were to characterize and compare the cognitive profile and natural evolution of patients presenting late-onset psychotic symptoms (LOPS: onset ≥50 years old) to those of elderly patients (≥50 years old) with life-long/early-onset schizophrenia (EOS: onset <40 years old).

Methods: Neuropsychological profiles of 15 LOPS patients were compared to those of 17 elderly EOS patients and to those of two control groups (n = 11/group). The evolution of the two patient groups was compared using an independent diagnostic consensual procedure involving a geriatric psychiatry physician/clinician and a neuropsychologist blinded to the initial psychiatric diagnosis.

Results: EOS presented significant memory and executive impairments when compared to controls but there was no significant difference between LOPS and their controls when age and education were taken into account. However, a detailed inspection of normative data suggests more executive impairments in LOPS than in EOS. The clinical judgment of experts was in favour of significant cognitive deficits with or without dementia in most LOPS (82.3%–94.1%) and EOS (80.0%–93.3%) patients. Regarding evolution, mild cognitive impairment (MCI) and vascular cognitive impairment (VCI) were the most common clinical diagnoses made by geriatric psychiatry physicians/clinicians for the LOPS (40%). In addition, 20% of LOPS versus 5.9% of EOS patients met the diagnostic criteria for dementia by consensus of the experts. Cerebral abnormalities were confirmed (CT scan; SPECT) in 73.3% of LOPS patients.

Conclusion: The present results suggest cognitive deficits (mostly of executive functions) and vascular and neurodegenerative vulnerability in LOPS. Further studies with larger samples are needed to confirm the present findings.


Corresponding author

Correspondence should be addressed to: Caroline Girard, Ph.D., School of psychology, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Laval University, Québec, Canada, G1V 0A6. Phone: +1 418 656 2131; Fax: +1 418 656 3646. Email:


Hide All
Andreasen, N. C. (1983). Scale for the Assessment of Negative Symptoms (SANS). Iowa City: University of Iowa.
Andreasen, N. C. (1984). Scale for the Assessment of Positive Symptoms (SAPS). Iowa City: University of Iowa.
Bondi, M. W. et al. (1994). Preclinical cognitive markers of dementia of the Alzheimer's type. Neuropsychology, 8, 374384.
Bowler, J. V. and Hachinski, V. (eds.) (2003). Vascular Cognitive Impairment: Preventable Dementia. Oxford: Oxford University Press.
Bozikas, V. P., Kovari, E., Bouras, C. and Karavatos, A. (2002). Neurofibrillary tangles in elderly patients with late onset schizophrenia. Neuroscience Letters, 324, 109112.
Brodaty, H., Sachdev, P., Koschera, A., Monk, D. and Cullen, B. (2003). Long-term outcome of late-onset schizophrenia: 5-year follow-up study. British Journal of Psychiatry, 183, 213219.
Cahn, D. A. et al. (1995). Detection of dementia of the Alzheimer type in a population-based sample: neuropsychological test performance. Journal of the International Neuropsychological Society, 1, 252260.
Canadian Study of Health and Aging Working Group (1994) Canadian Study of Health and Aging: study methods and prevalence of dementia. Canadian Medical Association Journal, 150, 899912.
Casanova, M. F., Stevens, J. R., Brown, R., Royston, C. and Bruton, C. (2002). Distangling the pathology of schizophrenia and paraphrenia. Acta Neuropathologica, 103, 313320.
Chui, H. C., Victoroff, J. I., Margolin, D., Jaqust, W., Shankle, R. and Katzman, R. (1992). Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer's Disease Diagnostic and Treatment Center. Neurology, 42, 473480.
Cohen, J. (1992). Statistical power analysis. Current Directions in Psychological Sciences, 1, 98101.
Canadian Pharmacists Association (2010). Compendium of Pharmaceuticals and Specialties: The Canadian Drug Reference for Health Professionals. Ottawa: Canadian Pharmacists Association.
Delis, D. C., Kramer, J. H., Kaplan, E. and Ober, B. A. (2000). California Verbal Learning Test–II, Second Edition. San Antonio, TX: The Psychological Corporation.
Delis, D. C., Kaplan, E. and Kramer, J. H. (2001). Delis Kaplan Executive System. San Antonio, TX: The Psychological Corporation.
Erkinjuntti, T. and Gauthier, S. (2009). The concept of vascular cognitive impairment. Frontiers of Neurology and Neurosciences, 24, 7985.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatry Research, 12, 189198.
Girard, C. and Simard, M. (2008). Clinical characterization of late- and very-late-onset first psychotic episode in psychiatric inpatients. American Journal of Geriatric Psychiatry, 16, 478487.
Gold, J. M., Randolph, C., Carpenter, C. J., Goldberg, T. E. and Weinberger, D. R. (1992). Forms of memory failure in schizophrenia. Journal of Abnormal Psychology, 101, 487494.
Graham, J. E. et al. (1997). Prevalence and severity of cognitive impairment with and without dementia in an elderly population. Lancet, 349, 17931796.
Heaton, R. K., Gladsjo, J. A., Palmer, B. W., Kuck, J., Marcotte, T. D. and Jeste, D. V. (2001). Stability and course of neuropsychological deficits in schizophrenia. Archives of General Psychiatry, 58, 2432.
Heaton, R. et al. (1994). Neuropsychological deficits in schizophrenics: relationship to age, chronicity and dementia, Archives of General Psychiatry, 51, 469476.
Heinrichs, R. W. and Zarkanis, K. K. (1998). Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology, 12, 426445.
Hoff, A. L. et al. (1996). A neuropsychological study of early onset schizophrenia. Schizophrenia Research, 20, 2128.
Hopkins, B. and Roth, M. (1953). Psychological test performance in patients over sixty. II. Paraphrenia, arteriosclerotic psychosis and acute confusion. Journal of Mental Sciences, 99, 451463.
Howard, R., Rabins, P. V.Seeman, M. V.Jeste, D. V., and the International Late-Onset Schizophrenia Group (2000). Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus. American Journal of Psychiatry, 157, 172178.
Howard, R. (2001). Late-onset schizophrenia and very late-onset schizophrenia-like psychosis. Review in Clinical Gerontology, 11, 337352.
Huang, C. and Zhang, Y. (2009). Clinical differences between late-onset and early-onset chronically hospitalized elderly schizophrenic patients in Taiwan. International Journal of Geriatric Psychiatry, 24, 11661172.
Hung, G.B.K. (2007). A comparison of two methods for calculating total antipsychotic dose. Hong Kong Journal of Psychiatry, 17, 8790.
Jeste, D. V. et al. (1995). Clinical and neuropsychological characteristics of patients with late-onset schizophrenia. American Journal of Psychiatry, 152, 722730.
Jeste, D. V. et al. (1998). Relationship of neuropsychological and MRI measures to age of onset of schizophrenia. Acta Psychiatrica Scandinavica, 98, 156164.
Kerssens, C. J., Pijnenburg, Y. A., Schouws, S., Eikelenboom, P. and van Tilburg, W. (2006). [Late-onset schizophrenia: is it a dementia nonpraecox? Review article with advice on differential diagnosis]. Tijdschrift voor Psychiatrie, 48, 717727.
Kohler, S., van Os, J., de Graaf, R., Vollebergh, W., Verhey, F. and Krabbendam, L. (2007). Psychosis risk as a function of age at onset: a comparison between early- and late-onset psychosis in a general population sample. Social Psychiatry and Psychiatric Epidemiology, 42, 288294.
Korner, A., Lopez, A. G., Lauritzen, L., Andersen, P. K. and Kessing, L. V. (2008). Delusional disorder in old age and the risk of developing dementia: a nationwide register-based study. Aging and Mental Health, 12, 625629.
Korner, A., Lopez, A. G., Lauritzen, L., Andersen, P. K. and Kessing, L. V. (2009a). Acute and transient psychosis in old age and the subsequent risk of dementia: a nationwide register-based study. Geriatrics and Gerontology International, 9, 6268.
Korner, A., Lopez, A. G., Lauritzen, L., Andersen, P. K. and Kessing, L. V. (2009b). Late and very-late first-contact schizophrenia and the risk of dementia: a nationwide register based study. International Journal of Geriatric Psychiatry, 24, 6167.
Lagodka, A. and Robert, P. (2009). [Is late-onset schizophrenia related to neurodegenerative processes? A review of literature]. L'Encephale, 35, 386393.
Lopez, O. L., Becker, J. T. and Sweet, R. A. (2005). Non-cognitive symptoms in mild cognitive impairment subjects. Neurocase, 11, 6571.
Masur, D. M., Sliwinski, M., Lipton, R. B. and Blau, A. D. (1994). Neuropsychological prediction of dementia and the absence of dementia in healthy elderly persons. Neurology, 44, 14271432.
Mattis, S. (2001). Dementia Rating Scale–2. Lutz, FL: Psychological Assessment Resources Inc.
McKeith, I. G. et al. (2005). Diagnosis and management of dementia with Lewy bodies: Third Report of the DLB Consortium. Neurology, 27, 18631872.
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939944.
Mesulam, M. M. and Weintraub, S. (1992). Spectrum of primary progressive aphasia. Ballieres Clinical Neurology, 1, 583609.
Mishara, A. L. and Goldberg, T. E. (2004). A meta-analysis and critical review of the effects of conventional neuroleptic treatment on cognition in schizophrenia: opening a closed book. Biological Psychiatry, 15, 10131022.
Nabalamba, A. and Patten, S. B. (2010). Prevalence of mental disorders in a Canadian household population with dementia. Canadian Journal of Neurological Sciences, 37, 186194.
Neary, D. et al. (1998). Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology, 51, 15461554.
Paulsen, J. S. et al. (1995). The nature of learning and memory impairments in schizophrenia. Journal of the International Neuropsychological Society, 1, 8899.
Petersen, R. C. (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256, 183194.
Rabins, P. V. and Lavrisha, M. (2003). Long-term follow-up and phenomenologic differences distinguish among late-onset schizophrenia, late-life depression, and progressive dementia. American Journal of Geriatric Psychiatry 11, 589594.
Rajji, T. K., Ismail, Z. and Mulsant, B. H. (2009). Age at onset and cognition in schizophrenia: meta-analysis. British Journal of Psychiatry, 195, 286293.
Reeves, R. R. and Brister, J. C. (2008). Psychosis in late life: emerging issues. Journal of Psychosocial Nursing and Mental Health Services, 46, 4552.
Román, G. C. et al. (1993). Vascular dementia diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology, 43, 250260.
Rouleau, I., Salmon, D. P., Butters, N., Kennedy, C. and McGuire, K. (1992). Quantitative and qualitative analyses of clock drawings in Alzheimer's and Hungtington's disease. Brain and Cognition, 18, 7087.
Sachdev, P., Brodaty, H., Rose, N. and Cathcart, S. (1999). Schizophrenia with onset after age 50 years. 2: Neurological, neuropsychological and MRI investigation. British Journal of Psychiatry, 175, 416421.
Saykin, A. J., Gur, R. E., Mozley, P. D., Resnick, S. M., Kester, D. B. and Stafiniak, P. (1991). Neuropsychological function in schizophrenia: selective impairment in memory and learning. Archives of General Psychiatry, 48, 618624.
Shay, K. A. et al. (1991). The clinical validity of the Mattis Dementia Rating Scale in staging Alzheimer's dementia. Journal of Geriatric Psychiatry and Neurology, 4, 1825.
Simard, M. and Grandmaison, E. (2006). Les déficits des fonctions visuospatiales dans la schizophrénie: l'hypothèse d'une dysfonction fronto-temporale peut-elle tout expliquer? Revue de Neuropsychologie, 16, 79115.
Stip, E. (2006). Cognition, schizophrenia and the effects of antipsychotics. L'Encephale, 32, 341350.
Teng, E. L. and Chui, H. C. (1987). The Modified Mini-Mental State (3MS) examination. Journal of Clinical Psychiatry, 48, 314318.
Tierney, M. C., Szalai, J. P., Snow, W. G. and Fisher, R. H. (1996). The prediction of Alzheimer disease: the role of patient and informant perceptions of cognitive deficits. Archives of Neurology, 53, 423427.
Tuulio-Henriksson, A., Partonen, T., Suvisaari, J., Haukka, J. and Lönqvist, J. (2004). Age at onset and cognitive functioning in schizophrenia. British Journal of Psychiatry, 185, 215219.
Wechsler, D. (1997). Wechsler Adult Intelligence Test – Third Edition. San Antonio, TX: The Psychological Corporation.
Wynn Owen, P. A. and Castle, D. J. (1999). Late-onset schizophrenia: epidemiology, diagnosis, management and outcomes. Drugs and Aging, 15, 8189.
Zakzanis, K. K., Andrikopoulos, J., Young, D. A., Campbell, Z. and Sethian, T. (2003). Neuropsychological differentiation of late-onset schizophrenia and dementia of the Alzheimer's type. Applied Neuropsychology, 10, 105114.


Related content

Powered by UNSILO

Late-onset-psychosis: cognition

  • Caroline Girard (a1) (a2) (a3), Martine Simard (a1) (a2), Robert Noiseux (a3), Louis Laplante (a1), Michel Dugas (a4), François Rousseau (a5), Nadine Gagnon (a5), François Primeau (a3), Evelyn Keller (a5) and Patrick J. Bernier (a6)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.