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Clinical and cognitive diversity of psychotic states arising in late life (late paraphrenia)

Published online by Cambridge University Press:  09 July 2009

O. P. Almeida ,
R. J. Howard ,
R. Levy ,
A. S. David ,
R. G. Morris  and
B. J. Sahakian
O. P. Almeida*
Affiliation:
Section of Old Age Psychiatry, Institute of Psychiatry, London
R. J. Howard
Affiliation:
Section of Old Age Psychiatry, Institute of Psychiatry, London
R. Levy
Affiliation:
Section of Old Age Psychiatry, Institute of Psychiatry, London
A. S. David
Affiliation:
Section of Old Age Psychiatry, Institute of Psychiatry, London
R. G. Morris
Affiliation:
Section of Old Age Psychiatry, Institute of Psychiatry, London
B. J. Sahakian
Affiliation:
Section of Old Age Psychiatry, Institute of Psychiatry, London
*
1Address for correspondence: Professor Osvaldo P. Almeida, Departamento de Psiquiatria da FMUSP, Rua Dr Ovidio Pires de Campos S/N, São Paulo – SP, CEP: 05403–010, Caixa Postal 8091, Brazil.
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Synopsis

This study aimed to explore the heterogeneity of paranoid psychosis with onset in late life by using cognitive factors in a centroid method of cluster analysis. Forty-seven subjects were allocated to two different clusters, the first with 24 (51·1 %) and the second with 23 (48·9 %) patients. Their cognitive attainment was evaluated against the performance of 33 elderly controls, all groups being matched for age, sex, and the numbers of years of education. Patients in cluster 2 showed a pattern of widespread cognitive impairment, which involved general measures of cognitive performance (MMSE, CAMCOG, WAIS-R verbal and performance scores), memory (digit and spatial span, delayed matching-to-sample, recognition memory for words and faces), and executive functions (verbal fluency, extra and intra-dimensional shift ability, spatial working memory, and planning). In contrast, patients in cluster 1 were only impaired on their extra-dimensional set shift and planning abilities, suggesting a more specific and restricted executive functioning deficit. We also analysed the impact that the use of antipsychotic medication could have had on patients' cognitive performance, which was shown to be negligible. In addition, there was no difference between the clusters with regard to the number of patients using neuroleptics, suggesting that the medication was unlikely to have introduced a performance bias in the two patient clusters. The validity of the subdivision of these patients into two separate groups was further supported by other clinical findings. Patients in cluster 1 exhibited more severe psychotic symptoms, as measured by the SAPS, than their counterparts in cluster 2, and were also more likely to display first-rank symptoms of Schneider. Conversely, cluster 2 membership was strongly associated with the presence of neurological signs and negative symptoms. We suggest that psychotic states arising in late life are a heterogeneous condition that may be best divided in two: ‘type A’, including patients with a wide range of psychotic symptoms, mild increase in the frequency of neurological signs, and cognitive deficits restricted to executive functions, and ‘type B’, which includes patients with less complex psychotic symptoms associated with a marked increase in the frequency of neurological signs and generalized cognitive impairment. The basis for this subdivision and the prospect for future studies are discussed.

Type
Original Articles
Information
Psychological Medicine , Volume 25 , Issue 4 , July 1995 , pp. 699 - 714
Copyright
Copyright © Cambridge University Press 1995

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