Cognitive dysfunction in chronic schizophrenia followed prospectively over 10 years and its longitudinal relationship to the emergence of tardive dyskinesia

Abstract

SynopsisBasic cognitive function was assessed at initial and at 5- and 10-year follow-up assessments among 41 primarily middle-aged in-patients manifesting the severest form of schizophrenia; additionally, the presence and severity of tardive dyskinesia was evaluated on each occasion. Overall, there was a modest but significant deterioration in cognitive function over the decade, particularly among older men. Longitudinally, patients with persistent tardive (orofacial) dyskinesia continued to show poorer cognitive function than those consistently without such movement disorder, though within neither group did cognitive function change over the decade. Those patients demonstrating prospectively the emergence of orofacial dyskinesia showed a marked deterioration in their cognitive function over the same time-frame within which their movement disorder emerged, but this decline did not progress further thereafter. There appears to exist some modest, progressive deterioration in cognitive function even late in the chronic phase of severe schizophrenic illness which appears to derive primarily from patients showing de novo emergence of tardive orofacial dyskinesia.

Tardive dyskinesia in a chronically institutionalized population of elderly schizophrenic patients: prevalence and association with cognitive impairment

“…The fact that 40% of the present sample did not manifest TD despite a duration of neuroleptic exposure and an average duration of mental illness exceeding 40 years clearly suggests that individuals dier in their susceptibility to the disorder. Consistent with previous reports (Hayashi et al, 1996;Smith and Baldasserini, 1980;Waddington and Youssef, 1996), patients with TD were on average older than those without. Mean MMSE scores did not dier between groups of patients with and without TD as de®ned by the criteria of Schooler and Kane; however, MMSE scores were signi®cantly lower in subjects who met the criteria of Waddington and Youssef (1996) for orofacial TD.…”

“…Consistent with previous reports (Hayashi et al, 1996;Smith and Baldasserini, 1980;Waddington and Youssef, 1996), patients with TD were on average older than those without. Mean MMSE scores did not dier between groups of patients with and without TD as de®ned by the criteria of Schooler and Kane; however, MMSE scores were signi®cantly lower in subjects who met the criteria of Waddington and Youssef (1996) for orofacial TD. When the individual orofacial regions (ie face, lips, tongue, jaw) were examined separately, MMSE scores were found to be signi®cantly lower in subjects with abnormal movements of the lips, and a trend in the same direction was seen for subjects with lingual involvement.…”

“…These criteria require a rating of at least 2 (mild) in two separate regions or a rating of 473±479 (1998) at least 3 (moderate) in any single region. In addition, we identi®ed a subset of patients with orofacial TD according to the criteria of Waddington and Youssef (1996). These criteria apply the Schooler and Kane criteria solely to the oral and facial regions (face, lips, tongue, jaw) regardless of whether or not abnormal movements are scored in other regions.…”

“…Prevalence increased with age but was not related to current antipsychotic or anticholinergic regimen. Mean MMSE score did not dier between groups of patients with and without TD as de®ned by the criteria of Schooler and Kane (1982); however, the mean MMSE score was signi®cantly (p 5 0.004) lower in subjects with orofacial TD as de®ned by Waddington and Youssef (1996), and the dierence was not entirely accounted for by the older age of the latter group.Conclusions. TD and cognitive impairment both increase with age.…”

Neuropsychological Performance in Older Patients With Schizophrenia: A Meta-Analysis of Cross-sectional and Longitudinal Studies

“…Early descriptions of schizophrenia by Emil Kraepelin as ''dementia praecox'' led to the contention that cognitive deterioration occurs beyond that found in the initial stages of the illness. Some early studies indicated progressive decline in neurocognitive function with age 9,10 but this has been disputed with indications that deficits later in life are typical of normal aging. [11][12][13] (Irani, et al, unpublished data) Furthermore, postmortem data from elderly patients with schizophrenia has not shown excess of those neuropathological abnormalities found in typical neurodegenerative disorders such as Alzheimer's disease, 14 yet chemical markers such as cortical amines and neuropeptides deficits have been associated with more severe cognitive dysfunction in some patients.…”