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Cognitive features 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

The cognitive performance of 47 elderly psychotic patients with onset of symptoms in late life (late paraphrenia) was compared to that of 33 controls matched for age, sex, ethnic origin, number of years of education, and pre-morbid IQ as measured by the NART. Neuropsychological indices of general cognitive functioning (MMSE, CAMCOG, WAIS-R verbal and performance scores) showed that patients were performing the tasks at a significantly lower level than controls. Patients also showed a trend to have a lower span capacity than controls, particularly at the spatial span subtest. There was no obvious impairment of learning as measured by the digit and spatial recurring span tasks nor of simultaneous matching-to-sample ability. However, patients' performance on a delayed-matching-to-sample procedure was significantly worse than that of controls. In addition, patients performed worse than controls on the Recognition Memory Test for Faces, but not for Words. Finally, the performance of patients on tests assessing executive functioning (Verbal Fluency Test, Computerized Extra and Intra-Dimensional Shift Task, Computerized Spatial Working Memory Task, and Computerized Tower of London Task) was consistently worse than that of controls. These results suggest that psychotic states arising in late life are predominantly associated with a decline on measures of general cognitive ability and executive functioning. The neuropsychological meaning of these findings is discussed in the light of cognitive models of psychotic symptoms, as well as of schizophrenia and dementia research. We concluded that the lack of a clear pattern of impairment among these patients may be the result of their clinical and cognitive diversity.

Type
Original Articles
Information
Psychological Medicine , Volume 25 , Issue 4 , July 1995 , pp. 685 - 698
Copyright
Copyright © Cambridge University Press 1995

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