Age Disorientation in Schizophrenia

Age-disoriented patients are cognitively more impaired than their age-oriented counterparts.
Whether the cognitive impairment is present to a greater degree premorbid among these patients, studies have not yet established this, but some data support this.
Others have reported that rated school performance and grade-level do not distinguish age-disoriented from age-oriented subjects.
Some have suggested that marked cognitive decline occurs following the first break.
Harvey et al. reported that age-related decline in mini-mental state examination scores is dramatically greater among age-disoriented schizophrenia patients than age-oriented subjects, consistent with more rapid deterioration.
Examination of the specific PANSS items revealed that the age-disoriented group was consistently more delusional and more conceptually disorganized and showed increased stereotyped thinking, motor retardation, unusual thought content, disorientation, and poor attention.
There was no relationship between the proximity of assessment month to birth month and the severity of age disorientation.
There was no relationship between total mini-mental state examination score and either rote memory on the Miller-Selfridge recall task context memory on the same recall task or the type/token ratio generated from the speech sample.
Age-disoriented patients have certain more severe psychiatric symptoms, more voluntary motor disturbances, more orofacial involuntary movements, and more severe non-localizing sensory signs.
Most of the assessed cognitive abilities of the age disoriented (i.e., mini-mental state examination performance, context memory, speech repetitiveness) are more disrupted than those of matched age-oriented schizophrenic control subjects.
Within the age-disoriented group, there was no relationship between mini-mental state examination total scores and other cognitive features, suggesting that age disorientation is not merely an issue of increased severity.
More severe motor abnormalities predict poor outcome.
Studies have associated the emergence of involuntary orofacial movements with more severe cognitive decline among schizophrenic samples, irrespective of age disorientation.

References

Harvey PD, Lombardi J, Kincaid MM, et al: Cognitive functioning in chronically hospitalized schizophrenic patients: age-related changes and age disorientation as predictor of impairment. Schizophr Res 1995; 17:15–24
Liddle PF, Crow TJ: Age disorientation in chronic schizophrenia is associated with global intellectual impairment. Br J Psychiatry 1984; 144:193–199
Burich N, Crow TJ, Johnstone EC, et al: Age disorientation in chronic schizophrenia is not associated with pre-morbid intellectual impairment or past physical treatment. Br J Psychiatry 1988; 152:466–469
Johnstone EC, Macmillan JF, Frith CD, et al: Further investigation of the predictors of outcome following first schizophrenic episodes. Br J Psychiatry 1990; 157:182–189
Turner TH: A diagnostic analysis of the casebook of Ticehurst House Asylum, 1845–1890. Psychol Med 1992; 21(suppl):1–70
Waddington JL, Youssef HA: Cognitive dysfunction in chronic schizophrenia followed prospectively over 10 years and its longitudinal relationship to the emergence of tardive dyskinesia. Psychol Med 1996; 26:681–688

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