Thursday, 21 August 2003
This presentation is part of : Thursday Poster Sessions

PD-059 Aging Impact on Cognitive Outcome in Schizophrenia versus Bipolar Disorder

Mircea Polosan, Psychiatry, University Hospital of Grenoble, Grenoble cedex 9, France, Thierry Gallarda, Psychiatry, Service Hospitalo Universitaire, Paris, France, Thierry Bougerol, University department of psychiatry, University Hospital of Grenoble, Grenoble cedex 9, France, and Jean-Pierre Olié, University department of psychiatry, Sainte-Anne Hospital, Paris, France.

Objective: Dementia is a clinical and public health issue of growing importance as life expectancy increases across the world. Currently, there is only limited information available about the simultaneous impact of aging and mental illness on the evolution of the cognitive functions. Despite the schizophrenia’s kraepelinian given name of “precox dementia,” supported by the initial considerations on the downgrading cognitive outcome of the illness, recent trials are questioning the gradual progression of the cognitive decline in all types of schizophrenia.

Conversely, the good prognosis awarded indiscriminately to all manic-depressive illnesses has been largely called into question lately, as well. This study's objective was to evaluate cognitive outcome in elderly schizophrenic and bipolar patients.

Study Design: Objective cognitive testing appears to be the most logical approach to screening for dementia. This comparative transverse study focuses on the cognitive performances of elderly schizophrenics and bipolars, assessed by means of a short cognitive battery of tests (B2C). This battery has already been successfully used in screening elderly patients for early dementia-type disorders.

Methods: Two homogenous outpatients groups, consisting of 32 elderly clinically-stabilized schizophrenics and 40 elderly euthymic bipolars of type I and II, closely monitored though consultations, have been evaluated using B2C. Patient groups were matched according to age, gender, educational level and duration of illness. This battery of tests includes: temporal orientation, the five-word memory test, the clock drawing test, and verbal fluency. Their autonomy has been evaluated also, as a measure of the cognitive troubles' impact.

Results: The cognitive profile of the two groups of patients did not turn out to be significantly different. Both groups showed similar memory performances. Any significant difference was noticed on executive and visuo-constructive functions as explored by the clock drawing test. The schizophrenic group showed significant impairment on verbal fluency in comparison with bipolar patients but the difference was no more significant when adjusted by educational level factor. These results are in agreement with some other published study results and are contrasting with the findings for young adults.

Conclusion: These results tend to indicate that the cognitive differences noticed between young patients affected by schizophrenia and those affected by bipolar disorders are becoming blurred under the cumulated effects of aging and mental illness. Further studies, especially longitudinal ones, are required for additional confirmation and for a better understanding of the interactions between mental disorders and old age.

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