The dementias of schizophrenia

Oliveira-Souza, Ricardo de; Marrocos, Rogério Paysano; Moll, Jorge

doi:10.1590/S1980-57642008DN10200003

Abstract

Cases of "adolescent insanity" were known to Kraepelin's forerunners and lay at the core of his concept of dementia præcox. In the post-neuroleptic era it became clear that dementia may also occur in schizophrenia as a fully reversible state depending on psychopathological status. In the present review we discuss the validity of applying the concept of dementia to schizophrenia. We concur with the view that schizophrenia may lead to a true dementia both (i) as a fixed end-stage consequence of the disease process itself, or (ii) as a drug-responsive reversible state. There is an urgent need to examine the patterns of dementia in other common neuropsychiatric disorders, employing current methods of neurobehavioral investigation.

Key words:
dementia; schizophrenia; dementia præcox.

Resumo

Casos de "insanidade da adolescência" eram conhecidos dos precursores de Kraepelin e repousam na raiz do seu conceito de demência precoce. A era pós-neurolética deixou claro que demência pode ocorrer na esquizofrenia como estado totalmente reversível dependendo do estado psicopatológico. Na presente revisão, discutimos a validade da aplicação do conceito de demência à esquizofrenia. Concordamos que a esquizofrenia pode levar a uma demência verdadeira, tanto (i) como conseqüência do processo patológico, propriamente dito, ou (ii) como estado reversível por tratamento adequado. Fica a necessidade de se examinar os padrões de demência em outras doenças neuropsiquiátricas comuns pelos métodos atuais de investigação neurocomportamental.

Palavras-chave:
demência; esquizofrenia; demência precoce.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

References

¹
Critchley M. The Divine Banquet of the Brain. New York, NY: Raven Press; 1979.
²
M Rizzo, PJ Eslinger, Hilgard ER. The trilogy of mind: cognition, affection, and conation. J Hist Behav Sci 1980;16:107-117.
³
Oliveira-Souza R, Moll J, Eslinger PJ. Neuropsychological assessment. In: M Rizzo, PJ Eslinger, editors. Principles and Practice of Behavioral Neurology and Neuropsychology. New York, NY: Oxford; 2003:47-64.
⁴
Folstein MF, McHugh PR. Dementia syndrome of depression. In: R Katzman, RD Terry, KL Bick, editors. Alzheimer's Disease: Senile Dementia and Related Disorders. New York: Raven Press; 1978:87-96.
⁵
American Psychiatric Association. Diagnostic and Statistic Manual of Mental Disorders, 4th edition (DSM-IV). Washington, DC: American Psychiatric Association; 1994.
⁶
Takada LT, Caramelli P, Radanovic M, et al. Prevalence of potentially reversible dementias in a dementia outpatient clinic of a tertiary university-affiliated hospital in Brazil. Arq Neuropsiquiatr 2003;61:925-929.
⁷
Tatemichi TK, Desmond DW, Prohovnik I. Strategic infarcts in vascular dementia. A clinical and brain imaging experience. Arzneimittelforschung 1995;45:371-385.
⁸
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.
⁹
Schultz SK, Andreasen NC. Schizophrenia. Lancet 1999; 353:1425-1430.
¹⁰
Andreasen NC, Black DW. Introductory Textbook of Psychiatry, 2nd edition. Washington, DC: Am Psychiatric Press; 1995.
¹¹
Breier A, Schreiber JL, Dyer J, Pickar D. National Institute of Mental Health longitudinal study of chronic schizophrenia. Arch Gen Psychiatry 1991;48:239-246.
¹²
Andreasen NC, Carpenter WT, Kane JM, Lasser RA, Marder SR, Weinberger DR. Remission in schizophrenia: Proposed criteria and rationale for consensus. Am J Psychiatry 2005;162:441-449.
¹³
Keefe RSE, Frescka E, Apter SH, et al. Clinical characteristics of kraepelinian schizophrenia: Replication and extension of previous findings. Am J Psychiatry 1996;153:806-811.
¹⁴
O'Leary DS, Flaum M, Kesler ML, Flashman LA, Arndt S, Andreasen NC. Cognitive correlates of the negative, disorganized, and psychotic symptom dimension of schizophrenia. J Neuropsychiatry Clin Neurosci 2000;12:4-15.
¹⁵
Palmer BW, Heaton RK, Paulsen JS, Kuck J, Braff D, Harris MJ. Is it possible to be schizophrenic yet neuropsychologically normal? Neuropsychology 1997;11:437-446.
¹⁶
Kahlbaum KL. Catatonia. Baltimore: The Johns Hopkins University Press; 1973.
¹⁷
Sedler MJ. The legacy of Ewald Hecker: A new translation of "Die Hebephrenie" (translated by Marie-Louise Schoelly). Am J Psychiatry 1985;142:1265-1271.
¹⁸
Kraepelin E. Kraepelin E. Dementia Præcox and Paraphrenia (Originally published in 1919). Translated by RM Barclay. Huntington, NY: Robert E. Krieger Publishing Co; 1971.
¹⁹
O'Connell P, Woodruff PWR, Wright I, Jones P, Murray RM. Developmental insanity or dementia praecox: was the wrong concept adopted? Schizophr Res 1997;23:97-106.
²⁰
Caramelli P, Viel AH. 100 Anos da Doença de Alzheimer. São Paulo: Segmento Farma; 2006.
²¹
Bleuler E. Dementia Præcox or the Group of Schizophrenias (Originally published in 1911). Translated by Joseph Zinkin. New York: International University Press; 1950.
²²
Zec RF. Neuropsychology of schizophrenia according to Kraepelin: disorders of volition and executive functioning. Eur Arch Psychiatry Clin Neurosci 1995;245:216-223.
²³
Brucki S, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do Mini-Exame do Estado Mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.
²⁴
Benton AL, Sivan AB, Hamsher KS, Varney NR, Spreen O. Contributions to Neuropsychological Assessment. A Clinical Manual, 2nd edition. New York, NY: Oxford UP; 1994.
²⁵
De Renzi E, Faglioni P. Normative data and screening power of a shortened version of the Token Test. Cortex 1978;14:41-49.
²⁶
Grober E, Buschke H, Crystal H, Bang S, Dresner R. Screening for dementia by memory testing. Neurology 1988;38: 900-903.
²⁷
Johnstone EC, Crow TJ, Frith CD, Stevens M, Kreel L, Husband J. The dementia of dementia praecox. Acta Psychiatr Scand 1978;57:305-24.
²⁸
Lawson WB, Waldman IN, Weinberger DR. Schizophrenic dementia. Clinical and computed axial tomography correlates. J Nerv Ment Dis 1988;176:207-212.
²⁹
Brown R, Colter N, Corsellis JAN, et al. Postmortem evidence of structural brain changes in schizophrenia. Differences in brain weight, temporal horn area, and parahippocampal gyrus compared with affective disorders. Arch Gen Psychiatry 1986;46:36-42.
³⁰
Crow WJ, Mitchell WS. Subjective age in chronic schizophrenia: Evidence for s sub-group of patients with defective learning capacity? Br J Psychiatry 1975;126:360-363.
³¹
Oliveira-Souza R, Marrocos RP, Passman LJ. Postural and gait abnormalities in schizophrenia. J Neurol Sci 1997;150(suppl 1)S46.
³²
Goldberg TE, Gold JM. Neurocognitive deficits in schizophrenia. In: SR Hirsch, DR Weinberger, editors. Schizophrenia. London: Oxford: Blackwell Science; 1995:146-162.
³³
de Vries PJ, Honer WG, Kemp PM, McKenna PJ. Dementia as a complication of schizophrenia. J Neurol Neurosurg Psychiatry 2001;70:588-596.
³⁴
Roberts GW, Royston MC, Weinberger DR. Schizophrenia. In: DI Graham, PL Lantos, editors. Greenfield's Neuropathology. London: Edward Arnold Publishers Ltd. 1997:897-929.
³⁵
Arnold SE, Trojanowski JQ. Cognitive impairment in elderly schizophrenics: A dementia (still) lacking distinctive histopathology. Schizophr Bull 1996;22:5-9.
³⁶
Bruton CJ, Crow TJ, Frith CD, Johnstone EC, Owens DGC, Roberts GW. Schizophrenia and the brain: a prospective clinico-neuropathological study. Psychol Med 1990;20:285-304.
³⁷
Kirkpatrick B, Golden RN, Fletcher RH. Is there a dementia of schizophrenia? Psychiatr Med 1987;4:253-263.
³⁸
Jellinger KA, Gabriel E. No increased incidence of Alzheimer's disease in elderly schizophrenics. Acta Neuropathol 1999;97:165-169.
³⁹
Kiloh LG. Pseudo-dementia. Acta Psychiatr Scand 1961; 37:336-351.
⁴⁰
Mesulam MM. Dementia: Its definition, differential diagnosis, and subtypes. JAMA 1985;253:2559-2561.
⁴¹
Small GW, Jarvik LF. The dementia syndrome. Lancet 1982;2:1443-1446.
⁴²
Wilk CM, Gold JM, McMahon RP, Humber K, Iannone VN, Buchanan RW. No, it is not possible to be schizophrenic yet neuropsychologically normal. Neuropsychology 2005;19:778-786.
⁴³
Green MF, Nuechterlein KH, Gold JM, et al. Approaching a consensus cognitive battery for clinical trials in schizophrenia: The NIMH-MATRICS conference to select cognitive domains and test criteria. Biol Psychiatry 2004;56:301-307.
⁴⁴
Oliveira-Souza R, Marrocos RP, Figueiredo WM. Sustained long-term improvement with clozapine in schizophrenia. Arq Neuropsiquiatr 1999;57:18-22.
⁴⁵
Andreasen NC. A unitary model of schizophrenia. Bleuler's "fragmented phrene" as schizencephaly. Arch Gen Psychiatry 1999;56;781-787.

Publication Dates

Publication in this collection
Apr-Jun 2007

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Critchley M. The Divine Banquet of the Brain. New York, NY: Raven Press; 1979.

[2] ²
M Rizzo, PJ Eslinger, Hilgard ER. The trilogy of mind: cognition, affection, and conation. J Hist Behav Sci 1980;16:107-117.

[3] ³
Oliveira-Souza R, Moll J, Eslinger PJ. Neuropsychological assessment. In: M Rizzo, PJ Eslinger, editors. Principles and Practice of Behavioral Neurology and Neuropsychology. New York, NY: Oxford; 2003:47-64.

[4] ⁴
Folstein MF, McHugh PR. Dementia syndrome of depression. In: R Katzman, RD Terry, KL Bick, editors. Alzheimer's Disease: Senile Dementia and Related Disorders. New York: Raven Press; 1978:87-96.

[5] ⁵
American Psychiatric Association. Diagnostic and Statistic Manual of Mental Disorders, 4th edition (DSM-IV). Washington, DC: American Psychiatric Association; 1994.

[6] ⁶
Takada LT, Caramelli P, Radanovic M, et al. Prevalence of potentially reversible dementias in a dementia outpatient clinic of a tertiary university-affiliated hospital in Brazil. Arq Neuropsiquiatr 2003;61:925-929.

[7] ⁷
Tatemichi TK, Desmond DW, Prohovnik I. Strategic infarcts in vascular dementia. A clinical and brain imaging experience. Arzneimittelforschung 1995;45:371-385.

[8] ⁸
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.

[9] ⁹
Schultz SK, Andreasen NC. Schizophrenia. Lancet 1999; 353:1425-1430.

[10] ¹⁰
Andreasen NC, Black DW. Introductory Textbook of Psychiatry, 2nd edition. Washington, DC: Am Psychiatric Press; 1995.

[11] ¹¹
Breier A, Schreiber JL, Dyer J, Pickar D. National Institute of Mental Health longitudinal study of chronic schizophrenia. Arch Gen Psychiatry 1991;48:239-246.

[12] ¹²
Andreasen NC, Carpenter WT, Kane JM, Lasser RA, Marder SR, Weinberger DR. Remission in schizophrenia: Proposed criteria and rationale for consensus. Am J Psychiatry 2005;162:441-449.

[13] ¹³
Keefe RSE, Frescka E, Apter SH, et al. Clinical characteristics of kraepelinian schizophrenia: Replication and extension of previous findings. Am J Psychiatry 1996;153:806-811.

[14] ¹⁴
O'Leary DS, Flaum M, Kesler ML, Flashman LA, Arndt S, Andreasen NC. Cognitive correlates of the negative, disorganized, and psychotic symptom dimension of schizophrenia. J Neuropsychiatry Clin Neurosci 2000;12:4-15.

[15] ¹⁵
Palmer BW, Heaton RK, Paulsen JS, Kuck J, Braff D, Harris MJ. Is it possible to be schizophrenic yet neuropsychologically normal? Neuropsychology 1997;11:437-446.

[16] ¹⁶
Kahlbaum KL. Catatonia. Baltimore: The Johns Hopkins University Press; 1973.

[17] ¹⁷
Sedler MJ. The legacy of Ewald Hecker: A new translation of "Die Hebephrenie" (translated by Marie-Louise Schoelly). Am J Psychiatry 1985;142:1265-1271.

[18] ¹⁸
Kraepelin E. Kraepelin E. Dementia Præcox and Paraphrenia (Originally published in 1919). Translated by RM Barclay. Huntington, NY: Robert E. Krieger Publishing Co; 1971.

[19] ¹⁹
O'Connell P, Woodruff PWR, Wright I, Jones P, Murray RM. Developmental insanity or dementia praecox: was the wrong concept adopted? Schizophr Res 1997;23:97-106.

[20] ²⁰
Caramelli P, Viel AH. 100 Anos da Doença de Alzheimer. São Paulo: Segmento Farma; 2006.

[21] ²¹
Bleuler E. Dementia Præcox or the Group of Schizophrenias (Originally published in 1911). Translated by Joseph Zinkin. New York: International University Press; 1950.

[22] ²²
Zec RF. Neuropsychology of schizophrenia according to Kraepelin: disorders of volition and executive functioning. Eur Arch Psychiatry Clin Neurosci 1995;245:216-223.

[23] ²³
Brucki S, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do Mini-Exame do Estado Mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.

[24] ²⁴
Benton AL, Sivan AB, Hamsher KS, Varney NR, Spreen O. Contributions to Neuropsychological Assessment. A Clinical Manual, 2nd edition. New York, NY: Oxford UP; 1994.

[25] ²⁵
De Renzi E, Faglioni P. Normative data and screening power of a shortened version of the Token Test. Cortex 1978;14:41-49.

[26] ²⁶
Grober E, Buschke H, Crystal H, Bang S, Dresner R. Screening for dementia by memory testing. Neurology 1988;38: 900-903.

[27] ²⁷
Johnstone EC, Crow TJ, Frith CD, Stevens M, Kreel L, Husband J. The dementia of dementia praecox. Acta Psychiatr Scand 1978;57:305-24.

[28] ²⁸
Lawson WB, Waldman IN, Weinberger DR. Schizophrenic dementia. Clinical and computed axial tomography correlates. J Nerv Ment Dis 1988;176:207-212.

[29] ²⁹
Brown R, Colter N, Corsellis JAN, et al. Postmortem evidence of structural brain changes in schizophrenia. Differences in brain weight, temporal horn area, and parahippocampal gyrus compared with affective disorders. Arch Gen Psychiatry 1986;46:36-42.

[30] ³⁰
Crow WJ, Mitchell WS. Subjective age in chronic schizophrenia: Evidence for s sub-group of patients with defective learning capacity? Br J Psychiatry 1975;126:360-363.

[31] ³¹
Oliveira-Souza R, Marrocos RP, Passman LJ. Postural and gait abnormalities in schizophrenia. J Neurol Sci 1997;150(suppl 1)S46.

[32] ³²
Goldberg TE, Gold JM. Neurocognitive deficits in schizophrenia. In: SR Hirsch, DR Weinberger, editors. Schizophrenia. London: Oxford: Blackwell Science; 1995:146-162.

[33] ³³
de Vries PJ, Honer WG, Kemp PM, McKenna PJ. Dementia as a complication of schizophrenia. J Neurol Neurosurg Psychiatry 2001;70:588-596.

[34] ³⁴
Roberts GW, Royston MC, Weinberger DR. Schizophrenia. In: DI Graham, PL Lantos, editors. Greenfield's Neuropathology. London: Edward Arnold Publishers Ltd. 1997:897-929.

[35] ³⁵
Arnold SE, Trojanowski JQ. Cognitive impairment in elderly schizophrenics: A dementia (still) lacking distinctive histopathology. Schizophr Bull 1996;22:5-9.

[36] ³⁶
Bruton CJ, Crow TJ, Frith CD, Johnstone EC, Owens DGC, Roberts GW. Schizophrenia and the brain: a prospective clinico-neuropathological study. Psychol Med 1990;20:285-304.

[37] ³⁷
Kirkpatrick B, Golden RN, Fletcher RH. Is there a dementia of schizophrenia? Psychiatr Med 1987;4:253-263.

[38] ³⁸
Jellinger KA, Gabriel E. No increased incidence of Alzheimer's disease in elderly schizophrenics. Acta Neuropathol 1999;97:165-169.

[39] ³⁹
Kiloh LG. Pseudo-dementia. Acta Psychiatr Scand 1961; 37:336-351.

[40] ⁴⁰
Mesulam MM. Dementia: Its definition, differential diagnosis, and subtypes. JAMA 1985;253:2559-2561.

[41] ⁴¹
Small GW, Jarvik LF. The dementia syndrome. Lancet 1982;2:1443-1446.

[42] ⁴²
Wilk CM, Gold JM, McMahon RP, Humber K, Iannone VN, Buchanan RW. No, it is not possible to be schizophrenic yet neuropsychologically normal. Neuropsychology 2005;19:778-786.

[43] ⁴³
Green MF, Nuechterlein KH, Gold JM, et al. Approaching a consensus cognitive battery for clinical trials in schizophrenia: The NIMH-MATRICS conference to select cognitive domains and test criteria. Biol Psychiatry 2004;56:301-307.

[44] ⁴⁴
Oliveira-Souza R, Marrocos RP, Figueiredo WM. Sustained long-term improvement with clozapine in schizophrenia. Arq Neuropsiquiatr 1999;57:18-22.

[45] ⁴⁵
Andreasen NC. A unitary model of schizophrenia. Bleuler's "fragmented phrene" as schizencephaly. Arch Gen Psychiatry 1999;56;781-787.

Brasil