Kerssens C J, Pijnenburg Y A L, Schouws S, Eikelenboom P, van Tilburg W
GGZ Buitenamstel Amsterdam.
Tijdschr Psychiatr. 2006;48(9):717-27.
For many years now researchers have been discussing whether late-onset schizophrenia (LOS) is in fact a separate subgroup of schizophrenia. They also want to find out whether LOS has a neurodegenerative aetiology and is a progressive illness.
To obtain insight into the clinical aspects, aetiological factors and the course of late-onset schizophrenia. In addition, advice is given about better ways of diagnosing LOS in clinical practice and about differentiating LOS from dementia.
The literature was searched via Medline and the Cochrane Library on the basis of the key words '(very) late-onset schizophrenia' and 'paraphrenia' combined with 'course', 'outcome', 'cognition', 'decline', 'white matter hyperintensities', 'MRI', and 'neuropsychological', 'postmortem' and cerebrospinal fluid'. The period studied was from 1960 to November 2004.
Clinical parameters andfunctional and structural brain research point to differences from and similarities to the early form of schizophrenia (EOS). In cases of 'very-late-onset schizophrenia-like psychosis' (VLOS) the clinical differences vis-à-vis EOS are even more marked. It is not known to what extent neurodegenerative factors play a role. There is no clear consensus about the course of (V)LOS either.
In view of the aetiologial and physiopathological factors it is still not clear whether (V)LOS can be differentiated from EOS on a neurobiological basis. There is insufficient proof about the extent to which (V)LOS is a dementia nonpraecox with neurodegenerative aetiology. To achieve clear differentiation between the various forms of dementia it is essential that the clinical diagnosis of LOS is supported as strongly as possible and is evaluated continually.
多年来，研究人员一直在讨论晚发性精神分裂症（LOS）是否实际上是精神分裂症的一个独立亚组。他们还想弄清楚LOS是否具有神经退行性病因以及是否为进行性疾病。
深入了解晚发性精神分裂症的临床特征、病因因素及病程。此外，就临床实践中更好地诊断LOS以及将LOS与痴呆症相鉴别提供建议。
通过Medline和Cochrane图书馆，以关键词“（极）晚发性精神分裂症”和“妄想痴呆”，结合“病程”“转归”“认知”“衰退”“白质高信号”“磁共振成像”以及“神经心理学”“尸检”和“脑脊液”进行文献检索。研究时间段为1960年至2004年11月。
临床参数以及脑功能和结构研究表明，LOS与早发性精神分裂症（EOS）既有差异又有相似之处。在“极晚发性精神分裂症样精神病”（VLOS）病例中，与EOS的临床差异更为明显。目前尚不清楚神经退行性因素在多大程度上起作用。对于（V）LOS的病程也没有明确的共识。
鉴于病因学和生理病理学因素，目前仍不清楚（V）LOS是否能在神经生物学基础上与EOS区分开来。关于（V）LOS在多大程度上是一种具有神经退行性病因的非早发性痴呆，证据不足。为了在各种形式的痴呆之间实现明确区分，至关重要的是，LOS的临床诊断应尽可能得到有力支持并持续进行评估。
