Arnold S E, Trojanowski J Q
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, USA.
Schizophr Bull. 1996;22(1):5-9. doi: 10.1093/schbul/22.1.5.
Recent clinical and neuropsychological studies have shown that severe deterioration in cognitive and functional capacities is prevalent in elderly, chronically hospitalized patients with schizophrenia. Postmortem studies of tissue from patients who were clinically well characterized have found notably little neurodegenerative or other pathology to explain the dementia. In contrast, several large studies using archival material have reported an unexpectedly high occurrence of Alzheimer's disease pathology in patients with schizophrenia irrespective of clinical status. Reasons for conflicting results likely include inaccuracies in psychiatric diagnoses but also could be due to differences in sample selection, treatment histories, and environmental influences. Thus, the neurobiological substrates for dementia in late-life schizophrenia remain uncertain. Further studies should incorporate standard diagnostic procedures with community-based and institutionalized schizophrenia patients as well as psychiatric control patients with similar treatment histories. These should apply sensitive neuropathological methods to assess disease-specific and nonspecific markers of neurodegeneration and dementia.
近期的临床和神经心理学研究表明，认知和功能能力的严重衰退在患有精神分裂症的老年慢性住院患者中很普遍。对临床特征明确的患者组织进行的尸检研究发现，几乎没有神经退行性变或其他病理学特征可以解释这种痴呆症。相比之下，几项使用存档材料的大型研究报告称，无论临床状态如何，精神分裂症患者中阿尔茨海默病病理学的发生率出奇地高。结果相互矛盾的原因可能包括精神科诊断的不准确，但也可能是由于样本选择、治疗史和环境影响的差异。因此，晚年精神分裂症患者痴呆症的神经生物学基础仍不确定。进一步的研究应将标准诊断程序应用于社区和机构化的精神分裂症患者以及具有相似治疗史的精神科对照患者。这些研究应采用敏感的神经病理学方法来评估神经退行性变和痴呆症的疾病特异性和非特异性标志物。
