Cognitive Functioning in Late-Life Schizophrenia: Its Importance and Implications for Overall Outcome

Cognitive impairment is an intrinsic feature of schizophrenia and a discriminating factor between patients who require high and low levels of community support. Although it was long believed that positive and disorganized symptoms of schizophrenia “burned out” over time and only negative or deficit symptoms would be detected in late life, several recent studies have suggested that this conception is not fully accurate. However, patients who are unable to care for themselves and suffer from deficits in adaptive life functioning often have negative symptoms as well as severe cognitive impairment. The strong correlation with cognitive function, even when the severity of negative symptoms is considered, suggests that interventions aimed at improvement of adaptive outcome may be targeted at enhancement of cognition. These interventions may include atypical neuroleptic medications and augmentation strategies directly targeting cognition with specific agents that may not affect the positive or negative symptoms of the illness.