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Long-Term Follow-up and Phenomenologic Differences Distinguish Among Late-Onset Schizophrenia, Late-Life Depression, and Progressive Dementia

Received March 26, 2003; revised May 19, 2003; accepted August 28, 2003. From the Departments of Psychiatry and Behavioral Sciences (PVR,ML), and the Departments of Medicine, Health Policy and Management, and Mental Health (PVR), Johns Hopkins Medical Institutions, Baltimore, MD. Send correspondence to Peter V. Rabins, M.D., M.P.H. Meyer 279, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287-7279. e-mail: pvrabins{at}jhmi.edu

Objective: The diagnosis of patients with late-life onset of hallucinations and delusions but an absence of mood or cognitive disorder remains controversial. The authors used long-term follow-up and phenomenology to assess whether outcome varied by diagnosis. Methods: Twenty-eight individuals with late-life psychosis but no mood or cognitive disorder were compared with 48 individuals with late-life major depression and 47 individuals with psychotic symptoms and late-life dementia. All subjects were followed for a minimum of 1 year. Data from the last time examined were used to determine likelihood of death at 84 months by Kaplan-Meier analysis in all groups and the likelihood of developing dementia in the depression and late-life onset psychosis groups at 120 months. Results: Patients with dementia-plus-psychosis were more likely to die at 84 months than those with major depression or late-onset hallucinations and delusions. Subjects with depression or late-onset hallucinations and delusions did not differ in likelihood of developing dementia at 120 months. Conclusions: These results support the hypothesis that a condition characterized by psychiatric symptoms and no mood symptoms can begin in later life and that this disorder is not a precursor to dementia.

Key Words: Schizophrenia • Depression • Dementias