Magazine article Clinical Psychiatry News

Myelination Defects May Play Key Role in Schizophrenia. (Cognitive Decline in Later Life)

Magazine article Clinical Psychiatry News

Myelination Defects May Play Key Role in Schizophrenia. (Cognitive Decline in Later Life)

Article excerpt

NEW YORK -- Cognitive function is not stable in schizophrenia and undergoes sparked deterioration later in life Dr. Kenneth L. Davis said at the annual meeting of the Association for Research in Nervous and Mental Disease.

A likely suspect is the diminished expression of genes responsible for myelination mediated by oligodendrocytes, said Dr. Davis, professor and chair of psychiatry at Mount Sinai School of Medicine, New York.

The conventional wisdom is that schizophrenia represents a "static lesion" whose cognitive deficits do nor progress. But his unit's experience with a large number of long-term patients from a state psychiatric center suggests otherwise, Dr. Davis said.

A survey showed a sharp decline around 65 years of age; a mean Mini-Mental Status Examination score of 13 was found in the older age group.

Subsequently, a longitudinal study of 1,103 patients with late-life schizophrenia showed substantial functional deterioration, as indicated by scores on the Clinical Dementia Rating Scale. Of the 457 patients who were able to care for themselves at the outset, more than half demonstrated marked declines in capacity for activities of daily life 6 years later.

Comorbid Alzheimer's disease or vascular dementia probably was not responsible: Postmortem studies of 100 patients from this group showed no evidence of neuropathology or dementia in 65%. In fact, cognitive impairment was worse in those patients who had no signs of organic disease, Dr. Davis said.

Medical comorbidity that appeared in the course of the study period was also unrelated to cognitive or functional deterioration.

Dr. Davis described diverse research findings that implicate myelination defects in the course of schizophrenia in later life.

In a postmortem comparison of brain tissue from 16 schizophrenia patients and 12 controls, aged 7279 years, microarray DNA analysis found differences between patients and controls only in genes responsible for myelination. …

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