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Temporal course of cognitive impairment in elderly, chronic schizophrenic patients: A prospective longitudinal study
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disabled schizophrenic patients to 72 alcoholic inpatients after alcohol withdrawal and to 57 healthy controls. The examinations were video-taped and scored by experienced clinicians. Interrater reliability for the NES subscales was Rho 2.93. A principal component analysis did not allow to separate the original five subscales of the NES. The ten original items with loadings 2.50 on the first factor, representing 20% of the variance, and four additional items were combined to a scale “Motor Sequencing”, with an internal consistency of s.87. Five motor tasks suggested by Luria were combined to a second scale “Set Formation”. The total NES score, Motor Sequencing and Set Formation have internal consistencies (~Q.63) in all four groups of subjects. These three scores separate schizophrenic patients from alcoholics and healthy controls. They are correlated with Raven progressive Matrices, with perseverative errors in the Wisconsin Card Sorting Test (.2X&.43), with communicative and attentional aspects of negative symptoms (.28
PSYCHOMETRIC EVALUATION A MULTI-SITE STUDY K.T. Mueser*,
OF THE SANS:
S. Mukherjee*, R. Reddy, S. Dufour, R.L. Borison, B.I. Diamond Department of Psychiatry, GA 30912, USA
Medical College
P. Mohan
R. Costa,
of Georgia, Augusta.
Using items of the Mini-Mental State Examination, we compared the profiles of cognitive impairment in 34 AD and 33 elderly schizophrenic patients, all of age more than 55 years. Schizophrenic patients were selected on the basis of age, with no consideration of cognitive status. Mean MMSE total scores were 18.2 (SD 4.7) in AD and 21.8 (SD 4.3) in schizophrenic patients. Since the groups differed in age (p<.OOl), total MMSE score (p<.OOl), and sex distribution (p<.Ol), data were analysed using multivariate methods to examine the effects of diagnosis after controlling for variance due to age, gender, and MMSE total score. AD patients performed significantly worse than schizophrenic patients on orientation to time (p=.O5) and delayed recall (p<.OOl). Schizophrenic patients performed significantly worse on the item of serial 7’s (p<.OO5), with no significant difference between the groups on orientation to place, language, and design copying. These findings indicate that performance on the items of delayed recall and serial 7’s distinguish between the cognitive impairments of schizophrenia and AD. As suggested by the CERAD data, an early marked impairment of delayed recall is a distinctive feature of AD.
S.L. Sayers
Medical College of Pennsylvania at EPPI, Department of Psychiatry, 3200 Henry Avenue, Philadelphia, PA 19129, USA The present investigation examined the inter-rater reliability, internal consistency, and test-retest reliability of the SANS in the context of a five-site collaborative study, the Treatment Strategies for schizophrenia study. Two-hundred-and-seven schizophrenic patients participating in the study were assessed with the SANS following a symptom exacerbation and again 3-6 months later. All assessments were performed by trained psychiatrists who were treating the patients. Inter-rater reliabilities ranged from high to low for the SANS items, but were statistically significant in most cases. Item-to-subscale total correlations were moderate to high for most items, as were coefficient alphas for each subscale, indicating adequate internal consistency. Test-retest correlations were of moderate magnitude. Few site differences were found in the psychometric characteristics for the SANS, suggesting that different centers used the instrument in a comparable fashion. However, some site differences in mean SANS ratings were present. The results suggest that the SANS has good psychometric properties and that it may be a useful instrument for the measurement of negative symptoms in multi-site clinical studies. The internal consistency of the SANS subscales for Alogia, AvolutionApathy, and Inattention could be improved by replacing some items and adding others.
PROFILES OF COGNITIVE IMPAIRMENT IN ELDERLY SCHIZOPHRENIC AND PROBABLE ALZHEIMER’S DISEASE PATIENTS
TEMPORAL COURSE OF COGNITIVE IMPAIRMENT IN ELDERLY, CHRONIC SCHIZOPHRENIC PATIENTS: A PROSPECTIVE LONGITUDINAL STUDY S. Mukherjee*,
P. Decina,
Department of Psychiatry, GA 30912, USA
P.L. Scapicchio
Medical College of Georgia, Augusta.
There is evidence that a large proportion of elderly schizophrenic patients, especially at tertiary care centers, manifest severe cognitive impairments that meets criteria for dementia. We present below two-year follow-up data from our ongoing prospective study of cognitive impairment in elderly schizophrenic patients at Ospedale Santa Maria Immacolata in Guidonia, Italy. Cognitive functioning was assessed using a lo-item scale, the total score on which is highly correlated with the mini-mental state examination total score. Seven patients were excluded for ‘muteness’ at baseline or follow-up. The mean age of the remaining 97 patients (64 men and 33 women) was 60.9+8.9 years. Across all patients there was a significant worsening of cognitive performance, with cognitive scores declining from 6.2k2.3 to 5.7k2.2 (P<.OOl). Possible predictors were examined by a stepwise regression analysis, and findings confirmed by simultaneous regression analyses. The only predictors of deterioration were a higher cognitive score at baseline and smoking status (greater in nonsmokers). Cognitive deterioration was unrelated to medication or symptom variable.
disabled schizophrenic patients to 72 alcoholic inpatients after alcohol withdrawal and to 57 healthy controls. The examinations were video-taped and scored by experienced clinicians. Interrater reliability for the NES subscales was Rho 2.93. A principal component analysis did not allow to separate the original five subscales of the NES. The ten original items with loadings 2.50 on the first factor, representing 20% of the variance, and four additional items were combined to a scale “Motor Sequencing”, with an internal consistency of s.87. Five motor tasks suggested by Luria were combined to a second scale “Set Formation”. The total NES score, Motor Sequencing and Set Formation have internal consistencies (~Q.63) in all four groups of subjects. These three scores separate schizophrenic patients from alcoholics and healthy controls. They are correlated with Raven progressive Matrices, with perseverative errors in the Wisconsin Card Sorting Test (.2X&.43), with communicative and attentional aspects of negative symptoms (.28
PSYCHOMETRIC EVALUATION A MULTI-SITE STUDY K.T. Mueser*,
OF THE SANS:
S. Mukherjee*, R. Reddy, S. Dufour, R.L. Borison, B.I. Diamond Department of Psychiatry, GA 30912, USA
Medical College
P. Mohan
R. Costa,
of Georgia, Augusta.
Using items of the Mini-Mental State Examination, we compared the profiles of cognitive impairment in 34 AD and 33 elderly schizophrenic patients, all of age more than 55 years. Schizophrenic patients were selected on the basis of age, with no consideration of cognitive status. Mean MMSE total scores were 18.2 (SD 4.7) in AD and 21.8 (SD 4.3) in schizophrenic patients. Since the groups differed in age (p<.OOl), total MMSE score (p<.OOl), and sex distribution (p<.Ol), data were analysed using multivariate methods to examine the effects of diagnosis after controlling for variance due to age, gender, and MMSE total score. AD patients performed significantly worse than schizophrenic patients on orientation to time (p=.O5) and delayed recall (p<.OOl). Schizophrenic patients performed significantly worse on the item of serial 7’s (p<.OO5), with no significant difference between the groups on orientation to place, language, and design copying. These findings indicate that performance on the items of delayed recall and serial 7’s distinguish between the cognitive impairments of schizophrenia and AD. As suggested by the CERAD data, an early marked impairment of delayed recall is a distinctive feature of AD.
S.L. Sayers
Medical College of Pennsylvania at EPPI, Department of Psychiatry, 3200 Henry Avenue, Philadelphia, PA 19129, USA The present investigation examined the inter-rater reliability, internal consistency, and test-retest reliability of the SANS in the context of a five-site collaborative study, the Treatment Strategies for schizophrenia study. Two-hundred-and-seven schizophrenic patients participating in the study were assessed with the SANS following a symptom exacerbation and again 3-6 months later. All assessments were performed by trained psychiatrists who were treating the patients. Inter-rater reliabilities ranged from high to low for the SANS items, but were statistically significant in most cases. Item-to-subscale total correlations were moderate to high for most items, as were coefficient alphas for each subscale, indicating adequate internal consistency. Test-retest correlations were of moderate magnitude. Few site differences were found in the psychometric characteristics for the SANS, suggesting that different centers used the instrument in a comparable fashion. However, some site differences in mean SANS ratings were present. The results suggest that the SANS has good psychometric properties and that it may be a useful instrument for the measurement of negative symptoms in multi-site clinical studies. The internal consistency of the SANS subscales for Alogia, AvolutionApathy, and Inattention could be improved by replacing some items and adding others.
PROFILES OF COGNITIVE IMPAIRMENT IN ELDERLY SCHIZOPHRENIC AND PROBABLE ALZHEIMER’S DISEASE PATIENTS
TEMPORAL COURSE OF COGNITIVE IMPAIRMENT IN ELDERLY, CHRONIC SCHIZOPHRENIC PATIENTS: A PROSPECTIVE LONGITUDINAL STUDY S. Mukherjee*,
P. Decina,
Department of Psychiatry, GA 30912, USA
P.L. Scapicchio
Medical College of Georgia, Augusta.
There is evidence that a large proportion of elderly schizophrenic patients, especially at tertiary care centers, manifest severe cognitive impairments that meets criteria for dementia. We present below two-year follow-up data from our ongoing prospective study of cognitive impairment in elderly schizophrenic patients at Ospedale Santa Maria Immacolata in Guidonia, Italy. Cognitive functioning was assessed using a lo-item scale, the total score on which is highly correlated with the mini-mental state examination total score. Seven patients were excluded for ‘muteness’ at baseline or follow-up. The mean age of the remaining 97 patients (64 men and 33 women) was 60.9+8.9 years. Across all patients there was a significant worsening of cognitive performance, with cognitive scores declining from 6.2k2.3 to 5.7k2.2 (P<.OOl). Possible predictors were examined by a stepwise regression analysis, and findings confirmed by simultaneous regression analyses. The only predictors of deterioration were a higher cognitive score at baseline and smoking status (greater in nonsmokers). Cognitive deterioration was unrelated to medication or symptom variable.