Dementia in Middle-Aged Patients with Schizophrenia

Article type: Research Article

Authors: Nicolas, Gaël^{a; b; c; d} | Beherec, Laurène^{b; c} | Hannequin, Didier^{a; c; d} | Opolczynski, Gaëlle^e | Rothärmel, Maud^{c; e} | Wallon, David^{a; c; d} | Véra, Pierre^f | Martinaud, Olivier^{a; d} | Guillin, Olivier^{c; e; 1} | Campion, Dominique^{b; c; d; 1; *}

Affiliations: [a] Department of Neurology, Rouen University Hospital, Rouen, France | [b] Deparment of Research, Rouvray Psychiatric Hospital, Sotteville-lès-Rouen, France | [c] Inserm, U1079, Rouen, France; University of Rouen, Normandie Univ, Institute for Research and Innovation in Biomedicine, Rouen, France | [d] CNR MAJ, Rouen, Lille and Paris Salpêtrière Hospitals, France | [e] University Department of Psychiatry, Rouvray Psychiatric Hospital, Sotteville-Lès-Rouen, France | [f] Department of Nuclear Medicine, Henri Becquerel Centre and Rouen University Hospital, Rouen, France

Correspondence: [*] Correspondence to: Dominique Campion, Inserm U1079, Faculté de Médecine, 22 boulevard Gambetta, 76183 Rouen, France. Tel.: +33 235148280; Fax: +33 235148237; E-mail: [email protected].

Note: [1] These authors contributed equally to this manuscript.

Abstract: Background:Although numerous studies have assessed cognitive dysfunction in patients with schizophrenia, very few have focused on the diagnosis of dementia. Objective:Our objectives were to accurately diagnose dementia in a cohort of middle-aged patients with schizophrenia and to assess the type of dementia. Methods:96 patients with schizophrenia (46 inpatients and 50 outpatients), aged 50 to 70 years, underwent a psychiatric, neurological, and neuropsychological evaluation at baseline and after a 20-month follow-up. We established a 3-step procedure: 1) diagnose dementia according to the DSM-IV criteria, using the Mattis Dementia Rating and Activities of Daily Living scales; 2) characterize dementia using brain imaging, perfusion by 99mTc-ECD-SPECT and laboratory tests including Alzheimer’s disease cerebrospinal fluid biomarkers; and 3) search for genetic determinants. Results:Fourteen patients fulfilled the diagnostic criteria of dementia. Four were diagnosed with possible or probable behavioral-variant frontotemporal dementia (bvFTD), two with probable Alzheimer’s disease, two with probable vascular dementia (including one due to CADASIL), one with CNS inflammatory disease, and six could not be fully characterized. Conclusions:The diagnosis of dementia in middle-aged patients with schizophrenia is challenging but possible, using a multistep procedure. The most frequent condition, bvFTD, could reflect the presence of an evolutive neurodegenerative process in some patients.

Keywords: Alzheimer's disease, dementia, frontotemporal lobar degeneration, Mattis Dementia Rating Scale, schizophrenia, vascular dementia

DOI: 10.3233/JAD-131688

Journal: Journal of Alzheimer's Disease, vol. 39, no. 4, pp. 809-822, 2014