Key clinical point: Very-late-onset schizophrenia-like psychosis (VLOS) is associated with increased risks of death and dementia.

Major finding: VLOS was associated with a 2.89-fold increased death risk and a 2.67-fold increased dementia risk (P less than .001 for both).

Study details: This prospective Israeli cohort study included 94,120 persons without dementia or schizophrenia diagnoses (aged >60 years) in 2012 who were followed-up for the risks of dementia or death from 2013 to 2017.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.

Commentary

“In spite of the demographic trends suggesting growing numbers of individuals with serious mental illness who survive into later life, there is still very limited data on outcomes in older people with schizophrenia. Building upon Kraepelin's original description of schizophrenia as dementia praecox, this study explores the relationship of very-late-onset schizophrenia-like psychosis (VLOS) , defined as onset at the age of 60 and over and subsequent risk of dementia and of death. Strengths of the study include the very large sample size and the representative national sample. Findings are in line with other studies that have found higher risk of dementia with VLOS. The authors suggest several interpretations of the results, including the notion of accelerated aging in schizophrenia and the possibility that VLOS may be a prodrome of dementing illness. These findings underscore the need to further investigate therapies that might help mitigate dementia rates in high-risk individuals.”

Martha Sajatovic, MD

Professor of Psychiatry and of Neurology

Willard Brown Chair in Neurological Outcomes Research

Director, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center

Case Western Reserve University School of Medicine