Divergent trajectories of physical, cognitive, and psychosocial aging in schizophrenia
Open accessAbstract
Aging is not a uniform process. In the general population, there is a paradox of aging: age-associated decline in physical and some cognitive functions stands in contrast to an enhancement of subjective quality of life and psychosocial functioning. This paradox is even more striking in people with schizophrenia. Compared with the overall population, individuals with schizophrenia have accelerated physical aging (with increased and premature medical comorbidity and mortality) but a normal rate of cognitive aging, although with mild cognitive impairment starting from premorbid period and persisting throughout life. Remarkably, psychosocial function improves with age, with diminished psychotic symptoms, reduced psychiatric relapses requiring hospitalization and better self-management. Many older adults with schizophrenia successfully adapt to the illness, with increased use of positive coping techniques, enhanced self-esteem and increased social support. Although complete remission is uncommon, most individuals with schizophrenia experience significant improvement in their quality of well-being. Cohort effect and survivor bias may provide a partial explanation for this phenomenon. However, the improvement also may reflect some brain changes that are beneficial for the course of schizophrenia along with neuroplasticity of aging. The proposed hypothesis has several implications. As significant medical morbidity in schizophrenia takes years to develop, studies of changes in sensitive biomarkers of aging during the course of illness may point to new treatments aimed at normalizing the rate of biological aging in schizophrenia. At the same time, effective psychotherapeutic interventions can affect brain structure and function and produce lasting positive behavioral changes in aging adults with schizophrenia.
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Schizophrenia, like MDD and BD, may also be associated with premature biological aging.
“Schizophrenia, like MDD and BD, may also be associated with premature biological aging (Anthes, 2014; Jeste et al., 2011; Kirkpatrick et al., 2008; Kochunov et al., 2013; Koutsouleris et al., 2014; Okusaga, 2014; Shivakumar et al., 2014).”
From Psychiatric disorders and leukocyte telomere length: Underlying mechanisms linking mental illness with cellular aging (2015) · cites this paper as Jeste et al., 2011
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- Authors
- Jeste, D. V., Wolkowitz, O. M., & Palmer, B. W.
- Affiliations
- University of California San Diego (US)
- University of California, San Francisco (US)
- Corresponding author
- Jeste, D. V.
- Venue
- Schizophrenia Bulletin
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-04-19
- Volume
- 37
- Issue
- 3
- Pages
- 451-455
- ISSN
- 0586-7614 (ISSN-L)
- 1745-1701
- PMC
- PMC3080682
- OpenAlex
- W2137675375
- Cited by
- 176
- References
- 26
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 11 · 2023: 8 · 2022: 10 · 2021: 16 · 2020: 9 · 2019: 18 · 2018: 9 · 2017: 15 · 2016: 15 · 2015: 13 · 2014: 14 · 2013: 13 · 2012: 6
- FWCI
- 7.66
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Schizophrenia Bulletin (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Mental Health (P30MH080002, MH083784, MH080002, R01MH083784, R01MH064722, MH071536, MH 64722, R01MH071536)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Aging and Gerontology Research
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- schizophrenia, aging
- MeSH terms
- Adaptation, Psychological, Aging, Cognition, Humans, Quality of Life, Schizophrenia, Schizophrenic Psychology, Social Support, Comorbidity
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