The dementia of dementia praecox

Abstract

A group of 18 long‐stay patients with a diagnosis of schizophrenia were compared with a group of 10 age‐matched subjects who had been institutionalized by reason of physical disease, on performance on tests of intellectual function; and with a group of agematched healthy subjects, both on tests of intellectual function, and radiographically, using the technique of computerized axial tomography (EMI scan) of the brain. By comparison with the normal controls the patients with schizophrenia had increased cerebral ventricular size (assessed as cross‐sectional area) and, by comparison with both control groups, showed substantial impairments on intellectual testing. The differences in ventricular area between patients and controls remained significant (P < 0.01) after four patients who had been leucotomized had been excluded. Within the non‐leucotomized patient group ventricular area was unrelated to previous neuroleptic medication, ECT or insulin coma therapy, but there was a significant relationship between ventricular area and intellectual impairment (P < 0.01). Intellectual impairment, as assessed by the Withers & Hinton test battery, the Inglis paired associate learning test, and the digits‐backward test, was greater (P < 0.05) in patients with negative features (affective flattening, retardation, poverty of speech) than in those without such features. Premorbid occupational histories suggested that nearly all of these patients had at one time functioned at an adequate intellectual level. The findings suggest that within the group of patients with schizophrenia there is a subgroup whose illnesses have hitherto been considered typically schizophrenic, who have severe intellectual impairment associated with evidence of structural brain disease. The size of this subgroup and the significance of the cerebral changes remain to be determined.