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Is late‐onset schizophrenia a subtype of schizophrenia?
Open accessAbstract
Vahia IV, Palmer BW, Depp C, Fellows I, Golshan S, Kraemer HC, Jeste DV. Is late‐onset schizophrenia a subtype of schizophrenia? Objective: To determine whether late‐onset schizophrenia (LOS, onset after age 40) should be considered a distinct subtype of schizophrenia. Method: Participants included 359 normal comparison subjects (NCs) and 854 schizophrenia out‐patients age >40 (110 LOS, 744 early‐onset schizophrenia or EOS). Assessments included standardized measures of psychopathology, neurocognition, and functioning. Results: Early‐onset schizophrenia and LOS groups differed from NCs on all measures of psychopathology and functioning, and most cognitive tests. Early‐onset schizophrenia and LOS groups had similar education, severity of depressive, negative, and deficit symptoms, crystallized knowledge, and auditory working memory, but LOS patients included more women and married individuals, had less severe positive symptoms and general psychopathology, and better processing speed, abstraction, verbal memory, and everyday functioning, and were on lower antipsychotic doses. Most EOS–LOS differences remained significant after adjusting for age, gender, severity of negative or deficit symptoms, and duration of illness. Conclusion: Late‐onset schizophrenia should be considered a subtype of schizophrenia.
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“Late‐onset schizophrenia appeared to be as stable a diagnosis as early‐onset schizophrenia; both diagnoses remained unchanged in up to 93% of cases in a follow‐up, and only rarely were they reclassified as mood disorders263, 264.”
From Mental health care for older adults: recent advances and new directions in clinical practice and research (2022) · cites this paper as [264]
In the citing paper
“Sensory deficits, especially long‐standing conductive deafness, are common in the late‐onset form 264 , but may primarily reflect the patients' reluctance to seek corrective measures or their inability to get correction of these deficits because of poor access to quality health care.”
From Mental health care for older adults: recent advances and new directions in clinical practice and research (2022) · cites this paper as [264]
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“Compared with earlier onset, late-onset schizophrenia is associated with less severe positive symptoms and response to lower doses of antipsychotic medications (Maglione et al., 2014; Vahia et al., 2010).”
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Self-citationSystematic review and collaborative recalculation of 133 693 incident cases of schizophrenia
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“…causal pathways involving additive and interactive psychosocial, neural or hormonal protective factors (or lack of risk factors) in the context of pathoplastic normal or pathological age-related processes that impact on a milder or absent neurodevelopmental vulnerability (Vahia et al. 2010).”
BackgroundNew perspectives on schizophrenia in later life: implications for treatment, policy, and research
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“This is because late onset of schizophrenia may represent a distinct sub-sample of the disorder characterised by less severe positive symptoms, better cognitive function, lower dose antipsychotics, better every day functioning and increased prevalence in women (Vahia et al., 2010).”
Menstrual exacerbation of schizophrenia symptoms
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“A greater proportion of LOS patients have successful occupational and marital histories compared with EOS patients [10].”
BackgroundResultInfluentialSelf-citationNo sex differences in neuropsychological performance in first episode psychosis patients
Ayesa‐Arriola, R., Rodríguez-Sánchez, J. M., Gómez-Ruíz, E., Roiz‐Santiáñez, R., Reeves, L. E., & Crespo‐Facorro, B. (2013) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2013.09.009 · Cited by 58
“Criterion based on convention considers late onset when prodromal symptoms begin after age 40 (Vahia et al., 2010).”
New Wine in Old Bottle: Late-Life Psychosis
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“However, the most current findings from the research group at the University of California, San Diego (UCSD) synthesizing the data on middle-age and older adults with schizophrenia collected over the past 20 years challenge some of the accepted similarities and distinctions between individuals with EOS and LOS [57].”
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“Interestingly, studies have quite consistently described a reduced intellectual capacity in LOS or VLOSLP compared with normal controls (Almeida et al., 1995a; Heaton et al., 1994; Jeste et al., 1995; Moore et al., 2006; Östling et al., 2004; Sachdev et al., 1999a; Vahia et al., 2010).”
InfluentialStafford, J., Dykxhoorn, J. L., Sommerlad, A., Dalman, C., Kirkbride, J. B., & Howard, R. J. (2021) · Psychological Medicine · doi:10.1017/s0033291721002099 · Cited by 57
“There is ongoing debate about the aetiology of VLOSLP and its relationship with neurodegeneration and dementia (Brodaty, Sachdev, Koschera, Monk, & Cullen, 2003; Vahia et al., 2010; Van Assche, Morrens, Luyten, Van de Ven, & Vandenbulcke, 2017).”
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“Antipsychotic medication use Antipsychotic medication use was determined by calculating the Chlorpromazine Equivalent dosage (CPZE) for all antipsychotic medications, based on standardized formulas (Jeste and Wyatt, 1982; Vahia et al., 2010).”
MethodSelf-citationLate-onset psychosis and very-late-onset-schizophrenia-like-psychosis: an updated systematic review
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“Psychopathological Psychopathological symptoms of patients with LOP or VLOSLP were studied in ten included studies (Brichant-Petitjean et al., 2013; Brodaty et al., 2003; Hanssen et al., 2015; Huang & Zhang, 2009; Hussein et al., 2012; Mason et al., 2013; Reeves et al., 2002; Sato et al., 2004; Vahia et al., 2010; Wak…”
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“Differences in epidemiology and presentation have been found in those with LOS and VLOSLP, including a higher prevalence among women and fewer negative symptoms (Howard et al., 2000; Stafford, Howard, & Kirkbride, 2018; Stafford, Howard, Dalman, & Kirkbride, 2019; Vahia et al., 2010).”
Lasalvia, A., Bonetto, C., Lenzi, J., Rucci, P., Iozzino, L., Cellini, M., Comacchio, C., Cristofalo, D., D’Agostino, A., de Girolamo, G., et al. (2017) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.116.190058 · Cited by 31
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“Schneiderian first-rank symptoms are common regardless of age of onset (Pearlson et al., 1989; Cohen et al., 2008; Vahia et al., 2010), and similar levels of delusional perception, bizarre delusions, and delusions of reference have been found (Howard et al., 1993a; 1993b; Castle et al., 1997).”
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“The current findings add to previous reports of more compromised verbal learning and memory (13, 14, 38) and sustained attention (39) in schizophrenia with earlier onset, but contradict others Table 3.”
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“Nevertheless, most studies support late onset as a subtype of schizophrenia (Vahia et al., 2010), with a similar symptom profile, although some suggest fewer negative symptoms in the late-onset group (Howard, Rabins, Seeman, & Jeste, 2000).”
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Self-citationAdvances in the Conceptualization and Study of Schizophrenia in Later Life
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Psychosis-related matricide associated with a lesion of the ventromedial prefrontal cortex.
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Clinical Approaches to Late-Onset Psychosis
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Brichant‐Petitjean, C., Legauffre, C., Ramoz, N., Adès, J., Gorwood, P. A. P. M., & Dubertret, C. (2013) · Schizophrenia Research · doi:10.1016/j.schres.2013.08.021 · Cited by 17
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Older Patients With Schizophrenia: Does Military Veteran Status Matter?
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Self-citationLate-Onset Psychosis; Is It Real?
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Late-Onset Schizophrenia: A Review for Clinicians
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“While many clinicians may categorize LOS and VLOSP together, the current consensus is that they are separate entities and should be treated as such ( Howard et al, 2000 ; Vahia et al, 2010 ).”
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Meesters, P. D. (2023) · Age and Ageing · doi:10.1093/ageing/afad161 · Cited by 12
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“In addition, compared to EOS, LOS require lower daily antipsychotic dose (Vahia et al., 2010).”
Li, H., Tang, J., Chen, L., Liao, Y., Zhou, B. R., He, Y. Z., Li, Z., Lv, L., Zeng, Y., & Chen, X. (2015) · Neuroscience Bulletin · doi:10.1007/s12264-015-1525-1 · Cited by 12
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InfluentialCan the neurodevelopmental theory account for sex differences in schizophrenia across the life span?
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Chai, Y., Tang, J. Y. ‐., Ma, D. C. F., Luo, H., & Chan, S. K. W. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.26795 · Cited by 13
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“Vahia et al. found that positive symptoms and general psychopathology were less severe in late-onset schizophrenia (LOS) patients than in early-onset (EOS) patients, but the groups did not differ in the severity of negative symptoms [6].”
Feller, C. M., Ilen, L., Eliez, S., & Schneider, M. (2024) · Journal of Neurodevelopmental Disorders · doi:10.1186/s11689-024-09527-y · Cited by 10
“For instance, the Social Skills Performance Assessment (SSPA; [51]) was initially developed to assess individuals with schizophrenia through role-plays (e.g., [52–54]) but was also used in other conditions (e.g., [55]), including ASD.”
MethodZhang, M., Yang, F., Fan, H., Fan, F., Wang, Z., Xiang, H., Huang, W., Tan, Y., Tan, S., & Hong, L. E. (2022) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2022.111535 · Cited by 6
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Edad de inicio de los síntomas y sexo en pacientes con trastorno del espectro esquizofrénico
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Assche, L. V., Takamiya, A., den Stock, J. V., de Ven, L. V., Luyten, P., Emsell, L., & Vandenbulcke, M. (2023) · Psychological Medicine · doi:10.1017/s0033291723002258 · Cited by 6
“Several aspects of processing speed are affected, such as cognitive speed, psychomotor and complex visuo-perceptual speed (Henderson et al., 1998; Jeste et al., 1995; Naguib & Levy, 1987; Vahia et al., 2010).”
BackgroundKassm, S. A., Limosin, F., Naja, W., Vandel, P., Rico, M. S., Alvarado, J. M., von Gunten, A., Hoertel, N., & CSA Study group (2021) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5512 · Cited by 5
“The VLOSLP type raises more controversy as reflected by its name.(6,11,12) It may be distinguished by its much greater preponderance in women, greater exposure to a range of social disadvantages and social isolation,(6) higher rates of sensory impairment,(6) lower rate of family history of schizophrenia,(6) and a poss…”
BackgroundMethodAgeing with psychosis – Fifty and beyond
Galletly, C. A., Suetani, S., Hahn, L. A., McKellar, D., & Castle, D. J. (2021) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674211009619 · Cited by 5
“Most research relating to older patients with psychosis has focused on people with late-onset disorders (Castle and Murray, 1993; Cohen et al., 2020; Vahia et al., 2010).”
BackgroundCognitive functions in late-onset psychosis
Гаяровна, А. Е., Ma, S., Rupchev, G., Sheshenin, V., & Витальевна, П. В. (2022) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro202212206163 · Cited by 5
Processing Speed Impairment in Schizophrenia
Pratt, D. N., Linares, N. N., Spencer, C., Olson, G. M., Maeve, H., Parmacek, S. N., Lee, L. E., Alliende, L. M., Zarubin, V. C., Dickinson, D., et al. (2025) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2025.3893 · Cited by 5
Risk Factors for Late-Onset Psychosis: A Case-Control Study
Skinner, J. P., Shinn, A. K., & Moran, L. V. (2024) · Schizophrenia Bulletin · doi:10.1093/schbul/sbae164 · Cited by 4
Gilabert‐Juan, J., Ivorra, J. L., Tolosa, A., Gratacòs, M., Costas, J., Sanjuán, J., & Moltó, M. D. (2010) · Psychiatry Research · doi:10.1016/j.psychres.2010.07.005 · Cited by 4
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“This resultantly inhibits nerve damage in the brain and symptoms of developmental disability [15].”
BackgroundPotential Explanatory Models of the Female Preponderance in Very Late Onset Schizophrenia
Johnstone, S., Cruz, G. A. D., Girard, T. A., Rajji, T. K., & Castle, D. J. (2022) · Women · doi:10.3390/women2040033 · Cited by 3
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“…was consistent with a study that detected the individuals with LOS were less impaired in verbal learning, assessed using the corrected long-delay free recall score of the California Verbal Learning Test, than those whose age of onset schizophrenia was before 40 years old (Vahia et al. 2010).”
BackgroundResultInfluentialMental Health and Treatment Considerations for Older Adults
Edelstein, B. A., Spalding, R., & Katz, E. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00137-0 · Cited by 3
Diagnostik und medikamentöse Therapie bei schizophrenen Patienten im Alter
Jagsch, C., Dietmaier, G., Jagsch, M., & Kurz, M. (2016) · Neuropsychiatrie · doi:10.1007/s40211-016-0183-0 · Cited by 2
A Case of Very-late-onset Schizophrenia-like Psychosis
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Psychoseerkrankungen im höheren Lebensalter
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Cauliflower ear in late onset psychosis
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Comparative Study of Clinical Features between Early- and Late-Onset Schizophrenia in South Korea
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Chapter 11. Schizophrenia Spectrum and Other Psychotic Disorders
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Self-citationLate-Onset Schizophrenia: Epidemiology, Clinical Profile, Prognosis, and Treatment Considerations
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“et al. [ 42 ] Symptom profile, functioning and neuropsychology Higher rate in LO Less positive symptoms LO=EO CVLT, WCST, Digit symbol, and block design: LO > EO”
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Schizophrenia Spectrum and Other Psychotic Disorders
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Admixture analysis of age at onset in older patients with schizophrenia spectrum disorders
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“Interpretation of results is complicated by the fact that age cut-off points for LOS vary between these studies (Hafner et al., 1998; Hanssen et al., 2015; Vahia et al., 2010).”
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Ryssia Wolfsohn's 1907 dissertation on “the heredity of dementia praecox”
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Psychiatric symptoms and disorders in old age: prevalence, course and diagnostic thresholds
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New Perspectives on Late-Life Psychosis
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Psychoseerkrankungen im höheren Lebensalter
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Shizofrenija z začetkom v poznem življenjskem obdobju
Veranič, L. Ž., Grilj, V., & Bergant, G. (2018) · Slovenian Medical Journal · doi:10.6016/zdravvestn.1952
Schizophrenie bei Kindern, Jugendlichen und alten Menschen
SCHIMMELMANN, B. G., Falkai, P., & Förstl, H. (2016) · Elsevier eBooks · doi:10.1016/b978-3-437-22305-1.00005-3
Metadata
- Authors
- Vahia, I. V., Palmer, B. W., Depp, C., Fellows, I., Golshan, S., Kraemer, H. C., & Jeste, D. V.
- Affiliations
- University of California San Diego (US)
- Stanford Medicine (US)
- Corresponding author
- Jeste, D. V.
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2010-02-25
- Volume
- 122
- Issue
- 5
- Pages
- 414-426
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- PMC
- PMC3939834
- OpenAlex
- W1752961086
- Cited by
- 119
- References
- 95
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 10 · 2023: 7 · 2022: 9 · 2021: 8 · 2020: 7 · 2019: 10 · 2018: 12 · 2017: 8 · 2016: 4 · 2015: 7 · 2014: 4 · 2013: 10 · 2012: 13
- FWCI
- 6.34
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- University of California, San Diego
- National Institute of Mental Health (P30MH080002, MH-43693, MH080002, MH019934, R01MH064722, MH 064722, T32MH019934)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- late-onset schizophrenia, early-onset schizophrenia, schizophrenia subtypes, schizophrenia diagnosis, neurocognitive function, functioning, psychopathology, negative symptoms, processing speed, auditory working memory, antipsychotic dosing, age of onset
- MeSH terms
- Activities of Daily Living, Adult, Age Factors, Aged, Analysis of Variance, Cognition, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Schizophrenia, Schizophrenic Psychology, Sex Factors, Chi-Square Distribution, Linear Models, Age of Onset
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