Onset after 45 yrs Most of the people who have schizophrenia sta experiencing their symptoms during their adolescence or early adulthood but patients with late onset schizophrenia begin to experience their symptoms only during later years after 40. Age of onset There has been no general agreement on the definition of late onset. Some chose 40 years of age as the cutoff whereas others defined late onset as onset after 45, 60 or 65 years of age. - To diagnose late onset schizophrenia the patient should meet the DSM IV criteria for schizophrenia (including duration of at least 6 months) with the additional requirement that the onset of symptoms (including the prodrome) be at or age 45. The prototypical patient is middle aged elderly women who functioned moderately well through early adulthood. Late onset schizophrenia meets the same DSM IV criteria as early onset schizophrenia however there appears to be some differences in how the disease presents. More likely to occur in females Increased prevalence of hearing loss and ocular pathology More likely to have tactile, visual and auditory hallucinationsdeg. Olfactory, tactile and gustatory hallucinations less common. More likely to have delusion of persecution These patients are less likely to have "disorganized thoughts" and are less likely to have the negative symptoms of schizophrenia. They have more "positive symptoms" and fewer "negative symptoms". Less "cognitive" impairment More "affective" component Family studies sugges that the prevalence of schizophrenia in relatives of late onset schizophrenia probands is higher than that in general population hut lower than that in relatives of earlier onset schizophrenia probands. Fewer catatonicsdeg and hebephrenics and more paranoiddeg or schizoiddeg tract. More ourable response to antipsychotic drugs'. - Majority of patients with late onset schizophrenia show almost complete resolution of psychotic symptoms with t/t with antipsychotic medications. Their prognosis is better than early onset schizophrenia. Early-Onset Schizophrenia Late -- Onset Schizophrenia Very Late--Onset Schizophrenia- Like Psychosis Age of onset Younger than age 40 Middle age (age 40 to 65) Late life (older than age 65) Predominant gender Men Women Women Paranoid subtype Common Very Common Common Negative Symptoms Marked Present Absent Thought disorder Present Present Absent Minor physical anomalies Present Present Absent Brain structure abnor? Malities (e.g.stroks, tumors) Absent Absent Marked Neuropsychological impairment: Learning Retention Marked Absent Present Absent Probably Marked Probably marked Progressive cognitive deterioration Absent Absent Marked Family history of schizophrenia Present Present Absent Early childhood maladjustment Present Present Absent Risk of tardive dyskinesia Present Present Marked Daily neuroleptic dose High Lower Lowest