1. First they said she had schizophrenia and now she cant remember
Sue Thomson
Goodwood Park Healthcare

2. Schizophrenia
Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.
When Emile Krapelin the father of modern psychiatry first diagnosed what he called “dementia Praecox” (premature dementia) schizophrenia he emphasized the progressive deterioration of cognition although he noted that memory – which is central to the diagnosis of dementia was unaffected
We also know that the development of Schizophrenia in most individual will decrease the persons IQ by 5-10

3. Dementia
Dementia is a syndrome – usually of a chronic or progressive nature – in which there is deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal ageing. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement.
(WHO, 2017)

4. Robert One of two children Left school in 6th form year to work
Maintained employment until 32
Owned several properties
Heavy alcohol used from bottles a day

5. Robert At 33 first treatment for mental illness – Schizophrenia
At 34 commenced on second psychotropic – cognitive decline noted following this
At 35 hospitalised hallucinating, seizures, self harm attempt - diagnosed somatoform disorder *
*At 36 the same thing was noted – Mild atrophy of the medial aspect of the left temporal lobe cortex with assymetric mild dilation of the right temporal horn.

6. Dementia?
At 39 - intrusive, doubly incontinent, decreasing memory, & ambitendence, ACER = 80
At 40 - Seen by psychiatrist diagnosed frontal temporal dementia but noted verbal functions still intact, memory problems significant *
At 44 – Inpatient admission Seen by psychiatrist no dementia
At 45 Seen by psychiatrist no dementia

7. 2018 Referred to MHS - declined Could recall old connections
Speech now altered significantly
Doubly incontinent
Lost 20kgs in 6/12 because of pacing
Referred to MHSOA he has DEMENTIA

8. Positive Symptoms
Are psychotic behaviours not generally seen in healthy people. People with positive symptoms may “lose touch” with some aspects of reality and include
Hallucinations
Delusions
Thought disorders (unusual or dysfunctional ways of thinking)
Movement disorders (agitated body movements)

9. Negative Symptoms
Associated with disruptions to normal emotions and behaviours.
“Flat affect” (reduced expression of emotions via facial expression or voice tone)
Reduced feelings of pleasure in everyday life
Difficulty beginning and sustaining activities
Reduced speaking

10. Cognitive symptoms
Poor “executive functioning” (the ability to understand information and use it to make decisions)
Trouble focusing or paying attention
Problems with “working memory” (the ability to use information immediately after learning it)
Early onset of FTD may result, in early stages, in misdiagnosing such a patient as having another primary psychiatric disorder, particularly schizophrenia, given that both share common areas of brain damage
FTD patients with psychosis seem to be younger at onset, and experience a longer delay between onset and subsequent presentation. Young persons presenting unusual behaviour, emotional blunting, social withdrawal, declining psychosocial functioning, and executive dysfunction with or without frontotemporal changes on imaging are likely to receive a psychiatric diagnosis of schizophrenia Furthermore, the existence of a group of patients with “nonprogressive” or “slow” bvFTD results in misdiagnois of schizophrenia when they may allways have had FTD

11. CT comparison

12. CT – only mild abnormalities
SPECT showed frontal or temporal hyperpofusion (de Vries et al (2000)

13. Dementia in Schizophrenia
“ … seems to be a real entity with a neuropsychological signature similar to that of frontotemporal dementia. Functional but not structural imaging abnormalities may also be characteristic”
(de Vris et al, 2001)
Long term risk of dementia in person with Schizophrenia Ribe et al – collected data on 2.5 million individuals over the age of 50 and found that the 1% of people with Schizophrenia had a 2 fold higher risk of developing dementia, even if you adjusted to cater for there decreased life span and increased health abnormalities the risk remains the same. (People with Schizophrenia live for years less than the non schizophrenic population)
The relative risk was even higher 4 fold amongst those under 64 – essentially 7.4 of every 100 people with Schizophrenia

14. Depression
Depression is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed.

15. Earlier Life Depression
Earlier life depression is significantly associated with risk of developing dementia
Vascular disease has the strongest evidence
Cortisol-Hippocampal Pathway
Amyloid plaque formation
Inflammatory changes
Nerve Growth Factors

16. Pathways linking depression as a risk factor for depression Buers, A
Pathways linking depression as a risk factor for depression Buers, A., Yaffe K (2011) Depression and risk of developing Dementia

17. Robert