Question. My mother, whose mental problems date back to the early 1970s, was diagnosed as a paranoid schizophrenic at age 55. We had to go to court to get her committed to a hospital. The problem is that the drugs administered to calm her down and prevent her aggressiveness have evaporated her memory. In the hospital, she could not find her way back to her room, and has since degenerated to the point that she can’t take care of herself at all. She babbles constantly, talking to mirrors and television screens. She seems to remember things that happened long ago, but cannot process new information. Can schizophrenia lead to dementia? Could any medication help her achieve even nominal functioning? What does recent research say about her about her prognosis?
Answer. I am sorry to hear about this difficult situation. Your mother’s prognosis depends fundamentally on her diagnosis, and I’m afraid this is quite unclear from my distant vantage point. However, I must tell you that the onset of schizophrenia at age 55 (or even 45) is quite rare. It typically has onset in late adolescence. Onset after age 45 does occur, but it must always raise the question of an “organic” (medical or neurological) cause that mimics schizophrenia.
Your mother’s severe memory impairment and confusion or disorientation increases the likelihood that her problem is medical/neurological in nature. Yet it is possible, depending on her regimen, that medications are at least partly responsible. High doses of the older antipsychotics (called neuroleptics) can induce confusion in susceptible patients, especially when combined with agents designed to reduce tremor or muscle stiffness. Even the newer “atypical antipsychotics” like clozapine (Clozaril), olanzapine (Zyprexa) and risperidone (Risperdal) can provoke confusional states in some patients.
Thus the first and most critical issue is diagnosis: is this an undiagnosed, rapidly-progressing dementing process, or is it drug-induced (and thus reversible) delirium? Schizophrenia does not lead to dementia in the strict sense of that term; i.e., it very rarely if ever produces anything resembling Alzheimer’s Disease. However, schizophrenia does not “immunize” people against dementia, and some patients do develop both disorders. It is also possible that your mother has an unusually severe “disorganized” form of schizophrenia, which occasionally presents with extreme cognitive confusion. However, such individuals are usually diagnosed with “hebephrenic” (or “disorganized) schizophrenia, rather than the paranoid type.
I strongly suggest that you obtain an immediate psychiatric “second opinion” on your mother’s diagnosis and treatment, ideally at a medical-psychiatric or neuropsychiatric inpatient unit affiliated with a major medical school. A complete physical and laboratory investigation may be required, possibly including further tests of brain function and structure. If properly diagnosed and treated, your mother may well show substantial improvement.