RESUMO
A quantitative review of literature concerning olfactory function in 22q11.2 deletion syndrome (22q11DS) patients was performed detailing the scope/magnitude of deficits and probing possible moderators. We searched MEDLINE, EMBASE and PubMed to identify studies for inclusion. Effect sizes were based on differences in psychophysical olfactory tests between 22q11DS patients (n = 194) and typically developing comparison subjects (n = 466). 22q11DS patients exhibited marked olfactory dysfunction (d=-1.11, 95% CI=-1.29<δ<-0.92) that was homogeneous (p = 0.86). Diffuse olfactory deficits were seen which were not moderated by age or sex. 22q11DS patients exhibit large/diffuse deficits in olfactory function that are of a similar magnitude to observed neuropsychological impairments.
RESUMO
OBJECTIVE: Cognitive deficits are among the most reliable predictors of functional impairment in schizophrenia and a particular concern for older individuals with schizophrenia. Previous reviews have focused on the nature and course of cognitive impairments in younger cohorts, but a quantitative meta-analysis in older patients is pending. METHOD: A previously used search strategy identified studies assessing performance on tests of global cognition and specific neuropsychological domains in older patients with schizophrenia and age-matched comparison groups. Both cross-sectional and longitudinal studies were included. Potential methodological, demographic, and clinical moderators were analyzed. RESULTS: Twenty-nine cross-sectional (2110 patients, 1738 comparison subjects) and 14 longitudinal (954 patients) studies met inclusion criteria. Patients were approximately 65 years old, with 11 years of education, 53% male and 79% Caucasian. Longitudinal analysis (range 1-6 years) revealed homogeneity with small effect sizes (d = -0.097) being observed. Cross-sectional analyses revealed large and heterogeneous deficits in global cognition (d = -1.19) and on specific neuropsychological tests (d = -0.7 to -1.14). Moderator analysis revealed a significant role for demographic (age, sex, education, race) and clinical factors (diagnosis, inpatient status, age of onset, duration of illness, positive and negative symptomology). Medication status (medicated vs nonmedicated) and chlorpromazine equivalents were inconsequential, albeit underrepresented. CONCLUSIONS: Large and generalized cognitive deficits in older individuals with schizophrenia represent a robust finding paralleling impairments across the life span, but these deficits do not decline over a 1-6 year period. The importance of considering demographic and clinical moderators in cross-sectional analyses is highlighted.
