36
Informaciones
Psiquiátricas
2014-n.º 216
dades crónicas, como la enfermedad pulmonar
obstructiva (EPOC), suponen un factor de ries-
go para el declive cognitivo.
Si tenemos en cuenta los factores señala-
dos, que interrelacionan con la cognición, y
cómo su presencia complica los déficits cog-
nitivos asociados a la edad, y aún más aque-
llos previos, como ocurre en el caso de la es-
quizofrenia, es fácil concluir que, bajo estas
condiciones, es imposible que los pacientes
con esquizofrenia envejezcan cognitivamen-
te de forma exitosa. Sin embargo, algunos
de estos déficits son prevenibles y tratables;
por ello, en los pacientes con esquizofrenia es
indispensable intervenir sobre los factores de
riesgo metabólicos y cardiovasculares. Parale-
lamente, es imperioso promover todo aquello
que incremente, desde temprana edad la reser-
va cognitiva activa de estos pacientes.
Palabras clave:
Esquizofrenia, envejeci-
miento, deterioro cognitivo, cognición, perfil
neuropsicológico, funciones ejecutivas, memo-
ria, síndrome metabólico, reserva cognitiva.
Abstract
Cognitive impairment is a cardinal symptom
of schizophrenia. It is not caused by psychotic
symptoms and has been considered a strong
predictor a person’s functional capacity. It
has been identified as a high cost factor (di-
rect and indirect) and a relevant target for
schizophrenia research.
Most Schizophrenic patients have cogniti-
ve impairment. Neuropsychological profile is
characterized by the compromise of diverse
cognitive domains: working memory, atten-
tion / vigilance, verbal memory and learning,
visual memory, executive function, speed of
information processing and social cognition.
Cognitive performance of patients is situated
between one and two standard deviations be-
low healthy subjects.
Cognitive evolution in Schizophrenic pa-
tients is unclear, and the debate about
whether it is a stable or progressive course is
open until now. Studies using a longitudinal
methodology have supported the hypothesis
that cognitive impairment is stable, whe-
reas cross-sectional studies have identified a
progressive clinical course. Few studies with
patients older than 65 years have been pu-
blished and, most of them were done with ins-
titutionalized patients. Recent studies have
compared young and elderly schizophrenic
patients; they concluded that the same cog-
nitive domains were affected in both. Howe-
ver, it is unclear whether the magnitude of
the deficit is comparable, and if all cognitive
domains behaved similarly in their decline as
in normal aging.
Among general population, some neurop-
sychological functions seem more sensitive
than others with aging. The speed in infor-
mation processing, episodic memory and wor-
king memory are more affected in the elderly.
However, there are a large number of indivi-
dual differences related to the effect of age
on cognition. This heterogeneity in cognitive
aging is determined by genetics and lifestyle.
Key factors associated with lifestyle affecting
cognition are cardiovascular risk factors. Their
presence in middle age has an effect on cog-
nition in elderly. Moreover, chronic diseases
such as chronic obstructive pulmonary disease
are risk factors for cognitive decline.
The above mentioned factors have a po-
tential capacity for complicating cognitive
decline linked to age, as well as the intrin-
sic neuropsychological impairment associated
with Schizophrenia. Consequently, is easy to
conclude that, under these conditions, it is
difficult for schizophrenic patients to age suc-
cessfully. It is important to note, that some
of cognitive deficits that schizophrenic pa-
tients manifest are preventable and treatable.
It is necessary to intervene on metabolic and
cardiovascular risk factors. Moreover, and in
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