11-13 The Kraepelinian notion of schizophrenia as dementia praecox colored conventional thinking regarding the long-term course of this disorder for many years, in that it was generally assumed that there was a progressive deterioration in functioning as patients aged. However, with the exception of studies of chronically institutionalized “poor outcome” patients,14,15 who represent a small minority of the contemporary population of older persons with schizophrenia,16

the weight, of empirical data on the longitudinal course of neuropsychological deficits in schizophrenia in fact documents a remarkably stable pattern of Inhibitors,research,lifescience,medical neuropsychological functioning,17,18 even among older patients with schizophrenia, as well as those whose symptoms first emerge in mid- to late life.18,19 For instance, in a recent, study from our research center, we annually administered Inhibitors,research,lifescience,medical a comprehensive neuropsychological test battery Inhibitors,research,lifescience,medical to 142 patients with DSM-III-R or DSM-IV diagnoses of schizophrenia (confirmed with a structured clinical interview), as well as 206 healthy comparison subjects. We found that patients’

neuropsychological functioning remained stable over follow-up periods of up to 5 years or more, even among the subset whose positive or negative symptoms Inhibitors,research,lifescience,medical deteriorated or improved over the follow-up periods, and among those ages 65 or older, as well as those

whose symptoms onset, in mid- to late life. In short, while patients with schizophrenia as a group have worse neurocognitive functioning than the general population, there does not appear to be risk of greater than age -normal progressive decline, at least among noninstitutionalized patients. Moreover, given Inhibitors,research,lifescience,medical the importance of neuropsychological abilities to independent, functioning, these findings of stability suggest a reason for optimism about, the long-term prospects of maintaining a degree of functional through independence as patients age. Informed consent and decisional capacity Patients with schizophrenia are routinely asked to provide informed consent for their antipsychotic see more medication treatment. However, because of the cognitive deficits, as well as insight, deficits, which are sometimes present among those with schizophrenia,9,20 some schizophrenia patients may lack the capacity to provide independent consent for treatment. On the other hand, empirical data document considerable heterogeneity among older as well as younger schizophrenia patients in terms of the level of decisional capacity,21-23 and age is not itself a strong predictor of the level of decisional capacity among such patients.