Skip to main content

Age at onset and cognition in schizophrenia: meta-analysis

  • T. K. Rajji (a1), Z. Ismail (a1) and B. H. Mulsant (a1)

The relationship between cognition and age at onset of schizophrenia is largely unknown.


To compare cognitive deficits in individuals with youth-onset and late-onset schizophrenia with those in adults with first-episode schizophrenia.


Twenty-nine databases (including EMBASE, MEDLINE and PsycINFO) were searched from 1980 to 2008. Selected publications had to include healthy controls and analyse separately individuals diagnosed with schizophrenia or a related disorder and individuals with first-episode, youth-onset or late-onset schizophrenia. Descriptive and cognitive data were extracted and the latter aggregated into 22 cognitive measures. Cohen's effect size raw and weighted means of cognitive deficits were generated and compared in the three groups.


Individuals with youth-onset and first-episode schizophrenia demonstrate large deficits (mean effect size ⩾0.8) on almost all cognitive measures. Individuals with youth-onset schizophrenia demonstrate larger deficits than those with first-episode schizophrenia on arithmetic, executive function, IQ, psychomotor speed of processing and verbal memory. In contrast, those with late-onset schizophrenia demonstrate minimal deficits on arithmetic, digit symbol coding and vocabulary, but larger ones on attention, fluency, global cognition, IQ and visuospatial construction.


Individuals with youth-onset schizophrenia have severe cognitive deficits, whereas those with late-onset schizophrenia have some relatively preserved cognitive functions. This finding supports the view that severity of the disease process is associated with different ages at onset. In addition, the cognitive pattern of people with late-onset schizophrenia suggests that their deficits are specific rather than solely as a result of ageing and related factors.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Age at onset and cognition in schizophrenia: meta-analysis
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Age at onset and cognition in schizophrenia: meta-analysis
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Age at onset and cognition in schizophrenia: meta-analysis
      Available formats
Corresponding author
B. H. Mulsant, Geriatric Mental Health Program, CAMH, 1001 Queen Street West, Toronto, Ontario M6J 1H4, Canada. Email:
Hide All

17 Jan 2009

T.K.R. is supported by the Centre for Addiction and Mental Health (CAMH) and the Canadian Institutes of Health Research (CIHR180087).

Declaration of interest


Hide All
1 Buchanan, RW, Carpenter, WT. Concept of schizophrenia. In Kaplan & Sadock's Comprehensive Textbook of Psychiatry (8th edn) (eds Sadock, BJ & Sadock, VA): 1329. Lippincott Williams & Wilkins, 2005.
2 Harris, MJ, Jeste, DV. Late-onset schizophrenia – an overview. Schizophr Bull 1988; 14: 3955.
3 Howard, R, Rabins, PV, Seeman, MV, Jeste, DV. Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus. Am J Psychiatry 2000; 157: 172–8.
4 McClennan, JM. Early-onset schizophrenia. In Kaplan & Sadock's Comprehensive Textbook of Psychiatry (8th edn) (eds Sadock, BJ & Sadock, VA): 3307. Lippincott Williams & Wilkins, 2005.
5 Delisi, LE. The significance of age of onset for schizophrenia. Schizophr Bull 1992; 18: 209–15.
6 Hoff, AL, Harris, D, Faustman, WO, Beal, M, DeVilliers, D, Mone, RD, et al. A neuropsychological study of early onset schizophrenia. Schizophr Res 1996; 20: 21–8.
7 Johnstone, EC, Owens, DGC, Bydder, GM, Colter, N, Crow, TJ, Frith, CD. The spectrum of structural brain changes in schizophrenia: age of onset as a predictor of cognitive and clinical impairments and their cerebral correlates. Psychol Med 1989; 19: 91103.
8 Eggers, C, Bunk, D. The long-term course of childhood-onset schizophrenia: a 42-year follow-up. Schizophr Bull 1997; 23: 105–17.
9 Crow, TJ, Colter, N, Frith, CD, Johnstone, EC, Owens, DGC. Developmental arrest of cerebral asymmetries in early onset schizophrenia. Psychiatry Res 1989; 29: 247–53.
10 Raz, S, Raz, N. Structural brain abnormalities in the major psychoses – a quantitative review of the evidence from computerized imaging. Psychol Bull 1990; 108: 93108.
11 Heinrichs, RW, Zakzanis, KK. Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 1998; 12: 426–45.
12 Rajji, TK, Mulsant, BH. Nature and course of cognitive function in late-life schizophrenia: a systematic review. Schizophr Res 2008; 102: 122–40.
13 Green, MF, Kern, RS, Heaton, RK. Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophr Res 2004; 72: 4151.
14 Heaton, R, Paulsen, JS, McAdams, LA, Kuck, J, Zisook, S, Braff, D, et al. Neuropsychological deficits in schizophrenics. Relationship to age, chronicity, and dementia. Arch Gen Psychiatry 1994; 51: 469–76.
15 Hoff, AL, Sakuma, M, Wieneke, M, Horon, R, Kushner, M, Delisi, LE. Longitudinal neuropsychological follow-up study of patients with first-episode schizophrenia. Am J Psychiatry 1999; 156: 1336–41.
16 White, T, Ho, BC, Ward, J, O'Leary, D, Andreasen, NC. Neuropsychological performance in first-episode adolescents with schizophrenia: a comparison with first-episode adults and adolescent control subjects. Biol Psychiatry 2006; 60: 463–71.
17 Jeste, DV, McAdams, LA, Palmer, BW, Braff, D, Jernigan, TL, Paulsen, JS, et al. Relationship of neuropsychological and MRI measures to age of onset of schizophrenia. Acta Psychiatr Scand 1998; 98: 156–64.
18 Paulsen, JS, Romero, R, Chan, A, Davis, AV, Heaton, RK, Jeste, DV. Impairment of the semantic network in schizophrenia. In 23rd Annual Meeting of the International-Neuropsychological-Society: 0811. Elsevier Science Ireland, 1995.
19 Tuulio-Henriksson, A, Partonen, T, Suviusaari, J, Haukka, J, Lönnqvist, J. Age at onset and cognitive functioning in schizophrenia. Br J Psychiatry 2004; 185: 215–9.
20 Jeste, DV, Harris, MJ, Krull, A, Kuck, J, McAdams, LA, Heaton, R. Clinical and neuropsychological characteristics of patients with late-onset schizophrenia. Am J Psychiatry 1995; 152: 722–30.
21 Sachdev, P, Brodaty, H, Rose, N, Cathcart, S. Schizophrenia with onset after age 50 years. 2: Neurological, neuropsychological and MRI investigation. Br J Psychiatry 1999; 175: 416–21.
22 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). APA, 1980.
23 DeLisi, LE, Hoff, AL, Schwartz, JE, Shields, GW, Halthore, SN, Gupta, SM, et al. Brain morphology in 1st-episode schizophrenic-like psychotic patients: a quantitative magnetic resonance imaging study. Biol Psychiatry 1991; 29: 159–75.
24 Bellgrove, MA, Collinson, S, Mattingley, JB, Pantelis, C, Fitzgerald, PB, James, AC, et al. Attenuation of perceptual asymmetries in patients with early-onset schizophrenia: evidence in favour of reduced hemispheric differentiation in schizophrenia? Laterality 2004; 9: 7991.
25 Delisi, LE, Goldin, LR, Maxwell, ME, Kazuba, DM, Gershon, ES. Clinical features of illness in siblings with schizophrenia or schizoaffective disorder. Arch Gen Psychiatry 1987; 44: 891–6.
26 Cohen, J. Statistical Power Analysis for the Behavioral Sciences, (2nd edn). Academic Press, 1988.
27 Wolf, FM. Meta-Analysis: Quantitative Methods for Research Synthesis. Sage, 1986.
28 Lipsey, MW, Wilson, DB. Practical Meta-Analysis. Sage, 2000.
29 Nicolson, R, Rapoport, JL. Childhood-onset schizophrenia: rare but worth studying. Biol Psychiatry 1999; 46: 1418–28.
30 Rapoport, JL, Addington, AM, Frangou, S, Psych, M. The neurodevelopmental model of schizophrenia: update 2005. Mol Psychiatry 2005; 10: 434–49.
31 Aleman, A, Hijman, R, de Haan, EHF, Kahn, RS. Memory impairment in schizophrenia: a meta-analysis. Am J Psychiatry 1999; 156: 1358–66.
32 Fioravanti, M, Carlone, O, Vitale, B, Cinti, ME, Clare, L. A meta-analysis of cognitive deficits in adults with a diagnosis of schizophrenia. Neuropsychol Rev 2005; 15: 7395.
33 Henry, JD, Crawford, JR. A meta-analytic review of verbal fluency deficits in schizophrenia relative to other neurocognitive deficits. Cogn Neuropsychiatry 2005; 10: 133.
34 Laws, KR. A meta-analytic review of Wisconsin Card Sort studies in schizophrenia: general intellectual deficit in disguise? Cogn Neuropsychiatry 1999; 4: 130.
35 Palmer, BW, Heaton, RK, Paulsen, JS, Kuck, J, Braff, D, Harris, MJ, et al. Is it possible to be schizophrenic yet neuropsychologically normal? Neuropsychology 1997; 11: 437–46.
36 Lee, JH, Park, S. Working memory impairments in schizophrenia: a meta-analysis. J Abnorm Psychol 2005; 114: 599611.
37 Drevets, WC, Rubin, EH. Psychotic symptoms and the longitudinal course of senile dementia of the Alzheimer type. Biol Psychiatry 1989; 25: 3948.
38 Lopez, OL, Wisniewski, SR, Becker, JT, Boller, F, DeKosky, ST. Psychiatric medication and abnormal behavior as predictors of progression in probable Alzheimer disease. Arch Neurol 1999; 56: 1266–72.
39 Basso, MR, Nasrallah, HA, Olson, SC, Bornstein, RA. Cognitive deficits distinguish patients with adolescent- and adult-onset schizophrenia. Neuropsychiatr Neuropsychol Behav Neurol 1997; 10: 107–12.
40 Nicolson, R, Brookner, FB, Lenane, M, Gochman, P, Ingraham, LJ, Egan, MF, et al. Parental schizophrenia spectrum disorders in childhood-onset and adult-onset schizophrenia. Am J Psychiatry 2003; 160: 490–5.
41 Vidal, CN, Rapoport, JL, Hayashi, KM, Geaga, JA, Sui, YH, McLemore, LE, et al. Dynamically spreading frontal and cingulate deficits mapped in adolescents with schizophrenia. Arch Gen Psychiatry 2006; 63: 2534.
42 Dickinson, D, Ramsey, ME, Gold, JM. Overlooking the obvious: a meta-analytic comparison of digit symbol coding tasks and other cognitive measures in schizophrenia. Arch Gen Psychiatry 2007; 64: 532–42.
43 Sanfilipo, M, Lafargue, T, Rusinek, H, Arena, L, Loneragan, C, Lautin, A, et al. Cognitive performance in schizophrenia: relationship to regional brain volumes and psychiatric symptoms. Psychiatry Res 2002; 116: 123.
44 Keefe, RSE. The contribution of neuropsychology to psychiatry. Am J Psychiatry 1995; 152: 615.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
Type Description Title
Supplementary materials

Rajji et al. supplementary material
Supplementary Material

 PDF (80 KB)
80 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Age at onset and cognition in schizophrenia: meta-analysis

  • T. K. Rajji (a1), Z. Ismail (a1) and B. H. Mulsant (a1)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *