Insight into illness in late-life schizophrenia: a function of illness severity and premorbid intellectual function

Schizophr Res. 2013 Oct;150(1):217-22. doi: 10.1016/j.schres.2013.07.025. Epub 2013 Aug 21.


Impaired insight into illness is a common but poorly understood phenomenon in schizophrenia. Several studies in midlife adults with schizophrenia have reported an association between impaired insight and illness severity, executive dysfunction, premorbid intellectual function, and to a lesser degree attention. Aging is associated with a decline in attention and executive function. Thus, the relationship between cognition and insight is expected to differ between younger and older adults with schizophrenia. This study assessed this relationship among 50 patients with schizophrenia 60 years and older. Insight was explained by illness severity (16.2% of the variance) and premorbid intellectual function (23.9% of the variance), but not by attention or executive function. Our findings suggest that the predictors of insight in schizophrenia differ early and later in life. In particular, insight's association with attention and executive function observed in younger patients is attenuated by age-related changes in cognition. In contrast, premorbid intellectual function continues to be a strong predictor of insight in late life, which highlights the need to better understand and enhance cognitive function early in the course of schizophrenia.

Keywords: Aging; Cognition; Illness awareness; Insight; Schizophrenia.

MeSH terms

  • Age Factors
  • Aged
  • Attention Deficit Disorder with Hyperactivity / etiology
  • Awareness / physiology*
  • Cognition Disorders / diagnosis
  • Cognition Disorders / etiology*
  • Executive Function / physiology
  • Female
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Predictive Value of Tests
  • Psychiatric Status Rating Scales
  • Schizophrenia / complications*
  • Schizophrenic Psychology*