ARTICLE IN PRESS Mémoire Origine et renouveau du concept de démence dans la schizophrénie Origin and renewal of the dementia concept in schizophrenia J.-M. Azorin *, A. Kaladjian, E. Fakra SHU Psychiatrie Adultes, CHU Sainte-Marguerite, 13274 Marseille Cedex 09, France Reçu le 6 avril 2005 ; accepté le 16 mai 2005 Résumé Une littérature de plus en plus importante est consacrée au rôle que pourrait jouer un processus démentiel dans l’évolution du trouble schizo- phrénique. L ’histoire même du concept de démence semble avoir tracé la voie qui mène à ce regain d’intérêt. Si la définition de la démence comme affection de la cognition remonte, en psychiatrie, à Pinel, au XIX e siècle le trouble est conçu à la fois comme une maladie du cerveau mais qui peut avoir une étiologie psychique. La notion de « démence précoce » résume, dans le cadre de la schizophrénie, ces conceptions. L ’identification d’une atteinte cognitive extensive paraissant indépendante des symptômes psychiatriques a constitué une étape importante dans la réflexion sur les relations entre démence et schizophrénie. Les études de suivi d’ordre neuropsychologique ou en neuro-imagerie ont montré que cette atteinte pouvait dans certains cas progresser, plaidant pour une étiologie dégénérative. Des descriptions cliniques ont confirmé ces observa- tions. Des modèles neuropathologiques et neurobiologiques de ce déficit cognitif sont aujourd’hui proposés, qui sont à même de déboucher sur des stratégies préventives dans le traitement de la schizophrénie. © 2005 Elsevier SAS. Tous droits réservés. Abstract An increasing amount of current literature on schizophrenia is devoted to the role dementia may play in its course. This renewed interest had the way paved by the very history of the dementia concept. Before Kraepelin coined the term of "dementia praecox" as the hallmark of a common terminal state for hebephrenia, catatonia and paranoid psychosis, dementia acquired, as soon as the end of the 18th-century its cognitive meaning. In France, Pinel yet spoke of an "abolition of thinking", but in the same time considered dementia as one of the four forms of mental alienation, alongside with mania, melancolia and idiotism. During the 19-th century dementia was defined as an acquired deficit of intelligence supported by a brain disease, but which could be due to a mental illness. Owing to progress in neuropathology, several diseases such as Alzhei- mer or Pick illnesses were identified as causes of dementia, so that the concept was annexed by neurologists and received less interest from psychiatrists, during the last century. That seemed to change, twenty years ago, when clinical discussions emerged around the issues raised by depressive (pseudo) dementia. In psychiatry, the broader conceptualization of schizophrenia introduced by Bleuler in 1911 has not been widely adopted, many authors having been continuing sharing the Kraepelinian view that, at least one form of the disease, was a chronic progressive illness leading to severe impairments in cognitive and social functioning. Historical variations in diagnostic criteria used for schizophrenia had an impact on the way psychiatrists assessed outcome of the disease, leading some of them to consider schizophrenia as a nosological category without natural boundaries and propose to abandon the concept. However the use of narrow criteria is currently prevailing. Advances in neuro- cognitive testing and changes in theoretical models allowed, at the end of the last century, to document that schizophrenia was characterized by a broadly based cognitive impairment. Deficits were found in various domains: global and selective verbal memory, non-verbal memory, bilateral and unilateral motor performance, visual and auditory attention, general intelligence, spatial ability, executive function, language and interhemi- spheric tactile-transfer test performance. The hypothesis according to which the vast majority of these cognitive deficits had a neurodevelop- mental origin was recently challenged by findings from longitudinal neurocognitive and neuroimaging studies. Some studies, for example, show that if first episode patients have smaller left hippocampal volumes as compared with controls, there is also an association of smaller right hippocampal volumes with increased illness duration in chronic schizophrenia. Others have shown that neuropsychological evaluations before http://france.elsevier.com/direct/AMEPSY/ Annales Médico-Psychologiques ■■ (2005) ■■■–■■■ Modele+ * Auteur correspondant. Adresse e-mail : jazorin@ap-hm.fr (J.-M. Azorin). 0003-4487/$ - see front matter © 2005 Elsevier SAS. Tous droits réservés. doi:10.1016/j.amp.2005.05.008 AMEPSY-498