Structural, Vascular, and Functional Brain Aging in Schizophrenia: Implications for Clinical Management

Schizophrenia is increasingly recognized as a disorder not only of early neurodevelopment but also of accelerated brain aging. Structural brain aging is characterized by neuronal loss, synaptic degeneration, and cortical atrophy, with particular vulnerability in the medial temporal lobe and hippocampal formation. Vascular brain aging contributes through both overt cerebrovascular events and insidious small vessel disease, compounded by modifiable risk factors such as hypertension and metabolic dysfunction. Functional brain aging, reflected in altered connectivity, intersects with the pathophysiology of schizophrenia, highlighting the dynamic interplay between disease processes and age-related decline across the lifespan. Effective management strategies should therefore include early detection of neurodegenerative changes, integrated care models bridging psychiatric and dementia services, multi-domain lifestyle interventions targeting vascular risk, and emerging neuromodulation approaches. While therapeutic evidence remains preliminary, these strategies underscore the importance of preserving cognitive reserve and promoting brain health in patients with schizophrenia as they age.