Dement Neurocogn Disord.  2014 Sep;13(3):63-73. 10.12779/dnd.2014.13.3.63.

Delusions in Alzheimer's Disease

Affiliations
  • 1Department of Neurology, Hyoja Geriatric Hospital, Yongin, Korea. kwakdr@gmail.com
  • 2Department of Neurology, Seoul Veterans Hospital, Seoul, Korea.
  • 3Department of Psychiatry, College of Medicine, Kwandong University, Gangnung, Korea.

Abstract

Alzheimer's disease (AD) is associated with cognitive and functional impairment as well as neuropsychiatric complications, including psychotic symptoms such as delusions and hallucinations. Recent studies strongly suggest that delusions should be separated from hallucinations. While AD with delusions is a phenotypically distinct from AD without delusions, subtypes of delusions may also define further distinct clinical entities. There has been also considerable debate as to whether delusions in patients with AD differ etiologically, phenomenologically, and therapeutically from delusions in other primary psychiatric illnesses. In other words, whether they are caused by changes to key areas of the brain that have been linked to the presence of delusions. This has led to speculation that these symptoms may respond better to certain drugs such as cholinesterase inhibitors. Integrating the epidemiology, clinical phenomenology, neuropathological and genetic literature for delusions in AD allows us to speculate on pathophysiology and is essential to making progress in the area of delusions in AD.

Keyword

Alzheimer's disease; Delusions; Subtypes; Cholinesterase inhibitors

MeSH Terms

Alzheimer Disease*
Brain
Cholinesterase Inhibitors
Delusions*
Epidemiology
Hallucinations
Humans
Cholinesterase Inhibitors

Cited by  1 articles

Understanding of Antipsychotics in Elderly Patients with Dementia
Yong Tae Kwak, YoungSoon Yang, Hye-ryeon Jang
Dement Neurocogn Disord. 2015;14(2):53-69.    doi: 10.12779/dnd.2015.14.2.53.


Reference

1. Steinberg M, Shao H, Zandi P, Welsh-Bohmer KA, Norton MC, Breitner JC, et al. Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatry. 2008; 23:170–177.
Article
2. Wiener PK, Kiosses DN, Klimstra S, Murphy C, Alexopoulos GS. A short-term inpatient program for agitated demented nursing home residents. Int J Geriatr Psychiatry. 2001; 16:866–872.
Article
3. Murray R, Hill PD, McGuffin P. The essentials of postgraduate psychiatr. Cambridge. New York, NY, USA: Cambridge University Press;1997. p. 231.
4. Alzheimer A. Uber eine eigenartige rkrankung der hirnrinde. Allg Z Psychiat Psych Gerichtl Med. 1907; 64:146–148.
5. Fischer C, Bozanovic-Sosic R, Norris M. Review of delusions in dementia. Am J Alzheimers Dis Other Demen. 2004; 19:19–23.
Article
6. Holt AE, Albert ML. Cognitive neuroscience of delusions in aging. Neuropsychiatr Dis Treat. 2006; 2:181–189.
Article
7. Levy ML, Cummings JL, Fairbanks LA, Bravi D, Calvani M, Carta A. Longitudinal assessment of symptoms of depression, agitation, and psychosis in 181 patients with Alzheimer's disease. Am J Psychiatry. 1996; 153:1438–1443.
Article
8. Gilley DW, Wilson RS, Beckett LA, Evans DA. Psychotic symptoms and physically aggressive behavior in Alzheimer's disease. J Am Geriatr Soc. 1997; 45:1074–1079.
Article
9. Gormley N, Rizwan MR, Lovestone S. Clinical predictors of aggressive behaviour in Alzheimer's disease. Int J Geriatr Psychiatry. 1998; 13:109–115.
Article
10. Haupt M, Romero B, Kurz A. Delusions and hallucinations in Alzheimer's disease: results from a two year longitudinal study. Int J Geriatr Psychiatry. 1996; 11:965–972.
Article
11. Rabins PV, Mace NL, Lucas M. The impact of dementia on the family. JAMA. 1982; 248:333–335.
Article
12. Steele C, Rovner B, Chase GA. Psychiatric symptoms and nursing home placement of patients with Alzheimer's disease. Am J Psychiatry. 1990; 147:1049–1051.
Article
13. Haupt M, Kurz A. Predictors of nursing home placement in patients withAlzheimer's disease. Int J Geriatr Psychiatry. 1993; 8:741–746.
Article
14. Jeste DV, Finkel SI. Psychosis of Alzheimer's disease and related dementias. Diagnostic criteria for a distinct syndrome. Am J Geriatr Psychiatry. 2000; 8:29–34.
Article
15. Lyketsos CG, Breitner JC, Rabins PV. An evidence-based proposal for the classification of neuropsychiatric disturbance in Alzheimer's disease. Int J Geriatr Psychiatry. 2001; 16:1037–1042.
Article
16. Mizrahi R, Starkstein SE, Jorge R, Robinson RG. Phenomenology and clinical correlates of delusions in Alzheimer disease. Am J Geriatr Psychiatry. 2006; 14:573–581.
Article
17. Jeste DV, Wragg RE, Salmon DP, Harris MJ, Thal LJ. Cognitive deficits of patients with Alzheimer's disease with and without delusions. Am J Psychiatry. 1992; 149:184–189.
Article
18. Migliorelli R, Petracca G, Teson A, Sabe L, Leiguarda R, Starkstein SE. Neuropsychiatric and neuropsychological correlates of delusions in Alzheimer's disease. Psychol Med. 1995; 25:505–513.
Article
19. Ikeda M, Shigenobu K, Fukuhara R, Hokoishi K, Nebu A, Maki N, et al. Delusions of Japanese patients with Alzheimer's disease. Int J Geriatr Psychiatry. 2003; 18:527–532.
Article
20. Bassiony MM, Steinberg MS, Warren A, Rosenblatt A, Baker AS, Lyketsos CG. Delusions and hallucinations in Alzheimer's disease: prevalence and clinical correlates. Int J Geriatr Psychiatry. 2000; 15:99–107.
Article
21. Ropacki SA, Jeste DV. Epidemiology of and risk factors for psychosis of Alzheimer's disease: a review of 55 studies published from 1990 to 2003. Am J Psychiatry. 2005; 162:2022–2030.
Article
22. Weamer EA, Emanuel JE, Varon D, Miyahara S, Wilkosz PA, Lopez OL. The relationship of excess cognitive impairment in MCI and early Alzheimer's disease to the subsequent emergence of psychosis. Int Psychogeriatr. 2009; 21:78–85.
Article
23. Ostling S, Gustafson D, Blennow K, Börjesson-Hanson A, Waern M. Psychotic Symptoms in a Population- Based Sample of 85-Year-Old Individuals With Dementia. J Geriatr Psychiatry Neurol. 2011; 24:3–8.
Article
24. Sweet RA, Bennett DA, Graff-Radford NR, Mayeux R. Assessment and familial aggregation of psychosis in Alzheimer's disease from the National Institute on Aging Late Onset Alzheimer's Disease Family Study. Brain. 2010; 133:1155–1162.
Article
25. Harciarek M, Kertesz A. The prevalence of misidentification syndromes in neurodegenerative diseases. Alzheimer disease and associated disorders. 2008; 22:163–169.
Article
26. Savva GM, Zaccai J, Matthews FE, Davidson JE, McKeith I, Brayne C. Prevalence, correlates and course of behavioural and psychological symptoms of dementia in the population. Br J Psychiatry. 2009; 194:212–219.
Article
27. Kwak YT, Yang Y, Kwak SG, Koo MS. Delusions of Korean patients with Alzheimer's disease: study of drug-naïve patients. Geriatr Gerontol Int. 2013; 13:307–313.
Article
28. Paulsen JS, Salmon DP, Thal LJ, Romero R, Weisstein-Jenkins C, Galasko D, et al. Incidence of and risk factors for hallucinations and delusions in patients with probable AD. Neurology. 2000; 54:1965–1971.
Article
29. Caligiuri MP, Peavy G, Salmon DP, Galasko DR, Thal LJ. Neuromotor abnormalities and risk for psychosis in Alzheimer's disease. Neurology. 2003; 61:954–958.
Article
30. Ballard CG, O'Brien JT, Swann AG, Thompson P, Neill D, McKeith IG. The natural history of psychosis and depression in dementia with Lewy bodies and Alzheimer's disease: persistence and new cases over 1 year of follow-up. J Clin Psychiatry. 2001; 62:46–49.
Article
31. Devanand DP, Jacobs DM, Tang MX, Del Castillo-Castaneda C, Sano M, Marder K, et al. The course of psychopathologic features in mild to moderate Alzheimer disease. Arch Gen Psychiatry. 1997; 54:257–263.
Article
32. Davidson M, Harvey P, Welsh KA, Powchik P, Putnam KM, Mohs RC. Cognitive functioning in late-life schizophrenia: a comparison of elderly schizophrenic patients with Alzheimer's disease. Am J Psychiatry. 1996; 153:1274–1279.
33. Jeste DV, Rockwell E, Harris MJ, Lohr JB, Lacro J. Conventional antipsychotics in elderly patients. Am J Geriatr Psychiatry. 1999; 7:70–76.
34. Marin DB, Green CR, Schneidler J, Harvey PD, Lawlor BA, Ryan TM, et al. Noncognitive disturbances in Alzheimer's disease: frequency, longitudinal course, and relationship to cognitive symptoms. J Am Geriatr Soc. 1997; 45:1331–1338.
Article
35. Tariot PN, Mack JL, Patterson MB, Edland SD, Weiner MF, Fillenbaum G, et al. The behavior rating scale for dementia of the consortium to establish a registry for Alzheimer's disease. Am J Psychiatry. 1995; 152:1349–1357.
36. Rubin EH, Drevets WC, Burke WJ. Nature of psychotic symptoms in senile dementia of the Alzheimer type. J Geriatr Psychiatry Neurol. 1988; 1:16–20.
37. Schneider LS, Katz IR, Park S, Napolitano J, Martinez RA, Azen SP. Psychosis of Alzheimer disease: validity of the construct and response to risperidone. Am J Geriatr Psychiatry. 2003; 11:414–425.
Article
38. Forstl H, Burns A, Levy R, Cairns N. Neuropathological correlates of psychotic phenomena in confirmed Alzheimer's disease. Br J Psychiatry. 1994; 165:53–59.
Article
39. Nagata T, Ishii K, Ito T, Aoki K, Ehara Y, Kada H, et al. Correlation between a reduction in Frontal Assessment Battery scores and delusional thoughts in patients with Alzheimer's disease. Psychiatry Clin Neurosci. 2009; 63:449–454.
Article
40. Perez-Madrinan G, Cook SE, Saxton JA, Miyahara S, Lopez OL, Kaufer DI, et al. Alzheimer disease with psychosis: excess cognitive impairment is restricted to the misidentification subtype. Am J Geriatr Psychiatry. 2004; 12:449–456.
Article
41. Forstl H, Besthorn C, Burns A, Geiger-Kabisch C, Levy R, Sattel A. Delusional misidentification in Alzheimer's disease: a summary of clinical and biological aspects. Psychopathology. 1994; 27:194–199.
Article
42. Kwak YT, Yang YS, Koo MS, Kwak SG. The Neuropsychological Characteristics of Misidentification Syndrome. J Neurol Transl Neurosci. 2013; 1:1015.
43. Aron AR, Fletcher PC, Bullmore ET, Sahakian BJ, Robbins TW. Stop signal inhibition disrupted by damage to right inferior frontal gyrus in humans. Nat Neurosci. 2003; 6:115–116.
Article
44. Chambers CD, Bellgrove MA, Stokes MG, Henderson TR, Garavan H, Robertson IH, et al. Executive "brake failure" following deactivation of human frontal lobe. J Cogn Neurosci. 2006; 18:444–455.
Article
45. Buchsbaum BR, Greer S, Chang WL, Berman KF. Meta-analysis of neuroimaging studies of the Wisconsin card-sorting task and component processes. Hum Brain Mapp. 2005; 25:35–45.
Article
46. Chikazoe J, Konishi S, Asari T, Jimura K, Miyashita Y. Activation of right inferior frontal gyrus during response inhibition across response modalities. J Cogn Neurosci. 2007; 19:69–80.
Article
47. Cook SE, Miyahara S, Bacanu SA, Perez-Madriñan G, Lopez OL, Kaufer DI, et al. Psychotic symptoms in Alzheimer disease: evidence for subtypes. Am J Geriatr Psychiatry. 2003; 11:406–413.
Article
48. Chemerinski E, Petracca G, Teson A, Sabe L, Leiguarda R, Starkstein SE. Prevalence and correlates of aggressive behavior in Alzheimer's disease. J Neuropsychiatry Clin Neurosci. 1998; 10:421–425.
Article
49. Lam LC, Tang WK, Leung V, Chiu HF. Behavioral profile of Alzheimer's disease in Chinese elderly - a validation study of the Chinese version of the Alzheimer's disease behavioral pathology rating scale. Int J Geriatr Psychiatry. 2001; 16:368–373.
Article
50. Kwak YT, Yang Y, Kwak SG. Clinical Characteristics of Behavioral and Psychological Symptoms in Patients with Drug-naïve Alzheimer's Disease. Dement Neurocognitive Disord. 2012; 11:87–94.
Article
51. Zubenko GS, Moossy J, Martinez AJ, Rao G, Claassen D, Rosen J, et al. Neuropathologic and neurochemical correlates of psychosis in primary dementia. Arch Neurol. 1991; 48:619–624.
Article
52. Mukaetova-Ladinska EB, Harrington CR, Roth M. Biochemical, neuropathological, and clinical correlations of neurofibrillary degeneration in Alzheimer's disease. In : Bergener M, Finkel SI, editors. Treating Alzheimer's and other dementias. New York: Springer;1995. p. 57–80.
53. Farber NB, Rubin EH, Newcomer JW, Kinscherf DA, Miller JP, Morris JC, et al. Increased neocortical neurofibrillary tangle density in subjects with Alzheimer disease and psychosis. Arch Gen Psychiatry. 2000; 57:1165–1173.
Article
54. Lai MK, Lai OF, Keene J, Esiri MM, Francis PT, Hope T, et al. Psychosis of Alzheimer's disease is associated with elevated muscarinic M2 binding in the cortex. Neurology. 2001; 57:805–811.
Article
55. Sweet RA, Panchalingam K, Pettegrew JW, McClure RJ, Hamilton RL, Lopez OL, et al. Psychosis in Alzheimer disease: postmortem magnetic resonance spectroscopy evidence of excess neuronal and membrane phospholipid pathology. Neurobiol Aging. 2002; 23:547–553.
Article
56. Cohen-Mansfield J, Golander H, Ben-Israel J, Garfinkel D. The meanings of delusions in dementia: a preliminary study. Psychiatry Res. 2011; 189:97–104.
Article
57. Sultzer DL, Brown CV, Mandelkern MA, Mahler ME, Mendez MF, Chen ST, et al. Delusional thoughts and regional frontal/temporal cortex metabolism in Alzheimer's disease. Am J Psychiatry. 2003; 160:341–349.
Article
58. Starkstein SE, Vazquez S, Petracca G, Sabe L, Migliorelli R, Tesón A, et al. A SPECT study of delusions in Alzheimer's disease. Neurology. 1994; 44:2055–2059.
Article
59. Kotrla KJ, Chacko RC, Harper RG, Jhingran S, Doody R. SPECT findings on psychosis in Alzheimer's disease. Am J Psychiatry. 1995; 152:1470–1475.
Article
60. Geroldi C, Akkawi NM, Galluzzi S, Ubezio M, Binetti G, Zanetti O, et al. Temporal lobe asymmetry in patients with Alzheimer's disease with delusions. J Neurol Neurosurg Psychiatry. 2000; 69:187–191.
Article
61. Matsuoka T, Narumoto J, Shibata K, Okamura A, Nakamura K, Okuyama C, et al. Insular hypoperfusion correlates with the severity of delusions in individuals with Alzheimer's disease. Dement Geriatr Cogn Disord. 2010; 29:287–293.
Article
62. Ismail Z, Nguyen MQ, Fischer CE, Schweizer TA, Mulsant BH. Neuroimaging of delusions in Alzheimer's disease. Psychiatry Res. 2012; 202:89–95.
Article
63. Tunstall N, Owen MJ, Williams J, Rice F, Carty S, Lillystone S, et al. Familial influence on variation in age of onset and behavioural phenotype in Alzheimer's disease. Br J Psychiatry. 2000; 176:156–159.
Article
64. Avramopoulos D, Fallin MD, Bassett SS. Linkage to chromosome 14q in Alzheimer's disease (AD) patients without psychotic symptoms. Am J Med Genet B Neuropsychiatr Genet. 2005; 132B:9–13.
Article
65. Scarmeas N, Brandt J, Albert M, Devanand DP, Marder K, Bell K, et al. Association between the APOE genotype and psychopathologic symptoms in Alzheimer's disease. Neurology. 2002; 58:1182–1188.
Article
66. Spalletta G, Bernardini S, Bellincampi L, Federici G, Trequattrini A, Caltagirone C. Delusion symptoms are associated with ApoE epsilon4 allelic variant at the early stage of Alzheimer's disease with late onset. Eur J Neurol. 2006; 13:176–182.
Article
67. Pritchard AL, Harris J, Pritchard CW, Coates J, Haque S, Holder R, et al. The effect of the apolipoprotein E gene polymorphisms and haplotypes on behavioural and psychological symptoms in probable Alzheimer's disease. J Neurol Neurosurg Psychiatry. 2007; 78:123–126.
Article
68. Borroni B, Grassi M, Agosti C, Costanzi C, Archetti S, Franzoni S, et al. Genetic correlates of behavioral endophenotypes in Alzheimer disease: role of COMT, 5-HTTLPR and APOE polymorphisms. Neurobiol Aging. 2006; 27:1595–1603.
Article
69. Assal F, Alarcon M, Solomon EC, Masterman D, Geschwind DH, Cummings JL. Association of the serotonin transporter and receptor gene polymorphisms in neuropsychiatric symptoms in Alzheimer disease. Arch Neurol. 2004; 61:1249–1253.
Article
70. Angelucci F, Bernardini S, Gravina P, Bellincampi L, Trequattrini A, Di Iulio F, et al. Delusion symptoms and response to antipsychotic treatment are associated with the 5-HT2A receptor polymorphism (102 T/C) in Alzheimer's disease: a 3-year follow-up longitudinal study. J Alzheimers Dis. 2009; 17:203–211.
Article
71. Holmes C, Smith H, Ganderton R, Arranz M, Collier D, Powell J, et al. Psychosis and aggression in Alzheimer's disease: the effect of dopamine receptor gene variation. J Neurol Neurosurg Psychiatry. 2001; 71:777–779.
Article
72. Cipriani G, Vedovello M, Nuti A, Di Fiorino M. Aggressive behavior in patients with dementia: correlates and management. Geriatr Gerontol Int. 2011; 11:408–413.
Article
73. Cantley C. A Handbook of Dementia Care. Buckingham; Phildelphia: Open University;2001.
74. Ayalon L, Gum AM, Feliciano L, Arean PA. Effectiveness of nonpharmacological interventions for the management of neuropsychiatric symptoms in patients with dementia: a systematic review. Arch Intern Med. 2006; 166:2182–2188.
Article
75. Alexopoulos GS, Jeste DV, Chung H, Carpenter D, Ross R, Docherty JP. The expert consensus guideline series. Treatment of dementia and its behavioral disturbances Introduction: methods, commentary, and summary. Postgrad Med. 2005; Spec No:6–22.
76. Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: metaanalysis of randomized placebo-controlled trials. JAMA. 2005; 294:1934–1943.
Article
77. Yaffe K. Treatment of neuropsychiatric symptoms in patients with dementia. N Engl J Med. 2007; 357:1441–1443.
Article
78. Karim S, Byrne EJ. Treatment of psychosis in elderly people. Adv Psychiatr Treat. 2005; 11:286–296.
Article
79. Holmes C, Wilkinson D, Dean C, Vethanayagam S, Olivieri S, Langley A, et al. The efficacy of donepezil in the treatment of neuropsychiatric symptoms in Alzheimer disease. Neurology. 2004; 63:214–219.
Article
80. Yoon JS, Kim JM, Lee H, Shin IS, Lee YH, Lee HY. Effects of Donepezil on Behavioral and Psychological Symptoms in Patients with Alzheimer's Disease. Korean J Psychopharmacol. 2003; 14:129–137.
81. Paleacu D, Mazeh D, Mirecki I, Even M, Barak Y. Donepezil for the treatment of behavioral symptoms in patients with Alzheimer's disease. Clin Neuropharmacol. 2002; 25:313–317.
Article
82. Barak Y, Bodner E, Zemishlani H, Mirecki I, Aizenberg D. Donepezil for the treatment of behavioral disturbances in Alzheimer's disease: A 6-month open trial. Arch Gerontol Geriatr. 2001; 33:237–241.
Article
83. Cummings JL, Koumaras B, Chen M, Mirski D. Effects of rivastigmine treatment on the neuropsychiatric and behavioral disturbances of nursing home residents with moderate to severe probable Alzheimer's disease: a 26-week, multicenter, open-label study. Am J Geriatr Pharmacother. 2005; 3:137–148.
Article
84. Rosler M, Anand R, Cicin-Sain A, Gauthier S, Agid Y, Dal-Bianco P, et al. Efficacy and safety of rivastigmine in patients with Alzheimer's disease: International randomised controlled trial. BMJ. 1999; 318:633–638.
Article
85. Cummings JL, Schneider L, Tariot PN, Kershaw PR, Yuan W. Reduction of behavioral disturbances and caregiver distress by galantamine in patients with Alzheimer's disease. Am J Psychiatry. 2004; 161:532–538.
Article
86. Sasaki S, Horie Y. The Effects of an Uninterrupted Switch from Donepezil to Galantamine without Dose Titration on Behavioral and Psychological Symptoms of Dementia in Alzheimer's Disease. Dement Geriatr Cogn Dis Extra. 2014; 4:131–139.
Article
87. Pollock BG, Mulsant BH, Rosen J, Mazumdar S, Blakesley RE, Houck PR, et al. A double-blind comparison of citalopram and risperidone for the treatment of behavioral and psychotic symptoms associated with dementia. Am J Geriatr Psychiatry. 2007; 15:942–952.
Article
Full Text Links
  • DND
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2022 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr