A SPECT study of delusions in Alzheimer's disease

Starkstein, Sergio E.; Vázquez, Silvia; Petracca, Gustavo; Sabe, Liliana; Migliorelli, R.; Tesón, Alejandra; Leiguarda, R

doi:10.1212/wnl.44.11.2055

Cited by 111 publications

(53 citation statements)

References 18 publications

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“…Other studies, which have restricted their investigation to AD, have found no differences in visuoperceptual function between psychotic and nonpsychotic patients. These negative findings may be explained by small sample sizes ( n < 18 in psychotic group) (Lopez et al ., 1991; Mentis et al ., 1995; Staff et al ., 1999; Starkstein et al ., 1994) or by their use of tests, including Ravens Progre s sive Matrices and Visual Form Discrimination, which are more complex in their requirements, and thus less specific for the ventral visual pathway, than the incomplete letters task.…”

Section: Discussionmentioning

confidence: 99%

Cognitive phenotype of psychotic symptoms in Alzheimer's disease: evidence for impaired visuoperceptual function in the misidentification subtype

Reeves

Clark-Papasavas

Gould

et al. 2015

Int J Geriatr Psychiatry

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BackgroundEstablishing the cognitive phenotype of psychotic symptoms in Alzheimer's disease (AD) could localise discrete pathology and target symptomatic treatment. This study aimed to establish whether psychotic symptoms would be associated with poorer performance on neuropsychological tests known to correlate with striatal dopaminergic function and to investigate whether these differences would be attributed to the paranoid (persecutory delusions) or misidentification (misidentification phenomena +/− hallucinations) subtype.MethodsSeventy patients with probable AD (34 psychotic and 36 nonpsychotic) were recruited to the study. Analysis of covariance was used to compare motor speed and the rapid visual processing test of sustained visual attention, after adjusting for potential confounding factors. Multivariate analyses were used to compare performance across other cognitive domains. Significant findings were explored by separating patients on the basis of subtype.ResultsRapid visual processing performance accuracy was reduced in patients with psychotic symptoms (F 1,58 = 5.94, p = 0.02) and differed significantly across subtypes (F 2,51 = 3.94, p = 0.03), largely because of poorer performance in the misidentification compared with nonpsychotic group. Multivariate analyses (corrected for multiple comparisons) showed poorer performance on the incomplete letters task in psychotic patients (F 1,63 = 8.77, p = 0.004) and across subtypes (F 2,55 = 10.90, p < 0.001), similarly attributed to the misidentification subtype.ConclusionsThese findings provide further support of the involvement of dopaminergic networks in the psychosis endophenotype in AD and, in addition, implicate the ventral (temporo‐occipital) pathway in the misidentification subtype. Future studies should investigate the early trajectory of neuropathological change in vivo across psychosis subtypes.© 2015 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd.

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Section: Discussionmentioning

confidence: 99%

Cognitive phenotype of psychotic symptoms in Alzheimer's disease: evidence for impaired visuoperceptual function in the misidentification subtype

Reeves

Clark-Papasavas

Gould

et al. 2015

Int J Geriatr Psychiatry

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“…50,55 SPECT evidence has suggested that delusions in AD may be associated with greater temporal lobe hypoperfusion. 56 At the same time, SPECT and MRI studies have shown greater atrophy in medial temporal structures and more severe loss in hippocampal volumes in patients with AD carrying the ε4 allele. 57,58 It is conceivable that the detected association between APOE genotype and delusions might reflect neuropathology more heavily concentrated in the temporal lobe.…”

Section: Discussionmentioning

confidence: 99%

Association between the APOE genotype and psychopathologic symptoms in Alzheimer’s disease

Scarmeas¹,

et al. 2002

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“…Neuroimaging studies may shed additional light on the association between ApoE e4 and psychotic manifestations of AD. One in vivo SPECT study has suggested that delusions in AD may be associated with hypoperfusion in the temporal lobes (Starkstein et al, 1994), and some (Lee et al, 2003) but not all (van Dyck et al, 1998) functional imaging studies have shown that AD patients who carry the e4 allele have reduced temporal lobe function. The structural MRI literature is more unified in showing greater medial temporal lobe atrophy in association with the e4 allele in AD (Lehtovirta et al, 1996b;Hashimoto et al, 2001;Basso et al, in press).…”

Section: Interpretation Of An Increased Risk Of Psychosis In Apoe E4 mentioning

confidence: 99%

Apolipoprotein E ɛ4 Allele Increases Risk for Psychotic Symptoms in Alzheimer's Disease

Zdanys

Kleiman

MacAvoy

et al. 2006

Neuropsychopharmacol

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The apolipoprotein E (ApoE) e4 allele is a well-documented genetic risk factor for sporadic Alzheimer's disease (AD). Its association with psychopathology among AD patients has been the subject of discrepant reports. We aimed to determine whether ApoE e4 + and e4-AD patients exhibit a different risk profile for psychotic symptoms and other behavioral disturbances. The Neuropsychiatric Inventory (NPI) was administered to determine the frequency and severity of psychotic and other behavioral symptoms in a sample of n ¼ 266 AD patients who had been genotyped for ApoE. Multiple logistic regression models were used to calculate the association between the ApoE e4 allele and the presence of psychotic symptoms (delusions or hallucinations). Exploratory analyses were also conducted to determine the impact of disease severity on e4 effects and to examine the association between e4 and other behavioral symptoms. ApoE e4 was significantly associated with psychotic symptoms (odds ratio (OR) ¼ 1.87, 95% CI ¼ 1.07-3.29, P ¼ 0.029), adjusting for age, sex, education, and MMSE score. More stringent definitions of clinically significant psychosis yielded similar results. Exploratory analyses suggested that this effect accrued specifically from patients with severe-stage AD and primarily from an association between e4 and delusions. The e4 allele did not appear to influence the development of most other behavioral symptoms in our sample. In conclusion, AD patients who carry the ApoE e4 allele are at greater risk than noncarriers for developing psychotic symptoms, particularly as the severity of their dementia progresses.

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A SPECT study of delusions in Alzheimer's disease

Cited by 111 publications

References 18 publications

Cognitive phenotype of psychotic symptoms in Alzheimer's disease: evidence for impaired visuoperceptual function in the misidentification subtype

Cognitive phenotype of psychotic symptoms in Alzheimer's disease: evidence for impaired visuoperceptual function in the misidentification subtype

Association between the APOE genotype and psychopathologic symptoms in Alzheimer’s disease

Apolipoprotein E ɛ4 Allele Increases Risk for Psychotic Symptoms in Alzheimer's Disease

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