Advances in the Diagnosis and Management of Psychotic Symptoms in Neurodegenerative Diseases: A Narrative Review

Decades of research have identified genetic and environmental factors involved in age-related neurodegenerative diseases and, to a lesser extent, neuropsychiatric disorders. Genomic instability, i.e., the loss of genome integrity, is a common feature among both neurodegenerative (mayo-trophic lateral sclerosis, Parkinson’s disease, Alzheimer’s disease) and psychiatric (schizophrenia, autism, bipolar depression) disorders. Genomic instability is associated with the accumulation of persistent DNA damage and the activation of DNA damage response (DDR) pathways, as well as pathologic neuronal cell loss or senescence. Typically, DDR signaling ensures that genomic and proteomic homeostasis are maintained in both dividing cells, including neural progenitors, and post-mitotic neurons. However, dysregulation of these protective responses, in part due to aging or environmental insults, contributes to the progressive development of neurodegenerative and/or psychiatric disorders. In this Special Issue, we introduce and highlight the overlap between neurodegenerative diseases and neuropsychiatric disorders, as well as the emerging clinical, genomic, and molecular evidence for the contributions of DNA damage and aberrant DNA repair. Our goal is to illuminate the importance of this subject to uncover possible treatment and prevention strategies for relevant devastating brain diseases.

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Mental Health in Later Life: Clinical Insights and Management Strategies for Late-Onset Psychiatric Conditions

Kerna,

Ngwu,

Rodriguez

et al. 2024

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Late-onset psychiatric conditions, which emerge or are first diagnosed in older adulthood, present unique challenges. This review examines their prevalence, risk factors, and clinical presentations, providing a comprehensive overview of their impact on older adults. Late-onset psychiatric disorders, including schizophrenia, bipolar disorder, and major depressive disorder (MDD), are increasingly recognized as significant health concerns among older adults. Epidemiological trends show a rising incidence, influenced by an aging population and demographic changes. Variability in prevalence rates due to gender differences and aging-related factors highlights the need for tailored research and clinical approaches. Risk factors include genetic predispositions, environmental exposures, and lifestyle factors. Genetic research emphasizes hereditary components, while environmental and lifestyle influences, such as stress and social isolation, add complexity to the clinical picture. Comorbidities, common in older adults, further complicate diagnosis and treatment. Clinical presentations of late-onset psychiatric conditions often differ from early-onset forms, with symptoms that may overlap with age-related changes, making diagnosis challenging. Accurate evaluation is necessary to distinguish these conditions from cognitive and neurodegenerative disorders. Managing and treating these conditions effectively requires a comprehensive, individualized approach integrating pharmacological interventions, psychotherapy, and behavioral therapies tailored to older adults. Pharmacological treatment should consider changes in drug metabolism, sensitivity with age, and the risks of polypharmacy. Essential psychotherapies include cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), with integrated care involving multidisciplinary teams to address both psychiatric and physical health. Neurologists and geriatricians are crucial in managing neurological manifestations and overall geriatric care. Addressing late-onset psychiatric conditions is critical given the growing old adult population. The rising prevalence emphasizes the need for ongoing research and innovation, focusing on early detection, refining diagnostic criteria, and exploring new therapeutic approaches to enhance care for older adults.

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Advances in the Diagnosis and Management of Psychotic Symptoms in Neurodegenerative Diseases: A Narrative Review

Cited by 3 publications

References 243 publications

Psychotic Symptoms and Syndromes

Psychotic Symptoms and Syndromes

Introducing the Role of Genotoxicity in Neurodegenerative Diseases and Neuropsychiatric Disorders

Mental Health in Later Life: Clinical Insights and Management Strategies for Late-Onset Psychiatric Conditions

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