Cognitive and Behavioral Determinants of Psychotic Symptoms in Alzheimer's Disease

Quaranta, Davide; Vita, Maria Gabriella; Bizzarro, Alessandra; Masullo, Carlo; Piccininni, Chiara; Gainotti, Guido; Marra, Camillo

doi:10.1159/000369161

Cited by 16 publications

(9 citation statements)

References 40 publications

(71 reference statements)

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“…However, the frequency of hallucinations in CDR 2 patients was high, at 14.5%, suggesting that hallucinations occur more frequently in AD patients as dementia progresses. These results do not contradict previous findings that AD patients with visual hallucinations present with worse cognitive impairment [ 39 ] and visuospatial abilities [ 40 ] than do those without visual hallucinations. Hallucinations were observed in two of the seven FTLD patients with CDR 3 (28.6%) in this study, although the small number of patient means the reliability of this finding may be low.…”

Section: Discussionsupporting

confidence: 51%

Differences of Behavioral and Psychological Symptoms of Dementia in Disease Severity in Four Major Dementias

et al. 2016

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Background/AimsBehavioral and psychological symptoms of dementia (BPSDs) negatively impact the prognosis of dementia patients and increase caregiver distress. The aims of this study were to clarify the differences of trajectories of 12 kinds of BPSDs by disease severity in four major dementias and to develop charts showing the frequency, severity, and associated caregiver distress (ACD) of BPSDs using the data of a Japan multicenter study (J-BIRD).MethodsWe gathered Neuropsychiatric Inventory (NPI) data of patients with Alzheimer’s disease (AD; n = 1091), dementia with Lewy bodies (DLB; n = 249), vascular dementia (VaD; n = 156), and frontotemporal lobar degeneration (FTLD; n = 102) collected during a 5-year period up to July 31, 2013 in seven centers for dementia in Japan. The NPI composite scores (frequency × severity) of 12 kinds of items were analyzed using a principal component analysis (PCA) in each dementia. The factor scores of the PCA were compared in each dementia by disease severity, which was determined with Clinical Dementia Rating (CDR).ResultsSignificant increases with higher CDR scores were observed in 1) two of the three factor scores which were loaded for all items except euphoria in AD, 2) two of the four factor scores for apathy, aberrant motor behavior (AMB), sleep disturbances, agitation, irritability, disinhibition, and euphoria in DLB, and 3) one of the four factor scores for apathy, depression, anxiety, and sleep disturbances in VaD. However, no increases were observed in any of the five factor scores in FTLD.ConclusionsAs dementia progresses, several BPSDs become more severe, including 1) apathy and sleep disturbances in AD, DLB, and VaD, 2) all of the BPSDs except euphoria in AD, 3) AMB, agitation, irritability, disinhibition, and euphoria in DLB, and 4) depression and anxiety in VaD. Trajectories of BPSDs in FTLD were unclear.

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Section: Discussionsupporting

confidence: 51%

Differences of Behavioral and Psychological Symptoms of Dementia in Disease Severity in Four Major Dementias

et al. 2016

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“…Moreover, the presence of PS was limited to a very weak number of participants, so this result should be interpreted with caution. Conversely to our findings, Quaranta et al showed that among 108 patients with moderate AD, the participants presenting PS had worse executive performances than patients without PS in univariate analysis 28 . However, the patients with PS had a global greater cognitive impairment and a more severe disease stage than ones without PS.…”

Section: Discussioncontrasting

confidence: 99%

Association between executive function and the evolution of behavioral disorders in Alzheimer's disease

Rouch

Padovan

Boublay

et al. 2020

Int J Geriat Psychiatry

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This study was aimed at evaluating the association between cognitive functioning and the occurrence of behavioral and psychological symptoms of dementia (BPSD) in patients with Alzheimer's disease (AD). Methods/Design: The population is derived from the PACO cohort, including 237 patients with prodromal or mild AD. A neuropsychological tests battery exploring verbal and visual memory, language, attention, and executive functions was performed at baseline. BPSD were assessed at 6-, 12-, and 18-month follow-up with neuropsychiatric inventory (NPI). Results: Lower baseline performance on Stroop test interference score was associated with higher subsequent overall NPI scores (P = .006), subscores of anxiety/ depression (P = .03), and apathy inventory (P = .01). Conversely, other executive functions, verbal or visual memory, and language performances were not associated with a higher risk of BPSD. Conclusion: Our results suggest that poorer inhibition performance would be associated with a higher risk of 18-month BPSD occurrence, including anxiety, depression, and apathy. A better knowledge of the predictive factors of the BPSDs would make it possible to better identify the patients at risk, to propose preventive strategies and an earlier adapted care.

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“…Delusional subtype, such as persecutory delusions or misidentification delusions, may additionally have separate neurobiology. For instance, patients with misidentification delusions may have more advanced decline compared to patients with persecutory delusions [61, 62]. Lastly, the subgroups were very modest in size, especially in the AD+H group with only 83 subjects.…”

Section: Discussionmentioning

confidence: 99%

Association Between Psychosis Phenotype and APOE Genotype on the Clinical Profiles of Alzheimer's Disease

Qian

Fischer

Schweizer

et al. 2018

CAR

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Background: Psychosis is a common phenomenon in Alzheimer’s disease (AD). The APOE ε4 allele is the strongest genetic risk factor for the development of AD, but it’s association with psychosis remains unclear. Objective: We investigated the associations between psychosis, subdivided into delusions and hallucinations, as well as APOE ε4 allele on cognitive and functional outcomes. Secondarily, we investigated the associations between APOE ε4, Lewy bodies, and psychosis. Methods: Data from the National Alzheimer’s Coordinating Center (NACC) were used. Nine hundred patients with a confirmed diagnosis of AD based on the NIA-AA Reagan were included in the analysis. Global cognition was assessed using the Mini-Mental State Exam (MMSE) and functional status was assessed using the Functional Activities Questionnaire (FAQ). Psychosis status was determined using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Factorial design was used to assess the effects of psychosis and APOE ε4, as well as their interaction. Results: Psychosis and the presence of APOE ε4 were both associated with lower MMSE scores, while only psychosis was associated with higher FAQ scores. Furthermore, patients with hallucinations had lower MMSE and higher FAQ scores than patients with only delusions. There was a significant interaction effect between psychosis and APOE ε4 on MMSE scores, with APOE ε4 negatively affecting patients with hallucinations-only psychosis. APOE ε4 was positively associated with the presence of Lewy body pathology, and both were found to be more prevalent in psychotic patients, with a stronger association with hallucinations. Conclusion: Psychosis in AD was associated with greater cognitive and functional impairments. Patients with hallucinations—with or without delusions—conferred even greater deficits compared to patients with only delusions. The APOE ε4 allele was associated with worse cognition, especially for patients with hallucination-only psychosis. APOE ε4 may mediate cognitive impairment in the hallucinations phenotype through the development of Lewy bodies. Our findings support that subtypes of psychosis should be evaluated separately.

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Cognitive and Behavioral Determinants of Psychotic Symptoms in Alzheimer's Disease

Cited by 16 publications

References 40 publications

Differences of Behavioral and Psychological Symptoms of Dementia in Disease Severity in Four Major Dementias

Differences of Behavioral and Psychological Symptoms of Dementia in Disease Severity in Four Major Dementias

Association between executive function and the evolution of behavioral disorders in Alzheimer's disease

Association Between Psychosis Phenotype and APOE Genotype on the Clinical Profiles of Alzheimer's Disease

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