Delusions and Hallucinations in Alzheimer’s Disease: Review of the Brain Decade

Bassiony, Medhat M.; Lyketsos, Constantine G.

doi:10.1176/appi.psy.44.5.388

Cited by 126 publications

(101 citation statements)

References 100 publications

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“…By contrast, Weiner et al (1999) reported marginal (P ¼ 0.05) positive associations between ApoE e4 and both delusions and hallucinations. This may reflect a statistical power issue, since delusions are more prevalent among AD patients than hallucinations (Hirono et al, 1998;Bassiony and Lyketsos, 2003), including in our present sample Note: NPI, neuropsychiatric inventory. OR (odds ratio) and 95% CI are for the effect of e4 carrier status in multiple logistic regression models, with NPI subscores as dependent variables and the following additional independent variables: age, sex, education, and MMSE.…”

Section: Comparison To Other Apoe E4 Ad Psychosis Studiesmentioning

confidence: 84%

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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Section: Comparison To Other Apoe E4 Ad Psychosis Studiesmentioning

confidence: 84%

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

Zdanys

Kleiman

MacAvoy

et al. 2006

Neuropsychopharmacol

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“…Delusions and hallucinations are not uncommon in patients with dementia of various etiologies (Bassiony et al 2003). The presence of such symptoms caused much distress to both patients and their care givers.…”

confidence: 99%

Delusions and Visual Hallucinations in Dementia Patients: Focus on Personal History of the Patients

Pai

2008

Tohoku J. Exp. Med.

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Psychotic features are frequently seen in dementia patients, which indeed cast a huge psychological and physical burden onto their care givers. This is especially true for delusions and hallucinations. If inquired into in greater detail, some of the delusions and even hallucinations can be found to arise from plausible origins. In this article, the author reports two dementia patients, with an attempt to link the unique psychotic features to the personal history of the individual patient. In addition to biological predisposition, the background and the personal history of each patient may play a role in the development of such psychotic features. To emphasize the background of the patients and to treat him or her as a person is also the core spirit of medical humanity, which is an issue important for dementia care. The author also discusses the two topics: visual hallucination in patients with dementia with Lewy bodies and the genetic polymorphism of dopamine D2 receptor gene in dementia patients with delusions. If clinicians spend more time to understanding the history of their patients, at least some of the need to use medical treatment can be reduced.

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“…1 Common neuropsychiatric symptoms in dementia and post-TBI include depression, apathy, irritability, agitation, aggression, wandering, change in sleep pattern, delusions, and hallucinations. [2][3][4] These symptoms can present as a psychiatric syndrome, such as major depression, or can occur in isolation. In dementia, neuropsychiatric symptoms are a major source of suffering to both patients and caregivers by interfering with sleep, 5 impairing quality of life, 6 leading to institutional placement, 7 and compounding caregiver financial burden and emotional stress.…”

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confidence: 99%

Neuropsychiatric Symptoms in Dementia Patients With and Without a History of Traumatic Brain Injury

Rao

Rosenberg²,

Miles³

et al. 2010

Journal of Neuropsychiatry

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The authors aim to determine if a history of traumatic brain injury (TBI) assessed before dementia onset is associated with a higher risk of neuropsychiatric symptoms after dementia onset. A population-based incident series of people with dementia were assessed for TBI prior to onset of dementia and for neuropsychiatric symptoms after the onset, using the Neuropsychiatric Inventory. Participants with predementia TBI were more likely to exhibit disinhibition (12.7%Address correspondence to Vani Rao, M.D., Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry, Johns Hopkins University, 5300 Alpha Commons Dr., 4th Floor, #444, Baltimore, MD 21224; vrao@jhmi.edu. These results were presented as a poster by DP at Northeastern Ohio Universities College of Medicine's Summer Research Fellowship Program on 9/3/08 in Rootstown, Ohio, and as an oral presentation at Summa Health System on 1/8/09 in Akron, Ohio. DP is a Medical Student Training in Aging Research (MSTAR) scholar and presented these results at the 2009 American Geriatric Society Annual Scientific Meeting. While patients affected by dementia and TBI independently are at increased risk for neuropsychiatric symptoms, no published data have examined the question of whether people with dementia who have sustained a TBI in the past are at increased risk for developing neuropsychiatric symptoms. Given that dementia and TBI are both associated with damage to the frontal cortex and associated frontal-subcortical circuits, and damage to these circuits from a variety of insults predisposes patients to psychopathology, 9 we hypothesized that, in persons with dementia, TBI prior to the onset of dementia would be a risk factor for increased neuropsychiatric symptoms associated with frontal lobe damage such as disinhibition, irritability, depression, apathy, and aggression. We examined this question in a population-based study of persons with dementia whose history of TBI was assessed prior to the onset of dementia and in whom dementia-onset was assessed prospectively (incident cohort). NIH Public Access METHODSThis is a prospective study involving persons with incident dementia who took part in the Cache County Study on Memory, Health, and Aging (CCSMHA). The CCSMHA is an ongoing population-based study of the epidemiology and progression of dementia. The study has been approved by Institutional Review Boards at Duke University Medical Center, Johns Hopkins University, and Utah State University. Informed consent was obtained from either the study participants or appropriate next of kin. This study has been described previously. 10,11 Briefly, a total of 5,092 respondents (5,677 were invited) ages 65 years and older participated in the study. All participants underwent a multistage screening and assessment for prevalent dementia (Wave 1). Those with dementia in Wave 1 and those that did not develop dementia or dropped out between Waves 1 and 3 were excluded from these analyses (n=4,265). TBI AssessmentHead injury was assessed prior to the onse...

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Delusions and Hallucinations in Alzheimer’s Disease: Review of the Brain Decade

Cited by 126 publications

References 100 publications

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

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

Delusions and Visual Hallucinations in Dementia Patients: Focus on Personal History of the Patients

Neuropsychiatric Symptoms in Dementia Patients With and Without a History of Traumatic Brain Injury

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