Psychosis of Alzheimer's Disease and Related Dementias: Diagnostic Criteria for a Distinct Syndrome

Jeste, Dilip V.; Finkel, Sanford I.

doi:10.1097/00019442-200002000-00004

Cited by 351 publications

(252 citation statements)

References 26 publications

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“…Our findings are also comparable with data on young adults with schizophrenia spectrum disorders (Cattapan‐Ludewig et al ., 2005; Hilti et al ., 2010a) and their nonaffected first degree relatives (Hilti et al ., 2010b), in whom reduced RVP accuracy has been described as a phenotypic marker, reflecting ‘impaired context representation’ (Hilti et al ., 2010b). The fact that such differences were detectable in patients with predominantly mild symptoms, some of whom were not experiencing symptoms at the time of testing, and who would not fulfil criteria for the psychosis syndrome (Jeste and Finkel, 2000) suggests that impaired RVP accuracy may similarly be a trait marker of psychosis proneness in AD.…”

Section: Discussionmentioning

confidence: 99%

“…Given the modest efficacy and adverse effect profile associated with antipsychotic use in AD (Schneider et al ., 2006), there is a compelling clinical need to elucidate the pathophysiology of psychotic symptoms and identify novel therapeutic targets (Geda et al ., 2013). There is clear evidence that the psychosis syndrome (delusions and/or hallucinations) (Jeste and Finkel, 2000) represents a distinct endophenotype of AD, with a heritability of around 60% (DeMichele‐Sweet and Sweet, 2010). Attempts to further categorise symptoms using factor analytical approaches have identified two broad subtypes (Cook et al ., 2003): a ‘paranoid’ subtype, which includes delusions of persecution and/or abandonment, and a ‘misidentification’ subtype, characterised by the presence of misidentification phenomena and/or hallucinations.…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

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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“…The Cornell scale for depression in dementia 9 and the Jeste and Finkel criteria for psychosis of AD and related dementias 10 were applied to AD and VaD groups to exclude depression or psychosis.…”

Section: Methodsmentioning

confidence: 99%

Limitations in differentiating vascular dementia from Alzheimer's disease with brief cognitive tests

Matioli

Caramelli

2010

Arq. Neuro-Psiquiatr.

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Objective: To investigate the diagnostic value of brief cognitive tests in differentiating vascular dementia (VaD) from Alzheimer's disease (AD). Method: Fifteen patients with mild VaD, 15 patients with mild probable AD and 30 healthy controls, matched for age, education and dementia severity, were submitted to the following cognitive tests: clock drawing (free drawing and copy), category and letter fluency, delayed recall test of figures and the EXIT 25 battery. Results: VaD patients performed worse than AD patients in category fluency (p=0.014), letter fluency (p=0.043) and CLOX 2 (p=0.023), while AD cases performed worse than VaD patients in delayed recall (p=0.013). However, ROC curves for these tests displayed low sensitivity and specificity for the differential diagnosis between VaD and AD. Conclusion: Although the performance of VaD and AD patients was significantly different in some cognitive tests, the value of such instruments in differentiating VaD from AD proved to be very limited. Key words: Alzheimer's disease, vascular dementia, clock drawing test, delayed recall, diagnosis, EXIT25, neuropsychological tests, verbal fluency.Limitações em diferenciar demência vascular de doença de Alzheimer através de testes cognitivos breves RESUMO Objetivo: Investigar o valor diagnóstico de testes cognitivos breves na diferenciação de demência vascular (DV) e doença de Alzheimer (DA). Método: Quinze pacientes com DV, 15 com DA provável e 30 controles saudáveis, pareados em relação à idade, escolaridade e gravidade da demência, foram submetidos aos seguintes testes: desenho do relógio espontâneo e cópia, fluência verbal semântica e fonêmica, teste de evocação de memória de figuras e a bateria EXIT25. Resultados: Pacientes com DV apresentaram pior desempenho na fluência verbal semântica (p=0,014), fonêmica (p=0,043), e no CLOX 2 (p=0,023). O grupo com DA obteve pior desempenho no teste de evocação tardia (p=0,013). As curvas ROC aplicadas a esses testes mostraram baixa sensibilidade e especificidade para o diagnóstico diferencial entre DV e DA. Conclusão: Embora o desempenho dos pacientes tenha sido diferente em alguns testes, o valor desses instrumentos para o diagnóstico diferencial entre DV e DA parece ser muito limitado. Palavras-chave: doença de Alzheimer, demência vascular, teste do desenho do relógio, memória de evocação, diagnóstico, EXIT25, testes neuropsicológicos, fluência verbal.

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“…This suggests a need for designing and conducting further clinical trials of appropriate medications for dementia-associated psychosis and/ or agitation. Although advances in defining phenotypes of psychosis in dementia have been made (eg operationalized criteria for psychosis (Jeste and Finkel, 2000)), these were not used in early clinical trials. Careful consideration must also be given to the validity of outcome measures used for psychosis and other neuropsychiatric symptoms, such as how these may relate to clinically meaningful outcomes.…”

Section: Comparisons With Typical Antipsychoticsmentioning

confidence: 99%

“…Psychosis of AD is characterized by delusions or hallucinations (Jeste and Finkel, 2000). The reported prevalence of delusions in AD patients ranges from 9 to 63% (median 36%), and that for hallucinations from 4 to 41% (median 18%) (Ropacki and Jeste, 2005).…”

mentioning

confidence: 99%

ACNP White Paper: Update on Use of Antipsychotic Drugs in Elderly Persons with Dementia

Jeste

Blazer

Casey

et al. 2007

Neuropsychopharmacol

329

273

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In elderly persons, antipsychotic drugs are clinically prescribed off-label for a number of disorders outside of their Food and Drug Administration (FDA)-approved indications (schizophrenia and bipolar disorder). The largest number of antipsychotic prescriptions in older adults is for behavioral disturbances associated with dementia. In April 2005, the FDA, based on a meta-analysis of 17 double-blind randomized placebo-controlled trials among elderly people with dementia, determined that atypical antipsychotics were associated with a significantly (1.6-1.7 times) greater mortality risk compared with placebo, and asked that drug manufacturers add a 'black box' warning to prescribing information for these drugs. Most deaths were due to either cardiac or infectious causes, the two most common immediate causes of death in dementia in general. Clinicians, patients, and caregivers are left with unclear choices of treatment for dementia patients with psychosis and/or severe agitation. Not only are psychosis and agitation common in persons with dementia but they also frequently cause considerable caregiver distress and hasten institutionalization of patients. At the same time, there is a paucity of evidence-based treatment alternatives to antipsychotics for this population. Thus, there is insufficient evidence to suggest that psychotropics other than antipsychotics represent an overall effective and safe, let alone better, treatment choice for psychosis or agitation in dementia; currently no such treatment has been approved by the FDA for these symptoms. Similarly, the data on the efficacy of specific psychosocial treatments in patients with dementia are limited and inconclusive. The goal of this White Paper is to review relevant issues and make clinical and research recommendations regarding the treatment of elderly dementia patients with psychosis and/ or agitation. The role of shared decision making and caution in using pharmacotherapy for these patients is stressed.

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Psychosis of Alzheimer's Disease and Related Dementias: Diagnostic Criteria for a Distinct Syndrome

Cited by 351 publications

References 26 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

Limitations in differentiating vascular dementia from Alzheimer's disease with brief cognitive tests

ACNP White Paper: Update on Use of Antipsychotic Drugs in Elderly Persons with Dementia

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