The Neuropsychological Profile and Phenomenology of Late Onset Psychosis: A Cross-sectional Study on the Differential Diagnosis of Very-Late-Onset Schizophrenia-Like Psychosis, Dementia with Lewy Bodies and Alzheimer’s Type Dementia with Psychosis

Assche, Leen Van; Aubel, Evelyne van; Ven, Lucas Van de; Bouckaert, Filip; Luyten, Patrick; Vandenbulcke, Mathieu

doi:10.1093/arclin/acy034

Cited by 46 publications

(41 citation statements)

References 59 publications

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“…It is also important to differentiate among very late-onset schizophrenia-like psychosis, Alzheimer's disease (AD), and DLB when diagnosing elderly patients with psychiatric symptoms. 20 In this study, positive findings were obtained in 90 of 104 cases and 70 of 96 cases on DaT scans and 123 I-MIBG scintigraphy, respectively. These indicative biomarkers may be useful to distinguish DLB from AD with psychotic symptoms and from very lateonset schizophrenia-like psychosis.…”

Section: Initial Symptomsmentioning

confidence: 52%

Characteristics of initial symptoms and symptoms at diagnosis in probable dementia with Lewy body disease: incidence of symptoms and gender differences

et al. 2020

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Aim: Although dementia with Lewy bodies (DLB) is characterized by a variety of initial symptoms, there are almost no reports of the initial symptoms of DLB assessed in a large number of cases. We retrospectively evaluated the initial symptoms of 234 participants with DLB and DLB-related symptoms at diagnosis and characterized any gender differences in the symptom profiles. Methods: This study consisted of 234 participants with probable DLB who met the diagnostic criteria outlined in the Fourth Consensus Report of the DLB Consortium (2017). DLB was confirmed based on several characteristic biomarkers for dopamine transporter imaging with 123 IN -omegafluoropropyl-2-beta-carbomethoxy-3-beta (4-iodophenyl) nortropane singlephoton emission computed tomography, 123 I-metaiodobenzylguanidine myocardial scintigraphy, and brain perfusion measured with single photon emission computed tomography. In addition, core and supportive clinical features were considered in the diagnosis. Results: Initial symptoms included cognitive impairment (41.9%) and psychiatric symptoms (i.e. visual and auditory hallucinations, delusions, and depression) (42.3%). Almost half of the women initially presented with psychiatric symptoms, with significantly more women than men presenting with auditory hallucinations. In contrast, men had a significantly higher rate of rapid eye movement sleep behaviour disorder (RBD) than women did. At diagnosis, DLB-related symptoms differed between men and women, with male patients exhibiting significantly more RBD, parkinsonism, hyposmia, and syncope than female patients. Moreover women presented significantly more often with auditory hallucinations than did men. Conclusions: Our results indicate that there are gender differences in the initial symptoms of DLB, as well as in the presentation of subsequent symptoms observed at diagnosis. There was a higher incidence of RBD in men, whereas women had a higher incidence of psychotic symptoms.

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Section: Initial Symptomsmentioning

confidence: 52%

Characteristics of initial symptoms and symptoms at diagnosis in probable dementia with Lewy body disease: incidence of symptoms and gender differences

et al. 2020

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“…Psychiatric-onset DLB cases are not easily differentiated from non-LB late-onset psychosis cases on the basis of primary psychiatric phenomenology or neuropsychological profile alone. 54 Psychomotor retardation such as slowed speech, thinking, and body movements can resemble the bradykinesia of parkinsonism. The occurrence of rest tremor or rigidity is more helpful than bradykinesia to suspect prodromal DLB in patients with depressive disorder, 53 but psychotropic-induced parkinsonism may complicate diagnosis.…”

Section: Low Occipital Uptake On Perfusion/metabolism Scanmentioning

confidence: 99%

“…As with all α-synucleinopathies, RBD may be a useful indicator, although a relationship between antidepressant usage and subsequent RBD onset is a potential confounder. e41 Although the primary psychiatric manifestations are often accompanied by mild cognitive deficits, 54 cognitive evaluation and interpretation of performance can be difficult when psychiatric symptoms are prominent. The frequency of cognitive fluctuations in psychiatric-onset LB cases has not been determined.…”

Section: Identification Of Delirium-onset Dlbmentioning

confidence: 99%

Research criteria for the diagnosis of prodromal dementia with Lewy bodies

et al. 2020

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The prodromal phase of dementia with Lewy bodies (DLB) includes (1) mild cognitive impairment (MCI), (2) delirium-onset, and (3) psychiatric-onset presentations. The purpose of our review is to determine whether there is sufficient information yet available to justify development of diagnostic criteria for each of these. Our goal is to achieve evidence-based recommendations for the recognition of DLB at a predementia, symptomatic stage. We propose operationalized diagnostic criteria for probable and possible mild cognitive impairment with Lewy bodies, which are intended for use in research settings pending validation for use in clinical practice. They are compatible with current criteria for other prodromal neurodegenerative disorders including Alzheimer and Parkinson disease. Although there is still insufficient evidence to propose formal criteria for delirium-onset and psychiatric-onset presentations of DLB, we feel that it is important to characterize them, raising the index of diagnostic suspicion and prioritizing them for further investigation.

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“…However, diagnosable paranoid states can also be caused by a wide range of direct disturbances to brain function. Paranoia is common in psychosis following epilepsy (21), brain injury (22,23) and dementia (24). It is also one of the most frequent unwanted side-effects for several classes of recreational drugs (25)(26)(27).…”

Section: Current Conceptualisation Of Paranoiamentioning

confidence: 99%

An evolutionary perspective on paranoia

Raihani¹,

Bell²

2018

Preprint

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Although paranoia is the most commonly presenting symptom of psychosis, paranoid thoughts occur frequently in the general population and range widely in severity, from mild socio-evaluative concerns to frank delusions about the harmful intentions of others. Furthermore, paranoia commonly appears after a surprisingly diverse range of difficulties including trauma, brain injury, sleep deprivation, drug use, and psychiatric and neurological disorder. Evolutionary accounts of paranoia have been proposed before but have largely focused on paranoia as a misplaced threat response. Although social threat is clearly a key component, the experience of paranoia is markedly more complex than these accounts would lead us to believe: paranoia can involve multiple alterations in the perception of the social environment, the identification of specific but seemingly arbitrary groups as the source of persecution, and extended beliefs about conspiracy and complex coordination between the perceived persecutors. Here, we argue for an evolutionary approach to paranoia that more fully accounts for its complex social phenomenology and considers how it can be understood in light of our evolved social cognition. More specifically, in terms of the ability to form coalitions and coordinate between groups in situations of cooperation and competition.

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The Neuropsychological Profile and Phenomenology of Late Onset Psychosis: A Cross-sectional Study on the Differential Diagnosis of Very-Late-Onset Schizophrenia-Like Psychosis, Dementia with Lewy Bodies and Alzheimer’s Type Dementia with Psychosis

Abstract: Phenomenology of psychosis may prove especially informative when comparing individuals with DLB to those with VLOSLP. Neuropsychological profiles are able to further aid differential diagnosis of the three groups.

Cited by 46 publications

References 59 publications

Characteristics of initial symptoms and symptoms at diagnosis in probable dementia with Lewy body disease: incidence of symptoms and gender differences

Characteristics of initial symptoms and symptoms at diagnosis in probable dementia with Lewy body disease: incidence of symptoms and gender differences

Research criteria for the diagnosis of prodromal dementia with Lewy bodies

An evolutionary perspective on paranoia

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