Delusions In Dementia Research Articles

P94. A Transdiagnostic Study of Morphometric Similarity Networks in Delusions in Dementia

Delusions in dementia of the Alzheimer’s type (DAT) and behavioral variant frontotemporal dementia (bvFTD) are distressing and lead to psychiatric misdiagnoses, and antipsychotic use has been found to predict mortality in dementia. We identified structural brain networks associated with delusions across bvFTD and DAT.

Neural basis of delusions in dementia

Neural basis of delusions in dementia

Delusions in Dementia

Delusion is a common neuropsychiatric symptom in dementia, especially in Alzheimer disease and dementia with Lewy bodies. Persecutory delusions are the most common, and include delusions of theft, jealousy, and abundant. Patients with persecutory delusions have impairment of the psychological processes mediating the formation and maintenance of normal social beliefs. Several disordered psychological processes such as attentional bias, attributional bias, jumping-to-conclusions reasoning bias, and theory of mild deficit may contribute to the delusion formation. Cognitive processes involving information about self, others, and social interaction are required in social cognition. Damage of the neural circuitry involved in social cognition ("social brain"), such as the medial prefrontal cortex, may be a neuroanatomical basis for persecutory delusions in dementia.

Associations between ZnT3, tau pathology, agitation, and delusions in dementia.

Neuropsychiatric symptoms such as agitation and delusions occur frequently in Lewy body dementia and Alzheimer's disease and represent significant burden and unmet treatment need. The underlying aetiology remains poorly understood. We used a multidimensional linear model to look for associations between measurements of agitation, delusions, amyloid, tau and α-synuclein pathology, and synaptic proteins (ZnT3, PSD95, synaptophysin, and β-III-tubulin) across multiple brain regions in post-mortem tissue from a cohort of 130 Lewy body dementia and Alzheimer's disease patients and non-demented controls. We found both agitations and delusions to be significantly associated with increased tau pathology and decreased levels of ZnT3. ZnT3 packages Zn2+ into synaptic vesicles to be released as a long-term modulator of synaptic activity. Our finding adds to the evidence that zinc modulating compounds are of interest for treatment or symptomatic relief in these dementias.

Prevalence and neurobiological basis of delusions in dementia

Background: Delusions and abnormal belief formation have been reported in some people with dementia, however, the prevalence of delusions in dementia and the neural correlates associated with their emergence have been underexplored.

Reliability and Validity of a New Behavioral Scale to Measure Behavioral and Psychological Symptoms in Dementias (BPSD): Luthra's Behavioral Assessment and Intervention Response (LuBAIR) Scale

age, education, gender, and study visit. They were also matched on baseline Mini-Mental Status Exam (MMSE) and matched visit global Clinical Dementia Rating Scale (CDR). Images were processed as per the ADNI protocol. Results: Independent samples t-tests demonstrated significantly increased activity in the left temporal, left anterior insula and right anterior insular regions. The left temporal volume of interest (VOI) had 21 voxels, centered at Montreal Neurological Institute (MNI) coordinates x 1⁄440 , y1⁄40 , z1⁄4 34. The left insula VOI had 45 voxels centered at MNI coordinates x 1⁄4 30, y1⁄414, z1⁄410. The right insula VOI had 151 voxels centred at MNI coordinates x1⁄4 32, y1⁄426, z1⁄44. Conclusions: These regions (temporal lobe, insular cortices) are involved in sensory and emotional processing and have been previously implicated in neuroimaging studies of delusions in dementia. Future studies should attempt to replicate these findings in a larger sample of patients.

The meanings of delusions in dementia: A preliminary study

One of the common symptoms of dementia is delusions. Due to a biological conceptualization of the behaviors represented as delusions, these are classified as psychotic symptoms. This is a qualitative and quantitative study aiming to describe the delusions experienced by older persons with dementia and the context of occurrence, and to elucidate their etiology. Participants were 74 nursing home residents aged 65 and over, diagnosed with dementia, from nine nursing homes in Israel. Participants with delusions were found to have significantly more difficulties in performing ADLs, and poorer vision and hearing. Based on assessment using the BEHAVE-AD, six categories of delusions were examined: 1. One's house is not one's home, 2. Theft, 3. Danger, 4. Abandonment, 5. Misidentification, and 6. Other non-paranoid. Common themes appeared across delusions including reality, disorientation, re-experience of past events, loneliness and insecurity, boredom, and trigger. Current results suggest that delusions may not represent psychotic symptoms for most participants, because they sometimes represented reality, or were neither firm nor incontrovertible. Thus, utilizing the term delusion relegates the person's behavior to the domain of severe psychiatric phenomena and precludes understanding its true meaning.

Psychosis in the Elderly

Ms. A, an 85-year-old Caucasian woman, was hospitalized for increased paranoia, visual hallucinations, and agitation. According to her son, Ms. A had had "strange thoughts" for as long as he could remember. For example, for a time, Ms. A would eat only foods that were white. Still, in her adult life, she had actively participated in developing and running a successful family business with her husband and had raised two sons. When her husband died 5 years ago, Ms. A developed a major depressive disorder, single episode, severe with psychotic features. She moved to an assisted living facility and did well there until she was hospitalized 2 years ago with agitation. At that time, she was diagnosed with late-onset Alzheimer's type dementia with delusions, depressed mood, and behavioral disturbance. She returned to the assisted living facility and was stable until a few months before her current hospitalization, which was precipitated by gradually worsening paranoid delusions, visual hallucinations, severe restlessness, and difficulty in being redirected. At admission, Ms. A's responses to questions were largely irrational or irrelevant to the topic at hand. In a more lucid moment, Ms. A conveyed that she had pain, gesturing to her stomach. Her vital signs were stable; she was afebrile and normotensive. Initial mental status examination revealed Ms. A to be an unkempt, distraught, elderly woman with poor eye contact and poor attention span. She was restless and would intermittently grasp imaginary objects in the air, uttering brief phrases or nonspecific sounds in response to questions. Her thought processes were disorganized as she conveyed vague thoughts with themes of fears of dying and of being harmed. She was irritable and had a labile affect and clouded sensorium that fluctuated between periods of lucidity and of obtundation. Her insight and judgment were severely impaired. Ms. A's psychotropic medications at the time of admission included 400 mg of quetiapine daily in divided doses for delusions, hallucinations, and agitation; 500 mg of divalproex daily for mood instability and agitation; 100 mg of sertraline daily for depression and agitation; and 4-6 mg of lorazepam daily in divided doses for anxiety and agitation. Her medical history was significant for hypothyroidism, coronary artery disease, atrial fibrillation, hypertension, hypercholesterolemia, and gastroesophageal reflux disease. For these conditions, she was taking 25 μg of levothyroxine daily, 0.125 mg of digoxin daily, 40 mg of enoxaparin daily, 325 mg of aspirin daily, 50 mg of metoprolol twice daily, 40 mg of simvastatin daily, and 40 mg of pantoprazole daily. Ms. A also had a history of recurrent urinary tract infections, chronic constipation, frequent falls, and osteoporosis. She had no known drug allergies.

IC-P1-045: Right prefrontal hypometabolism predicts delusions in dementia with Lewy bodies

IC-P1-045: Right prefrontal hypometabolism predicts delusions in dementia with Lewy bodies

Right prefrontal hypometabolism predicts delusions in dementia with Lewy bodies

Delusions (DEL) are frequent in dementia with Lewy bodies (DLB); however, the neural equivalent is poorly understood. The present study therefore aimed to identify the cerebral metabolic pattern of glucose of a DLB group suffering from DEL (DLB + DEL) as compared to a non-delusional group (DLB − DEL) and a control group (NL); and to determine the predictive value of the regional metabolic deficit for DEL symptomatology in comparison to other clinical variables significantly associated with DEL. Voxel-wise comparisons were conducted between the patient and control groups in SPM2. The most significant regional metabolic deficit of the DLB + DEL group was used a predictor for DEL symptomatology in a logistic regression analysis along with other variables significantly associated with DEL, such as visual hallucinations (VH), and overall cognitive impairment. A significant relative hypometabolism of the right prefrontal cortex was found in the DLB + DEL group, which predicted DEL symptomatology in the regression analysis. VH and overall cognitive dysfunction were no significant predictors. These results underline the significance of right prefrontal damage for DEL in DLB.

Delusion of Theft and Phantom Intruder Delusion in Demented Elderly Patients in Japan

Delusion of theft and phantom intruder delusion are among the most frequent delusions in dementia. The purpose of this study was to clarify the clinical characteristics of patients with these symptoms. The authors conducted a questionnaire survey; items included age, gender, dementia diagnosis, cognitive function, and activities of daily living. Other clinical characteristics were evaluated using the quality of life questionnaire for dementia. A total of 217 patients with dementia were rated. Frequencies of delusion of theft were as follows: frequent, 7%; sometimes, 11%; rare, 16%; and none, 66%. Frequencies of phantom intruder delusion were as follows: frequent, 4%; sometimes, 10%; rare, 9%; and none, 77%. Comparison between positive and negative groups with these symptoms revealed that positive groups had higher scores in 2 of 6 domains of the quality of life questionnaire for dementia, namely, negative affect and actions, and restlessness. The positive group with delusion of theft had higher scores in cognitive function and activities of daily living than did the negative group. These results suggest that negative affect and action and restlessness might be related to delusion of theft or phantom intruder delusion and that delusion of theft frequently occurs in the early stage of dementia.

Muscarinic M2 and M4 receptors in anterior cingulate cortex: relation to neuropsychiatric symptoms in dementia with Lewy bodies

Alterations in cholinergic functions have been reported to be associated with neuropsychiatric symptoms in dementia. Increased M1 muscarinic receptor binding in temporal cortex is associated with delusions in dementia with Lewy bodies (DLB) patients and increased M2/M4 receptor binding with psychosis in Alzheimer's disease. However, the relation between M2 and M4 muscarinic receptor and psychotic symptoms in DLB is unknown. The aim of this study was to measure M2 and M4 receptors in the anterior cingulate cortex in DLB and to correlate the neurochemical findings with neuropsychiatric symptoms. Muscarinic M2 and M4 receptor levels in the anterior cingulate cortex and adjacent cortex (Brodmann's area [BA] 32) were measured separately by using a radioligand binding protocol based on binding of [ 3H]AF-DX 384 in the presence and absence of dicyclomine, a potent M4 receptor antagonist. M2 receptor binding was significantly increased, while M4 receptor binding was unchanged in the cingulate cortex and BA32 of DLB patients compared with age-matched controls. Impaired consciousness was significantly associated with increased M4 binding and delusions were significantly associated with increased M2 binding. Increased M2 and M4 receptor binding in DLB was also associated with visual hallucinations. Upregulation of M2 and M4 muscarinic receptors in cingulate and adjacent cortex may thus contribute to the development of psychosis in DLB, with potential implications for treatments with drugs acting on these receptors.

Review of delusions in dementia.

Although delusions are common symptoms in dementia and are associated with a number of adverse outcomes, research in this area has been limited. This article attempts to summarize the existing literature on delusions in dementia with respect to known risk factors, etiology, pathogenesis, neurocognitive findings, behavioral symptoms, and treatment. This study reviews all relevant abstracts and articles pertaining to delusions and dementia. The reviewers found that the studies were limited by confusion concerning phenomenology. However, consistent findings show that delusions are associated with certain demographic variables, neuropathologic and neurocognitive findings, adverse behavioral outcomes, and limited treatment response. The authors conclude that further longitudinal studies with better clarification of terminology are required to clarify inconsistencies and shed light on future treatment options.

Humanistic sensibilities in the assessment of dementia patients.

Abstract A humanistic sensibility in contemporary geropsychology is thematized and encouraged. Dementia, in which the brain loses its world‐gathering and functional capacities, is described phenomenologically as a disintegration of being‐in‐the‐world. The humanistic perspective encourages the discipline to approach the question of diagnosis holistically, especially with regard to an exploration of the context and meaning of features such as depression and delusions. Phenomenological accounts of depression and delusions in dementia are offered as a corrective to humanistic psychology's traditional concern with the client's subjective experience. The clinical interview as a type of conversation is described; appropriate self‐disclosure and feedback are emphasized. Three clinical vignettes are presented.

Environmentally Dependent Delusions in Dementia

Environmentally Dependent Delusions in Dementia

Hallucinations and Delusions in Dementia

Hallucinations and delusions have been described in all types of dementia, including vascular dementia, Lewy body dementia, and dementia associated with Parkinson's disease. They have been recognized in Alzheimer's disease (AD) since the illness was first described (Alzheimer, 1957).

Persecutory Delusions in Dementia

Persecutory delusions are common in dementia. This study was undertaken to investigate the prevalence, associated factors, and characteristics of persecutory delusions in demented patients. The sample population included 167 demented patients (DSM-III-R criteria) admitted to a geropsychiatric ward. Patients were assessed for the occurrence of any persecutory delusions since the onset of dementia. The content of persecutory delusions, the patients' response to the delusions, and any concomitant psychiatric symptoms were also explored. Of the 167 demented patients, 45 (26.9%) showed symptoms of persecutory delusions. Patients with persecutory delusions had a higher prevalence of other delusions, hallucinations, and physically aggressive behaviors. The deluded patients often thought that their caregivers were their persecutors and had a wide range of responses to their delusions. After they were hospitalized, many of these patients attacked medical staff and were uncooperative with treatment. Persecutory delusions are common in dementia of various types. Deluded patients often have vigorous responses to their delusions including physically aggressive behaviors and suicide attempts. Careful evaluation is needed to assess the potential for violent and suicidal behaviors in these patients. Medical staff should be alert to clinical strategies for handling the treatment of such patients when they become violent or uncooperative.

Review: delusions in dementia.

Introduction The definition of a delusion is 'a false, unshakeable idea or belief . . . held with extraordinary conviction and subjective certainty' [1]. Delusions are a common symptom of a range of psychiatric illnesses including schizophrenia, depression, bipolar disorder and dementia. The inclusion of dementia in this list is sometimes surprising to both doctors and carers, who restrict the symptoms of dementia to the cognitive domain; yet Alzheimer's first description was of a 51year-old woman with focal cognitive deficits, delusions of jealousy and auditory hallucinations [2]. Considerable research has focused on the neuropathological findings, neuropsychological deficits and genetics of these diseases. It is only more recently that we have begun to untangle the non-cognitive or psychiatric features of the dementias.

Delusions and behavioral disturbances in cognitively impaired elderly persons.

To compare cognitive function and the prevalence of selected behavioral problems in delusional and non-delusional dementia patients. Retrospective medical record review. An outpatient geriatric assessment center. 114 consecutive patients with dementia. Delusions as recorded in a consultation report. Delusions were described in 25.5% of patients. A variety of behavioral disturbances were more common in delusional than non-delusional patients, including agitation, angry or hostile outbursts, urinary incontinence, wandering or pacing, and insomnia. While cognitive function as measured by the MMSE was similar in delusional and non-delusional patients (18.9 +/- 3.8 and 19.2 +/- 5.9, respectively), there was a statistically borderline tendency for delusions to occur more often in patients in the mid-range of cognitive impairment (17 less than or equal to MMSE less than or equal to 23) compared with patients with greater or lesser degrees of cognitive impairment (32% vs 17% respectively). Delusions in dementia are associated with a variety of behavioral problems. Further studies are needed to clarify the role of delusions in the development of disruptive behaviors in dementing illness.