Highlights
- •Psychotic symptoms are common in Alzheimer disease, affecting half of the patients in this sample over a three year period.
- •Both delusions and hallucinations are associated with greater cognitive and functional impairment, dementia severity, and caregiver burden.
- •The presence of both delusions and hallucinations is associated with worse outcomes than the presence of only one of these symptoms.
- •Delusions, both by themselves and in combination with hallucinations, predict institutionalization; use of antipsychotic medication predicts mortality.
- •The findings highlight the challenges of managing psychosis in Alzheimer disease given its poor prognosis and the mortality associated with antipsychotic medication.
Objective
Psychotic symptoms are a common feature in Alzheimer disease (AD), occurring in approximately
40% of patients. These symptoms are associated with worse clinical outcomes. Comparatively
little research, however, has distinguished delusions and hallucinations, which may
have distinct clinical, neuropathological, and genetic correlates. To address this,
the current study examined the clinical outcomes associated with delusions and hallucinations
in AD.
Design
Three-year observational study.
Setting
Nine memory clinics in Australia.
Participants
A total of 445 patients with AD.
Measurements
Measures of neuropsychiatric symptoms, dementia severity, cognition, function, caregiver
burden, and medication use were completed annually for 3 years with additional assessments
at 3 months and 6 months in the first year. Mortality data were obtained from state
registries approximately 5 years after the study.
Results
Of 445 patients, 102 (22.9%) developed only delusions, 39 (8.8%) developed only hallucinations,
and 84 (18.9%) developed both symptoms. Delusions and hallucinations were both associated
with greater dementia severity, poorer cognition and function, higher levels of other
neuropsychiatric symptoms, and greater caregiver burden. The presence of both symptoms
was associated with worse outcomes than only one of these symptoms. Delusions, both
by themselves and in combination with hallucinations, predicted institutionalization.
Antipsychotic medication use predicted mortality.
Conclusions
Delusions and hallucinations independently and in combination are associated with
poor clinical outcomes. The findings highlight the challenges managing these patients,
particularly given the high levels of caregiver burden associated with psychotic symptoms
and the likely mortality arising from antipsychotic medication.
Key Words
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Article info
Publication history
Published online: October 20, 2017
Accepted:
October 13,
2017
Received in revised form:
October 12,
2017
Received:
June 15,
2017
Identification
Copyright
© 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Psychosis in Neurodegeneration: Relating Phenomenology to Pathology and PrognosisThe American Journal of Geriatric PsychiatryVol. 26Issue 3
- PreviewPsychosis is a uniquely disabling complication of several neurodegenerative diseases. In recent years it has emerged as the focus of an increasing number of clinical investigations, approached from both pathological and phenomenological perspectives in several disease-specific contexts. One might imagine an eventual paradigmatic conception of psychosis that explicates its mechanistic underpinnings across multiple diseases. This is likely to be overly simplistic, given the heterogeneous nature of the symptoms that are often classified under the heading of psychosis, as well as the complexity of networks involved in generating perceptions and beliefs that are not congruent with reality.
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