Understanding delusion in dementia: A review

Alzheimer's disease and other dementia are associated with cognitive and functional impairment, as well as neuropsychiatric sequelae, including psychotic features. Research has largely concentrated on the study of cognitive decline, but the associated behavioral and neuropsychiatric symptoms are of equal importance in the clinical profile of the disease. Delusions are common, disabling and persistent in the course of dementia. The purpose of the present review was to examine the phenomenon of delusion in people with dementia. We searched the electronic databases for original research and review articles using the search terms “delusion, dementia, Alzheimer's disease, frontotemporal dementia, vascular dementia and Lewy body disease”. Various types of explanations have been proposed regarding the etiology of delusional belief in dementia, and cerebral correlates are considered. Pharmacological and non‐pharmacological treatments are analyzed. Geriatr Gerontol Int 2014; 14: 32–39.

[1]  M. Esiri,et al.  Psychosis of Alzheimer’s disease is associated with elevated muscarinic M2 binding in the cortex , 2001, Neurology.

[2]  H. Wehring,et al.  Comparison of Risk of Cerebrovascular Events in an Elderly VA Population With Dementia Between Antipsychotic and Nonantipsychotic Users , 2007, Journal of clinical psychopharmacology.

[3]  N. Tarrier,et al.  The impact of the Symptoms of dementia on caregivers , 1997, British Journal of Psychiatry.

[4]  C. Fairburn,et al.  Psychiatric symptoms in patients with dementia predict the later development of behavioural abnormalities , 1998, Psychological Medicine.

[5]  J. Cohen-Mansfield,et al.  Nonpharmacologic interventions for inappropriate behaviors in dementia: a review, summary, and critique. , 2004, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[6]  M. Trabucchi,et al.  Incidence of and risk factors for hallucinations and delusions in patients with probable AD , 2000, Neurology.

[7]  M. Morrell,et al.  The Expert Consensus Guideline Series Treatment of Epilepsy , 2001, Epilepsy & Behavior.

[8]  J. Cohen-Mansfield,et al.  The meanings of delusions in dementia: A preliminary study , 2011, Psychiatry Research.

[9]  Liat Ayalon,et al.  Effectiveness of nonpharmacological interventions for the management of neuropsychiatric symptoms in patients with dementia: a systematic review. , 2006, Archives of internal medicine.

[10]  Lon S Schneider,et al.  Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. , 2005, JAMA.

[11]  G. Fénelon,et al.  Hallucinations in Parkinson's disease: prevalence, phenomenology and risk factors. , 2000, Brain : a journal of neurology.

[12]  A. Treloar Psychiatric and Cognitive Disorders in Parkinson's Disease , 2003 .

[13]  M. Albert,et al.  Cognitive neuroscience of delusions in aging , 2006, Neuropsychiatric disease and treatment.

[14]  S. Shakir,et al.  Comparison of incidence rates of cerebrovascular accidents and transient ischaemic attacks in observational cohort studies of patients prescribed risperidone, quetiapine or olanzapine in general practice in England including patients with dementia , 2005, Journal of psychopharmacology.

[15]  K. Marder,et al.  The Columbia University Scale for Psychopathology in Alzheimer's disease. , 1992, Archives of neurology.

[16]  Arif Demirdaş,et al.  Kaplan Sadock Comprehensive Textbook of Psychiatry , 2007 .

[17]  Constantine G Lyketsos,et al.  Delusions and hallucinations in Alzheimer's disease: review of the brain decade. , 2003, Psychosomatics.

[18]  S. Finkel,et al.  Risperidone treatment in elderly patients with dementia: relative risk of cerebrovascular events versus other antipsychotics , 2005, International Psychogeriatrics.

[19]  L. Lam,et al.  Behavioral profile of Alzheimer's disease in Chinese elderly – a validation study of the Chinese version of the Alzheimer's disease behavioral pathology rating scale , 2001, International journal of geriatric psychiatry.

[20]  K. Yaffe Treatment of neuropsychiatric symptoms in patients with dementia. , 2007, The New England journal of medicine.

[21]  M. Freedman,et al.  Relationship of psychosis to aggression, apathy and function in dementia , 2001, International journal of geriatric psychiatry.

[22]  J. Hodges,et al.  Clinicopathological correlates in frontotemporal dementia , 2004, Annals of neurology.

[23]  S. Tsai,et al.  Delusional jealousy in dementia. , 1997, The Journal of clinical psychiatry.

[24]  S. Engelborghs,et al.  Neuropsychiatric symptoms of dementia: cross‐sectional analysis from a prospective, longitudinal Belgian study , 2005, International journal of geriatric psychiatry.

[25]  S. Factor,et al.  Threatening auditory hallucinations and Cotard syndrome in Parkinson disease. , 2004, Clinical neuropharmacology.

[26]  D. Jeste,et al.  Epidemiology of and risk factors for psychosis of Alzheimer's disease: a review of 55 studies published from 1990 to 2003. , 2005, The American journal of psychiatry.

[27]  Annalena Venneri,et al.  Neuroanatomical correlates of neuropsychiatric symptoms in Alzheimer's disease. , 2008, Brain : a journal of neurology.

[28]  J. Narumoto,et al.  Insular Hypoperfusion Correlates with the Severity of Delusions in Individuals with Alzheimer’s Disease , 2010, Dementia and Geriatric Cognitive Disorders.

[29]  M. Brüne,et al.  Erotomania Variants in Dementia , 2003, Journal of geriatric psychiatry and neurology.

[30]  I. McKeith,et al.  A comparative study of psychiatric symptoms in dementia with Lewy bodies and Parkinson's disease with and without dementia , 2001, International journal of geriatric psychiatry.

[31]  G. Cipriani,et al.  Aggressive behavior in patients with dementia: Correlates and management , 2011, Geriatrics & gerontology international.

[32]  G. Wilcock,et al.  PREVALENCE AND CORRELATES OF AGGRESSIVE BEHAVIOURS OCCURRING IN PATIENTS WITH ALZHEIMER'S DISEASE , 1997, International journal of geriatric psychiatry.

[33]  Tiffany E. Chow,et al.  Orbitofrontal and anterior cingulate cortex neurofibrillary tangle burden is associated with agitation in Alzheimer disease , 2001, Annals of neurology.

[34]  Y. Nagahama,et al.  Classification of psychotic symptoms in dementia with Lewy bodies. , 2007, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[35]  Karl J. Friston The free-energy principle: a unified brain theory? , 2010, Nature Reviews Neuroscience.

[36]  G. Frisoni,et al.  Temporal lobe asymmetry in patients with Alzheimer's disease with delusions , 2000, Journal of neurology, neurosurgery, and psychiatry.

[37]  E. Byrne,et al.  Treatment of psychosis in elderly people , 2005 .

[38]  A. Kertesz,et al.  Delusions and Hallucinations in Frontotemporal Dementia: A Clinicopathologic Case Report , 2008, Cognitive and behavioral neurology : official journal of the Society for Behavioral and Cognitive Neurology.

[39]  M. Ikeda,et al.  Reducing the burden of caring for Alzheimer's disease through the amelioration of ‘delusions of theft’ by drug therapy , 2002, International journal of geriatric psychiatry.

[40]  C. Fischer Delusions in Alzheimer's Disease: A Literature Review , 2004 .

[41]  M. Rossor,et al.  Delusions and hallucinations in dementia with Lewy bodies: Worsening with memantine , 2005, Neurology.

[42]  M. Owen,et al.  Familial influence on variation in age of onset and behavioural phenotype in Alzheimer's disease. , 2000, The British journal of psychiatry : the journal of mental science.

[43]  C. Lyketsos,et al.  Delusions and hallucinations in Alzheimer's disease: prevalence and clinical correlates , 2000, International journal of geriatric psychiatry.

[44]  S. Tsai,et al.  Chinese demented inpatients admitted following a suicide attempt: a case series , 2007, International journal of geriatric psychiatry.

[45]  M. Pai Delusions and visual hallucinations in dementia patients: focus on personal history of the patients. , 2008, Tohoku journal of experimental medicine.

[46]  Constantine G Lyketsos,et al.  Point and 5‐year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study , 2008, International journal of geriatric psychiatry.

[47]  K. Gwinn‐Hardy,et al.  Diagnostic criteria for psychosis in Parkinson's disease: Report of an NINDS, NIMH work group , 2007, Movement disorders : official journal of the Movement Disorder Society.

[48]  R. Leiguarda,et al.  Prevalence and correlates of aggressive behavior in Alzheimer's disease. , 1998, The Journal of neuropsychiatry and clinical neurosciences.

[49]  Uta Frith,et al.  The Biological Basis of Social Interaction , 2001 .

[50]  B. Mulsant,et al.  Neuroimaging of delusions in Alzheimer's disease , 2012, Psychiatry Research: Neuroimaging.

[51]  Nick C Fox,et al.  Delusions in frontotemporal lobar degeneration , 2009, Journal of Neurology.

[52]  Alexander Libin,et al.  Nonpharmacological treatment of agitation: a controlled trial of systematic individualized intervention. , 2007, The journals of gerontology. Series A, Biological sciences and medical sciences.

[53]  M. Riepe,et al.  Memantine in Moderate-to-severe Alzheimer's Disease , 2006 .

[54]  R. Lévy,et al.  Quantitative Magnetic Resonance Imaging Volumetry Distinguishes Delusional Disorder from Late-Onset Schizophrenia , 1994, British Journal of Psychiatry.

[55]  C. Filley,et al.  Erotomania after aneurysmal subarachnoid hemorrhage: case report and literature review. , 1998, The Journal of neuropsychiatry and clinical neurosciences.

[56]  A. di Fiorino,et al.  A romantic delusion: de Clerambault's syndrome in dementia , 2012, Geriatrics & gerontology international.

[57]  D. Collier,et al.  Psychosis and aggression in Alzheimer's disease: the effect of dopamine receptor gene variation , 2001, Journal of neurology, neurosurgery, and psychiatry.

[58]  Xiao-Jing Wang,et al.  Toward a neurobiology of delusions , 2010, Progress in Neurobiology.

[59]  J R Hodges,et al.  Selective impairment of verb processing associated with pathological changes in Brodmann areas 44 and 45 in the motor neurone disease-dementia-aphasia syndrome. , 2001, Brain : a journal of neurology.

[60]  D. Jeste,et al.  The expert consensus guideline series. Treatment of dementia and its behavioral disturbances. Introduction: methods, commentary, and summary. , 2005, Postgraduate medicine.

[61]  C. Lyketsos,et al.  Delusions in Alzheimer's disease: a review. , 1998, The Journal of neuropsychiatry and clinical neurosciences.

[62]  J. Cummings,et al.  Prevalence and clinical correlates of psychotic symptoms in Parkinson disease: a community-based study. , 1999, Archives of neurology.

[63]  J. Cummings,et al.  Delusional thoughts and regional frontal/temporal cortex metabolism in Alzheimer's disease. , 2003, The American journal of psychiatry.

[64]  A. di Fiorino,et al.  Dangerous passion: Othello syndrome and dementia , 2012, Psychiatry and clinical neurosciences.

[65]  C. Goetz,et al.  Coping strategies for visual hallucinations in Parkinson's disease , 2003, Movement disorders : official journal of the Movement Disorder Society.

[66]  L. Marsh,et al.  Psychosis in Parkinson’s disease , 2004, Current treatment options in neurology.

[67]  I. McKeith,et al.  Anxiety, depression and psychosis in vascular dementia: prevalence and associations. , 2000, Journal of affective disorders.

[68]  K. Kotrla,et al.  SPECT findings on psychosis in Alzheimer's disease. , 1995, The American journal of psychiatry.

[69]  M. Albert,et al.  Predicting time to nursing home care and death in individuals with Alzheimer disease. , 1997, JAMA.

[70]  J. Miller,et al.  Increased neocortical neurofibrillary tangle density in subjects with Alzheimer disease and psychosis. , 2000, Archives of general psychiatry.

[71]  Va Greater,et al.  Functional neuroimaging and presenting psychiatric features in frontotemporal dementia , 2006 .

[72]  C. Bell Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision: DSM-IV-TR Quick Reference to the Diagnostic Criteria from DSM-IV-TR , 2001 .

[73]  Pierre N Tariot,et al.  Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial. , 2004, JAMA.

[74]  L. Beckett,et al.  Psychotic Symptoms and Physically Aggressive Behavior in Alzheimer's Disease , 1997, Journal of the American Geriatrics Society.

[75]  J. Moossy,et al.  Neuropathologic and neurochemical correlates of psychosis in primary dementia. , 1991, Archives of neurology.

[76]  R. Leiguarda,et al.  A SPECT study of delusions in Alzheimer's disease , 1994, Neurology.

[77]  R. Levy,et al.  Delusional misidentification in Alzheimer's disease: a summary of clinical and biological aspects. , 1994, Psychopathology.

[78]  M. Folstein,et al.  Psychosis and physical aggression in probable Alzheimer's disease. , 1991, The American journal of psychiatry.

[79]  T. Schweizer,et al.  Delusions Increase Functional Impairment in Alzheimer’s Disease , 2012, Dementia and Geriatric Cognitive Disorders.