Delusions of theft in dementia of the Alzheimer type: a preliminary report

Understanding neuropsychiatric symptoms in Alzheimer's disease: challenges and advances in diagnosis and treatment

Neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) affect up to 97% of AD patients, with an estimated 80% of current AD patients experiencing these symptoms. Common AD-associated NPS include depression, anxiety, agitation, aggression, and apathy. The severity of NPS in AD is typically linked to the disease's progression and the extent of cognitive decline. Additionally, these symptoms are responsible for a significant increase in morbidity, mortality, caregiver burden, earlier nursing home placement, and greater healthcare expenditure. Despite their high prevalence and significant impact, there is a notable lack of clinical research on NPS in AD. In this article, we explore and analyze the prevalence, symptom manifestations, challenges in diagnosis, and treatment options of NPS associated with AD. Our literature review reveals that distinguishing and accurately diagnosing the NPS associated with AD remains a challenging task in clinical settings. It is often difficult to discern whether NPS are secondary to pathophysiological changes from AD or are comorbid psychiatric conditions. Furthermore, the availability of effective pharmaceutical interventions, as well as non-pharmacotherapies for NPS in AD, remains limited. By highlighting the advance and challenges in diagnosis and treatment of AD-associated NPS, we aspire to offer new insights into the complexity of identifying and treating these symptoms within the context of AD, and contribute to a deeper understanding of the multifaceted nature of NPS in AD.

Cognitive neuroscience of delusions in aging

Assessments and clinical understanding of late-onset delusions in the elderly are inconsistent and often incomplete. In this review, we consider the prevalence, neurobehavioral features, and neuroanatomic correlations of delusions in elderly persons - those with documented cognitive decline and those with no evidence of cognitive decline. Both groups exhibit a common phenotype: delusions are either of persecution or of misidentification. Late-onset delusions show a nearly complete absence of the grandiose, mystical, or erotomanic content typical of early onset psychoses. Absent also from both elderly populations are formal thought disorders, thought insertions, and delusions of external control. Neuroimaging and behavioral studies suggest a frontotemporal localization of delusions in the elderly, with right hemispheric lateralization in delusional misidentification and left lateralization in delusions of persecution. We propose that delusions in the elderly reflect a common neuroanatomic and functional phenotype, and we discuss applications of our proposal to diagnosis and treatment.

Neuropsychological functioning and delusions in dementia: a pilot study

The present pilot study investigated the pattern of neuropsychological functioning associated with the presence of delusions in mild-to-moderate dementia. Participants, all of whom met criteria for dementia, were divided into two groups, delusional (n = 9) and non-delusional (n = 9). Individuals with hallucinations were excluded. Participants completed a neuropsychological test battery. Global cognitive functioning (MMSE) and behavioral disturbance (BEHAVE-AD) were also assessed. Differences between the delusional and non-delusional group were most marked for immediate recall of stories, which was higher in the non-delusional group. Scores on semantic fluency, attention (mental control), and overall cognitive functioning (MMSE) were also lower in the delusional group. Conversely, simple attention span (Digit Span) was within normal limits in both groups. Floor effects were noted on measures of delayed recall and alternating attention. This study supports previous findings of greater neuropsychological impairment in delusional as compared to non-delusional individuals with dementia. However, some areas of cognitive functioning may be relatively preserved. Future research should examine semantic processing in persons with dementia with and without delusions.

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.

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.

Phantom boarder symptom in dementia

OBJECTIVE

Phantom boarder symptom (PBS), which has been labelled a misidentification and is commonly observed in cases of Alzheimer's disease, is the perceptual dysfunction where it is imagined that there are people in the home. It may also be encountered in cases of vascular dementia and other variants of this cognitive dysfunction. This study was undertaken to investigate PBS frequency and characteristics for a sample of dementia inpatients, and to determine the strength of the association with other psychotic symptoms.

METHODS

The sample population consisted of 240 dementia patients admitted to our geropsychiatric ward. Patients with and without PBS were compared in terms of general characteristics and psychotic symptoms.

RESULTS

Of the 240 dementia patients, PBS was identified in 56 (23.3%). There were no significant gender differences between the PBS and non-PBS groups. Means for age and onset-age were higher for the PBS group, and the prevalence of hallucinations and other misidentifications was greater compared to the non-PBS analog. Occurrence of PBS was not significantly associated with delusions or physical aggression.

CONCLUSIONS

PBS is a common symptom in dementia of various etiologies. Our association findings suggest that it may be more productive to classify PBS as a type of misidentification, instead of as a delusion.

Depressive disorders in Chinese patients with Alzheimer's disease

OBJECTIVE

The present study was to investigate the prevalence and potential risk factors of depressive disorders in Chinese patients with Alzheimer's disease (AD).

METHOD

A series of consecutive AD patients from the Memory Disorders Clinic of the Veterans General Hospital, Taipei were studied. Psychiatric diagnosis was made according to DSM-III-R criteria with the use of the Structured Clinical Interview for DSM-III-R (SCID). The Chinese version of the Cognitive Abilities Screening Instrument (CASI) and the Hamilton Depression Rating Scale (HDRS) were also applied. Primary caregivers were interviewed for the Clinical Dementia Rating (CDR) scale, the Barthel Index and the Alzheimer's Deficit Scale (ADS).

RESULTS

Among 141 AD patients, seven (5.0%) were diagnosed with major depression, 11 (7.8%) with dysthymia and five (3.5%) with depressive disorder not otherwise specified. Women were at elevated risk for depressive disorders and had more severe symptoms of depression.

CONCLUSIONS

The prevalence of depressive disorders among Chinese AD patients is in the middle of the range of western findings. The risk factor for depression is female gender.