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Shoham N, Eskinazi M, Hayes JF, Lewis G, Theodorsson M, Cooper C. Associations between psychosis and visual acuity impairment: A systematic review and meta-analysis. Acta Psychiatr Scand 2021; 144:6-27. [PMID: 34028803 PMCID: PMC8504204 DOI: 10.1111/acps.13330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Several theories propose that visual acuity impairment is associated with psychosis. Visual impairment could lead to psychosis or the converse, or they may share underlying pathology or risk factors. In the first evidence synthesis in this area for over 25 years, we collated studies measuring the association between visual acuity impairment and psychosis. METHODS We searched the MEDLINE, EMBASE, PsycINFO, and Web of Science databases for studies published from 1992 to 2020, using the Newcastle Ottawa Scale to assess risk of bias. We narratively synthesized findings and meta-analyzed sufficiently homogenous results. RESULTS We included 40 papers, which reported on 31 studies. Evidence from seven cohort studies was inconsistent, which precluded meta-analysis of this study design. These contradictory results also made it difficult to draw conclusions regarding a temporal association. We found evidence for an association from eight cross-sectional studies treating visual acuity impairment as the exposure and psychosis as the outcome [pooled odds ratio (OR) =1.76, 95% confidence interval (CI): 1.34-2.31], and four with the reverse exposure and outcome (OR: 1.85, 95% CI: 1.17-2.92). Seven case-control studies with mixed findings were found, but only two primarily addressed our research question, and these findings were mixed. CONCLUSIONS Although evidence supports a cross-sectional association between visual acuity impairment and psychosis, further research is needed to clarify the temporal direction, given the mixed findings in cohort studies. Understanding the association may give insights into prevention strategies for people at risk of visual acuity impairment and psychosis.
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Affiliation(s)
- Natalie Shoham
- Division of PsychiatryUniversity College LondonLondonUK,Camden and Islington NHS Foundation TrustLondonUK
| | - Michelle Eskinazi
- Division of PsychiatryUniversity College LondonLondonUK,Camden and Islington NHS Foundation TrustLondonUK
| | - Joseph F. Hayes
- Division of PsychiatryUniversity College LondonLondonUK,Camden and Islington NHS Foundation TrustLondonUK
| | - Gemma Lewis
- Division of PsychiatryUniversity College LondonLondonUK
| | | | - Claudia Cooper
- Division of PsychiatryUniversity College LondonLondonUK,Camden and Islington NHS Foundation TrustLondonUK
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Vik-Mo AO, Giil LM, Borda MG, Ballard C, Aarsland D. The individual course of neuropsychiatric symptoms in people with Alzheimer's and Lewy body dementia: 12-year longitudinal cohort study. Br J Psychiatry 2020; 216:43-48. [PMID: 31506117 DOI: 10.1192/bjp.2019.195] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Understanding the natural course of neuropsychiatric symptoms (NPS) in dementia is important for planning patient care and trial design, but few studies have described the long-term course of NPS in individuals. METHOD Primary inclusion of 223 patients with suspected mild dementia from general practice were followed by annual assessment, including the Neuropsychiatric Inventory (NPI), for up to 12 years. Total and item NPI scores were classified as stable, relapsing, single episodic or not present based on 4.96 (s.d. 2.3) observations (98% completeness of longitudinal data) for 113 patients with Alzheimer's disease and 84 patients with LBD (68 dementia with Lewy bodies and 16 Parkinson's disease dementia). RESULTS We found that 80% had stable NPI total ≥1, 50% had stable modest NPI total ≥12 and 25% had stable NPI total ≥24 scores. Very severe NPS (≥48) were mostly single episodes, but 8% of patients with Alzheimer's disease had stable severe NPS. Patients with Alzheimer's disease and the highest 20% NPI total scores had a more stable or relapsing course of four key symptoms: aberrant motor behaviour, aggression/agitation, delusions and irritability (odds ratio 55, P < 0.001). This was not seen in LBD. Finally, 57% of patients with Alzheimer's disease and 84% of patients with LBD had reoccurring psychotic symptoms. CONCLUSIONS We observed a highly individual course of NPS, with most presenting as a single episode or relapsing; a stable course was less common, especially in LBD. These findings demonstrate the importance of an individualised approach (i.e. personalised medicine) in dementia care.
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Affiliation(s)
- Audun Osland Vik-Mo
- Senior Consultant, Centre for Age-Related Medicine (SESAM), Stavanger University Hospital; and Researcher, Department of Clinical Science, University of Bergen, Norway
| | - Lasse Melvaer Giil
- Researcher, Department of Clinical Science, University of Bergen; and Resident, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Norway
| | - Miguel Germán Borda
- PhD student, Centre for Age-Related Medicine (SESAM); PhD student, Stavanger University Hospital; and Faculty of Health Sciences, University of Stavanger, Norway
| | - Clive Ballard
- Professor, Pro-Vice Chancellor and Executive Dean, Institute for Health Research, University of Exeter Medical School, UK
| | - Dag Aarsland
- Head of Research, Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Norway; and Professor, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Ostroumova OD, Goloborodova IV, Isaev RI, Pereverzev AP. [Antipsychotics: features of undesirable adverse reactions in elderly and senile age]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:105-117. [PMID: 30874535 DOI: 10.17116/jnevro2019119021105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This review summarizes and systematizes currently available literature on antipsychotics as one of the most frequently prescribed group of psychotropic drugs. Based on published data from clinical studies and meta-analyzes, the authors consider unwanted adverse reactions in patients taking antipsychotic medications. Mechanisms of development of undesirable drug reactions are discussed. Special attention is paid to those adverse reactions of antipsychotics that most often occur in old and very old age (increased risk of adverse cardiovascular and cerebrovascular events, sudden death, prolonged QTc interval, falls, fractures, orthostatic hypotension, extrapyramidal disorders, pneumonia, urinary tract infections, etc.).
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Affiliation(s)
- O D Ostroumova
- Sechenov First Moscow State Medical University, Moscow, Russia; Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - I V Goloborodova
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - R I Isaev
- Russian Clinical and Research Center of Gerontology of Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - A P Pereverzev
- Russian Clinical and Research Center of Gerontology of Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
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Abstract
The elderly with dementing illness often present with psychotic symptoms such as delusions, but the thematic content of delusions in the elderly differs from that of delusions expressed by younger individuals, and can be pathognomonic of early dementia. The aim of this paper is to review the recent literature on the delusion of theft, the most prevalent delusion in the elderly, in order to arrive at a deeper understanding of its sources and to identify successful therapeutic approaches. The literature from 2000 to the present was searched on the Google Scholar database using relevant search terms. Several older classical papers were also referenced. Understanding the origins of the delusion of theft - multiple losses, attempts at attributing such losses to an outside source, attempts at reliving a happier past - helps in devising responses that are comforting to the patient. The distress that often accompanies the delusion of having been robbed can be decreased by nursing home improvements in the handling of personal possessions, by the correction of sensory deficits, and by the provision of activities that distract from loneliness. Attention to stimuli that trigger the delusion helps to limit its occurrence. Medications may help, but can sometimes make matters worse. Understanding that delusional thinking can arise from sensory and cognitive deficits is critical to empathic caregiving and also to the lessening of caregiver burden.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, #605 260 Heath St. West, Toronto, ON, M5P 3L6, Canada.
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Abstract
Byrne provides an excellent clinical overview. However, I have selected four areas of clinical interest for more detailed consideration.
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Abstract
Antipsychotic drugs are among the most widely prescribed psychotropic medications for elderly people, particularly for the 5–8% of patients who are in institutions. The antipsychotics are indicated for treating psychotic disorders, including schizophrenia, delusional disorder, psychotic symptoms in mood disorders and for a number of organic psychoses.
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Soyinka A, Lawley D. Antipsychotic prescribing for behavioural and psychological symptoms of dementia. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.bp.106.010967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Aims and MethodTo review the quality of information and advice contained in correspondence from old age psychiatrists to general practitioners (GPs) regarding the prescription of antipsychotic drugs for the management of behavioural and psychological symptoms of dementia. Discharge summaries (n=22) and subsequent out-patient review letters were examined and compared with evidence-based guidelines in two phases of an audit cycle; first in 2002 and latterly in 2005.ResultsPractice was below acceptable standards during both phases of the audit cycle, with an actual drop in the quality of explicit advice given to GPs in 2005, despite national publicity about the issues and guidance from the Royal College of Psychiatrists.Clinical ImplicationsThe prescription of antipsychotic drugs is associated with an adverse prognosis for people with dementia. As such, it is imperative that such treatment is regularly reviewed and time limited. Old age psychiatrists need to ensure that this message is communicated to their primary care colleagues.
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Lanctôt KL, Amatniek J, Ancoli-Israel S, Arnold SE, Ballard C, Cohen-Mansfield J, Ismail Z, Lyketsos C, Miller DS, Musiek E, Osorio RS, Rosenberg PB, Satlin A, Steffens D, Tariot P, Bain LJ, Carrillo MC, Hendrix JA, Jurgens H, Boot B. Neuropsychiatric signs and symptoms of Alzheimer's disease: New treatment paradigms. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2017; 3:440-449. [PMID: 29067350 PMCID: PMC5651439 DOI: 10.1016/j.trci.2017.07.001] [Citation(s) in RCA: 196] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Neuropsychiatric symptoms (NPSs) are hallmarks of Alzheimer's disease (AD), causing substantial distress for both people with dementia and their caregivers, and contributing to early institutionalization. They are among the earliest signs and symptoms of neurocognitive disorders and incipient cognitive decline, yet are under-recognized and often challenging to treat. With this in mind, the Alzheimer's Association convened a Research Roundtable in May 2016, bringing together experts from academia, industry, and regulatory agencies to discuss the latest understanding of NPSs and review the development of therapeutics and biomarkers of NPSs in AD. This review will explore the neurobiology of NPSs in AD and specific symptoms common in AD such as psychosis, agitation, apathy, depression, and sleep disturbances. In addition, clinical trial designs for NPSs in AD and regulatory considerations will be discussed.
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Affiliation(s)
- Krista L. Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute and Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Canada
| | - Joan Amatniek
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California, San Diego, CA, USA
- Department of Medicine, University of California, San Diego, CA, USA
| | - Steven E. Arnold
- Interdisciplinary Brain Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Clive Ballard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- University of Exeter, Exeter, UK
| | - Jiska Cohen-Mansfield
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine and Minerva Center for the Interdisciplinary Study of End of Life, Tel Aviv University, Tel Aviv, Israel
| | - Zahinoor Ismail
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Constantine Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine Institutes, Baltimore, MD, USA
| | | | - Erik Musiek
- Department of Neurology, Hope Center for Neurological Disorders, and Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Ricardo S. Osorio
- Center for Brain Health, NYU Langone Medical Center, New York, NY, USA
| | - Paul B. Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - David Steffens
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| | | | | | | | | | | | - Brendon Boot
- Department of Neurology, Brigham and Women's Hospital, Harvard University School of Medicine, Boston, MA, USA
- Voyager Therapeutics, Cambridge, MA, USA
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Wattmo C, Wallin ÅK. Early- versus late-onset Alzheimer's disease in clinical practice: cognitive and global outcomes over 3 years. ALZHEIMERS RESEARCH & THERAPY 2017; 9:70. [PMID: 28859660 PMCID: PMC5580278 DOI: 10.1186/s13195-017-0294-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 07/27/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Whether age at onset influences Alzheimer's disease (AD) progression and the effectiveness of cholinesterase inhibitor (ChEI) therapy is not clear. We aimed to compare longitudinal cognitive and global outcomes in ChEI-treated patients with early-onset Alzheimer's disease (EOAD) versus late-onset Alzheimer's disease (LOAD) in clinical practice. METHODS This 3-year, prospective, observational, multicentre study included 1017 participants with mild to moderate AD; 143 had EOAD (age at onset < 65 years) and 874 had LOAD (age at onset ≥ 65 years). At baseline and semi-annually, patients were assessed using cognitive, global and activities of daily living (ADL) scales, and the dose of ChEI was recorded. Potential predictors of decline were analysed using mixed-effects models. RESULTS Six-month response to ChEI therapy and long-term prognosis in cognitive and global performance were similar between the age-at-onset groups. However, deterioration was significantly faster when using the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog) over 3 years in participants with EOAD than in those with LOAD; hence, prediction models for the mean ADAS-Cog trajectories are presented. The younger cohort had a larger proportion of homozygote apolipoprotein E (APOE) ε4 allele carriers than the older cohort; however, APOE genotype was not a significant predictor of cognitive impairment in the multivariate models. A slower rate of cognitive progression was related to initiation of ChEIs at an earlier stage of AD, higher ChEI dose and fewer years of education in both groups. In LOAD, male sex, better instrumental ADL ability and no antipsychotic drug use were additional protective characteristics. The older patients received a lower ChEI dose than the younger individuals during most of the study period. CONCLUSIONS Although the participants with EOAD showed a faster decline in ADAS-Cog, had a longer duration of AD before diagnosis, and had a higher frequency of two APOE ε4 alleles than those with LOAD, the cognitive and global responses to ChEI treatment and the longitudinal outcomes after 3 years were similar between the age-at-onset groups. A higher mean dose of ChEI and better cognitive status at the start of therapy were independent protective factors in both groups, stressing the importance of early treatment in adequate doses for all patients with AD.
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Affiliation(s)
- Carina Wattmo
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, SE-205 02, Malmö, Sweden.
| | - Åsa K Wallin
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, SE-205 02, Malmö, Sweden
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Farina N, Morrell L, Banerjee S. What is the therapeutic value of antidepressants in dementia? A narrative review. Int J Geriatr Psychiatry 2017; 32:32-49. [PMID: 27593707 DOI: 10.1002/gps.4566] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/17/2016] [Accepted: 07/26/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Antidepressants are commonly used in dementia. Depression is a frequent and important co-morbidity in dementia, and antidepressants are often used to treat depression and more widely. However, there are questions about their utility in depression in dementia and other behavioural and psychological symptoms of dementia. The aim of this narrative review is to summarize the evidence on whether there is therapeutic value in prescribing antidepressants to people with dementia. METHODS A PubMed search was performed to identify randomized controlled trials that prescribed antidepressants to people with dementia, either in the treatment of behavioural and psychological symptoms of dementia (depression, anxiety, agitation/aggression, psychosis and apathy) or for secondary outcomes (quality of life, carer burden, activities of daily living, cognition, clinical severity and adverse events). RESULTS Thirty-six randomized controlled trials were identified (participant n = 3386). A consistent finding in well-designed blinded placebo controlled trials in dementia is the lack of positive effect of antidepressants on outcomes of interest, including depression. One large well-designed study has reported a significant reduction in agitation in people with dementia, but at the expense of clinically significant adverse events. Otherwise, change observed in open trials is also seen in the placebo group, suggesting that any effect is not attributable to the prescription of antidepressants. CONCLUSIONS It is striking how few data there are on indications other than depression. We should question the use of antidepressants in dementia. Definitive trials of clinical effectiveness of specific indications such as anxiety and agitation in dementia and discontinuation of antidepressants in dementia are needed. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Nicolas Farina
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Lucy Morrell
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
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Increased risk of psychosis in patients with hearing impairment: Review and meta-analyses. Neurosci Biobehav Rev 2015; 62:1-20. [PMID: 26743858 DOI: 10.1016/j.neubiorev.2015.12.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/24/2015] [Accepted: 12/24/2015] [Indexed: 12/12/2022]
Abstract
Several studies suggest hearing impairment as a risk factor for psychosis. Hearing impairment is highly prevalent and potentially reversible, as it can be easily diagnosed and sometimes improved. Insight in the association between hearing impairment and psychosis can therefore contribute to prevention of psychosis. This paper provides meta-analyses of all epidemiologic evidence on the association between hearing impairment and psychosis and summarizes mechanisms that potentially underlie this relationship. Meta-analyses showed an increased risk of hearing impairment on all psychosis outcomes, such as hallucinations (OR 1.40(95%CI 1.18-1.65; n=227,005)), delusions (OR 1.55(95%CI 1.36-1.78; n=250,470)), psychotic symptoms (OR 2.23(95%CI 1.83-2.72; n=229,647) and delirium (OR 2.67(95%CI 2.05-3.48; n=12,432). Early exposure to hearing impairment elevated the risk of later development of schizophrenia (OR 3.15(95%CI 1.25-7.95; n=50,490)). Potential mechanisms underlying this association include loneliness, diminished theory of mind, disturbances of source monitoring and top-down processing and deafferentiation. Early assessment and treatment of hearing impairment in patients with (high risk of) psychosis may be essential in psychosis treatment and prevention.
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Behavioural and psychiatric symptoms in cognitive neurology. Neurologia 2015; 32:81-91. [PMID: 25728950 DOI: 10.1016/j.nrl.2015.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 01/06/2015] [Indexed: 02/06/2023] Open
Abstract
Behavioural and psychiatric symptoms (BPS) are frequent in neurological patients, contribute to disability, and decrease quality of life. We recorded BPS prevalence and type, as well as any associations with specific diagnoses, brain regions, and treatments, in consecutive outpatients examined in a cognitive neurology clinic. METHOD A retrospective analysis of 843 consecutive patients was performed, including a review of BPS, diagnosis, sensory impairment, lesion topography (neuroimaging), and treatment. The total sample was considered, and the cognitive impairment (CI) group (n=607) was compared to the non-CI group. RESULTS BPS was present in 59.9% of the patients (61.3% in the CI group, 56.4% in the non-CI group). One BPS was present in 31.1%, two in 17.4%, and three or more in 11.4%. BPS, especially depression and anxiety, are more frequent in women than in men. Psychotic and behavioural symptoms predominate in subjects aged 65 and older, and anxiety in those younger than 65. Psychotic symptoms appear more often in patients with sensory impairment. Psychotic and behavioural symptoms are more prevalent in patients with degenerative dementia; depression and anxiety in those who suffer a psychiatric disease or adverse effects of substances; emotional lability in individuals with a metabolic or hormonal disorder; hypochondria in those with a pain syndrome; and irritability in subjects with chronic hypoxia. Behavioural symptoms are more frequent in patients with anomalies in the frontal or right temporal or parietal lobes, and antipsychotics constitute the first line of treatment. Leaving standard treatments aside, associations were observed between dysthymia and opioid analgesics, betahistine and statins, and between psychotic symptoms and levodopa, piracetam, and vasodilators.
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ŞAHİN CANKURTARAN E. Management of Behavioral and Psychological Symptoms of Dementia. Noro Psikiyatr Ars 2014; 51:303-312. [PMID: 28360647 PMCID: PMC5353163 DOI: 10.5152/npa.2014.7405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 09/25/2013] [Indexed: 01/14/2023] Open
Abstract
Symptoms of disturbed perception, thought content, mood, or behavior that frequently occur in patients with dementia are defined as the term "Behavioral and Psychological Symptoms of Dementia (BPSD)." The behavioral symptoms of dementia include physical/verbal aggression, agitation, disinhibition, restlessness, wandering, culturally inappropriate behaviors, sexual disinhibition, and hoarding, and the psychological symptoms of dementia are anxiety, depressive mood, hallucinations and delusions, apathy, and misidentification syndrome. With the cognitive decline in Alzheimer's Dementia (AD), the frequency of neuropsychiatric symptoms increases. Apathy, depression, irritability, agitation, and anxiety are the most frequently detected neuropsychiatric symptoms of AD. In the mild stage of AD, affective symptoms are more likely to occur; agitated and psychotic behaviors are frequent in patients with moderately impaired cognitive function. When neuropsychiatric symptoms are first detected, medical conditions, such as delirium, infection, dehydration, diarrhea, and drug interactions, must be ruled out. The treatment of mild BPSD must be started with psychosocial approaches, such as behavioral management, caregiver education, and physical activity. Medications are indicated for BPSD symptoms that are refractory to non-pharmacological interventions or severe or jeopardizing the safety of a patient or others, often in conjunction with non-pharmacological interventions.
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Affiliation(s)
- Eylem ŞAHİN CANKURTARAN
- Dışkapı Yıldırım Beyazıt Training and Research Hospital, Clinic of Psychiatry, Ankara, Turkey
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Sommer IE, Roze CM, Linszen MMJ, Somers M, van Zanten GA. Hearing loss; the neglected risk factor for psychosis. Schizophr Res 2014; 158:266-7. [PMID: 25096542 DOI: 10.1016/j.schres.2014.07.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 07/14/2014] [Accepted: 07/15/2014] [Indexed: 10/24/2022]
Affiliation(s)
- I E Sommer
- Psychiatry Department UMCU Utrecht and Brain Center Rudolf Magnus, Heidelberglaan 100, Utrecht, The Netherlands.
| | - C M Roze
- GGZ ProPersona, Mental Health Care Centre for Hearing Disabled, Willy Brandtlaan 20, Ede, The Netherlands
| | - M M J Linszen
- Psychiatry Department UMCU Utrecht and Brain Center Rudolf Magnus, Heidelberglaan 100, Utrecht, The Netherlands
| | - M Somers
- Psychiatry Department UMCU Utrecht and Brain Center Rudolf Magnus, Heidelberglaan 100, Utrecht, The Netherlands
| | - G A van Zanten
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
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Creese B, Ballard C, Jones E. Cognitive impairment in studies of 5HTTLPR and psychosis in Alzheimer's disease: a systematic review. Dement Geriatr Cogn Disord 2013; 35:155-64. [PMID: 23392273 DOI: 10.1159/000346733] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2012] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND/AIMS Cognitive impairment is a well-established correlate of psychotic symptoms in Alzheimer's disease (AD-P). We review whether this relationship has confounded previous genetic association studies of 5HTTLPR and AD-P. METHODS We reviewed all studies on 5HTTLPR and conducted a semi-quantitative analysis. RESULTS Three out of 4 studies with low MMSE reported a significant association, while 1 out of 4 with high MMSE reported a significant association. CONCLUSIONS Variation in cognitive impairment in past studies has contributed to the inconsistency in findings. The findings presented here bring a greater clarity to our understanding of the role of 5HTTLPR in AD-P.
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Affiliation(s)
- Byron Creese
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
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Reeves SJ, Gould RL, Powell JF, Howard RJ. Origins of delusions in Alzheimer's disease. Neurosci Biobehav Rev 2012; 36:2274-87. [PMID: 22910677 DOI: 10.1016/j.neubiorev.2012.08.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 07/19/2012] [Accepted: 08/03/2012] [Indexed: 11/26/2022]
Abstract
Research over the past two decades supports a shared aetiology for delusions in Alzheimer's disease (AD) and schizophrenia. Functional networks involved in salience attribution and belief evaluation have been implicated in the two conditions, and striatal D2/3 receptors are increased to a comparable extent. Executive/frontal deficits are common to both disorders and predict emergent symptoms. Putative risk genes for schizophrenia, which may modify the AD process, have been more strongly implicated in delusions than those directly linked with late-onset AD. Phenotypic correlates of delusions in AD may be dependent upon delusional subtype. Persecutory delusions occur early in the disease and are associated with neurochemical and neuropathological changes in frontostriatal circuits. In contrast, misidentification delusions are associated with greater global cognitive deficits and advanced limbic pathology. It is unclear whether the two subtypes are phenomenologically and biologically distinct or are part of a continuum, in which misidentification delusions manifest increasingly as the pathological process extends. This has treatment implications, particularly if they are found to have discrete chemical and/or pathological markers.
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Affiliation(s)
- Suzanne J Reeves
- Department of Old Age Psychiatry, Institute of Psychiatry, Kings College London, De Crespigny Park, Camberwell, London SE58AF, UK.
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Prince M, Acosta D, Ferri CP, Guerra M, Huang Y, Jacob KS, Jotheeswaran AT, Liu Z, Rodriguez JJL, Salas A, Sosa AL, Williams JD. The association between common physical impairments and dementia in low and middle income countries, and, among people with dementia, their association with cognitive function and disability. A 10/66 Dementia Research Group population-based study. Int J Geriatr Psychiatry 2011; 26:511-9. [PMID: 20669334 DOI: 10.1002/gps.2558] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 04/29/2010] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Chronic physical comorbidity is common in dementia. However, there is an absence of evidence to support good practice guidelines for attention to these problems. We aimed to study the extent of this comorbidity and its impact on cognitive function and disability in population-based studies in low and middle income countries, where chronic diseases and impairments are likely to be both common and undertreated. METHODS A multicentre cross-sectional survey of all over 65 year old residents (n = 15 022) in 11 catchment areas in China, India, Cuba, Dominican Republic, Venezuela, Mexico and Peru. We estimated the prevalence of pain, incontinence, hearing and visual impairments, mobility impairment and undernutrition according to the presence of dementia and its severity, and, among those with dementia, the independent contribution of these impairments to cognitive function and disability, adjusting for age, gender, education and dementia severity. RESULTS Incontinence, hearing impairment, mobility impairment and undernutrition were consistently linearly associated with the presence of dementia and its severity across regions. Among people with dementia, incontinence, hearing impairment and mobility impairment were independently associated with disability in all regions while the contributions of pain, visual impairment and undernutrition were inconsistent. Only hearing impairment made a notable independent contribution to cognitive impairment. CONCLUSIONS There is an urgent need for clinical trials of the feasibility, efficacy and cost-effectiveness of regular physical health checks and remediation of identified pathologies, given the considerable comorbidity identified in our population based studies, and the strong evidence for independent impact upon functioning.
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Affiliation(s)
- Martin Prince
- King's College London, Institute of Psychiatry, Centre for Global Mental Health, Health Service and Population Research Department, London, UK.
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Ostling S, Gustafson D, Blennow K, Börjesson-Hanson A, Waern M. Psychotic symptoms in a population-based sample of 85-year-old individuals with dementia. J Geriatr Psychiatry Neurol 2011; 24:3-8. [PMID: 20601646 DOI: 10.1177/0891988710373596] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Psychotic symptoms are common in elderly persons with dementia. These symptoms affect a person's ability to function in daily life and put strain on the caregiver. Most studies focus on psychotic symptoms in clinical samples with Alzheimer disease (AD). Thus, their prevalence and relation with dementia subtype and severity in very old populations is unclear. We assessed a representative sample of 85-year-old individuals living in Gothenburg, Sweden (n = 494) using neuropsychiatric examinations, key informant interviews, and medical record reviews; 147 had dementia. Dementia and its severity were diagnosed in accordance with Diagnostic and Statistical Manual of Mental Disorders (Third Edition, Revision [DSM-III-R]) criteria. Alzheimer disease according to the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria was diagnosed in 64 persons and vascular dementia (VaD) according to Erkinjuntti criteria was observed in 69. Fourteen had dementia due to other causes. Psychotic symptoms were classified according to DSM-III-R. The prevalence of psychotic symptoms in this very old population was 36% among AD cases compared to 54% in VaD cases (P = .04). Proportions with psychotic symptoms increased with increasing dementia severity in individuals with AD. No such association could be shown in those with VaD. This finding of a high proportion of psychotic symptoms also in individuals with mild severity of VaD should alert health professionals to evaluate dementia in very old patients who present with hallucinations or delusions.
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Affiliation(s)
- Svante Ostling
- The Sahlgrenska Academy at Gothenburg University, Institute of Clinical Neuroscience and Physiology, Sahlgrenska University Hospital, Sweden.
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20
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Abstract
In the fifth in a series of six articles on packages of care for mental disorders in low- and middle-income countries, Martin Prince and colleagues discuss the treatment of dementia.
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Affiliation(s)
- Martin J Prince
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom.
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21
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Abstract
The advent of new immunostains have improved the ability to detect limbic and cortical Lewy bodies, and it is evident that dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia, after Alzheimer's disease (AD). Distinguishing DLB from AD has important implications for treatment, in terms of substances that may worsen symptoms and those that may improve them. Neurocognitive patterns, psychiatric features, extrapyramidal signs, and sleep disturbance are helpful in differentiating DLB from AD early in the disease course. Differences in the severity of cholinergic depletion and type/distribution of neuropathology contribute to these clinical differences.
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Abstract
There are a number of pathophysiological processes underlying age related changes in the auditory system. The effects of hearing loss can have consequences beyond the immediate loss of hearing, and may have profound effects on the functioning of the person. While a deficit in hearing can be corrected to some degree by a hearing aid, auditory rehabilitation requires much more than simply amplifying external sound. It is important that those dealing with elderly people are aware of all the issues involved in age related hearing loss.
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Affiliation(s)
- A Howarth
- Department of ENT and Head and Neck Surgery, Royal Gwent Hospital, Newport, Gwent, UK.
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24
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Lin SH, Yu CY, Pai MC. The occipital white matter lesions in Alzheimer's disease patients with visual hallucinations. Clin Imaging 2006; 30:388-93. [PMID: 17101407 DOI: 10.1016/j.clinimag.2006.09.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2006] [Accepted: 09/20/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE Investigators have suggested that lesions responsible for visual hallucinations (VHs) are situated in the visual association cortex. The aim of this study was to assess the relationship between occipital white matter lesions and VHs in Alzheimer's disease (AD) patients. METHODS AD patients with a history of VHs (AD+VH) and those without (AD-VH) were retrospectively studied. The two groups of patients were matched by sex and mental state. All subjects underwent brain magnetic resonance image (MRI) scans. The periventricular hyperintensities (PVHs) and deep white matter hyperintensities (DWHs) on MRIs were rated by two raters using a semiquantitative scoring method (0=absent; 6=confluent). RESULTS Five AD+VH patients and five AD-VH patients were enrolled into this study. The occipital PVH score was higher in the AD+VH patients than in the AD-VH patients. The occipital DWH score was zero in both groups. CONCLUSION The presence of VHs in AD was associated with increased occipital PVHs and an absence of occipital DWHs on brain MRIs, implying that structural lesions in the geniculocalcarine region and preserved subcortical connections with visual association areas are involved in the genesis of VHs in AD.
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Affiliation(s)
- Shu-Han Lin
- Division of Behavioral Neurology, Department of Neurology, National Cheng Kung University Hospital, Tainan 701, Taiwan
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25
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Abstract
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.
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Affiliation(s)
- Anna EM Holt
- Brain and Cognitive Sciences Department, Massachusetts Institute of Technology, Boston, MA, USA
| | - Martin L Albert
- Department of Neurology, Boston University School of Medicine, Harold Goodglass Aphasia Research Center, VA Boston Healthcare System, Boston, MA, USA
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Borroni B, Grassi M, Agosti C, Costanzi C, Archetti S, Franzoni S, Caltagirone C, Di Luca M, Caimi L, Padovani A. Genetic correlates of behavioral endophenotypes in Alzheimer disease: role of COMT, 5-HTTLPR and APOE polymorphisms. Neurobiol Aging 2005; 27:1595-603. [PMID: 16257094 DOI: 10.1016/j.neurobiolaging.2005.09.029] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2004] [Revised: 08/02/2005] [Accepted: 09/25/2005] [Indexed: 10/25/2022]
Abstract
Several studies have been conducted to understand the genetic correlates of Alzheimer disease (AD)-related behavioral and psychological symptoms in dementia (BPSD). However, given that BPSD rarely occur in isolation, it has been suggested that targeting BPSD individually is too narrow of an approach if one wants to accurately define all the associated risk factors. To date, we know of no work on genetic polymorphisms related to behavioral endophenotypes in AD. The present study sought to evaluate the relationship between such behavioral endophenotypes in AD and genetic variations in dopamine- or serotonin-related genes, such as catechol-O-methyltransferase (COMT) or 5-HTT gene-linked promoter region (5-HTTLPR), and apolipoprotein E (APOE). Among 232 AD patients who underwent clinical and neuropsychological examination, a behavioral and psychiatric evaluation, and genotyping at COMT, 5-HTTPLR, and APOE; 66.4% showed more than one behavioral symptom. By Principal Component Analysis of Neuropsychiatric Inventory (NPI) symptoms four endophenotypes were identified, these were termed "psychosis", "moods", "apathy", and "frontal". Modeling NPI symptom-endophenotype-genotype relationships, and taking into account possible confounds (i.e. demographic characteristics, comorbidities, concomitant pharmacological treatments, and disease severity) by latent variable models, COMT and 5-HTTLPR genetic variations correlated with "frontal" and "psychosis" endophenotypes. APOE genotype did not correlate with any endophenotype. These findings suggest that the possibility of identifying distinct phenotypes on a genetic basis among AD patients exists, and suggest that clustering of BPSD into endophenotypes might provide a new strategy for guiding future research on this issue.
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Affiliation(s)
- B Borroni
- Center for Aging Brain and Dementia, Department of Neurology, University of Brescia, Italy.
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27
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Abstract
Hallucinations are a common feature of certain degenerative diseases with a risk of dementia such as Alzheimer's disease, Lewy body dementia, and Parkinson's disease. Obtaining valid epidemiological data is nevertheless quite difficult because of methodological problems. As a rule, hallucinations are more prevalent in Lewy body disease than Parkinson's disease or Alzheimer's disease. The prevalence in parkinsonian dementia is about the same as in Lewy body disease. Complex visual hallucinations predominate, auditory or tactile hallucinations are more exceptional. Minor forms (illusions, sensation of presence) are also observed. Recurrence is common, mainly in the evening or at night. Patients with advanced mental impairment generally take the hallucinations for reality. The hallucinations can be associated with psychological and behavioral disorders such as delusionnal idea or identification disorders. It is important to search for other causes of hallucinations such as drugs, ocular disorders, or depression, but many of these disorders are common comorbidities in elderly patients with degenerative disease. There is no unique model fitting all the hypothesized pathogenic mechanisms. Complex visual hallucinations most likely arise from abnormal activation of the extra-striat temporal associative regions, but only hypothetical mechanisms have been proposed. Genetic studies and functional imaging have not provided convincing evidence. Current focus is placed on an imbalance between deficient cholinergic transmission and preserved or augmented monoaminergic transmission at the cortical level, but other neurotransmission systems could be involved. The dream dysregulation mechanism proposed in Parkinson's disease cannot be generalized. The link between cognitive disorders and hallucination is also poorly understood: hallucinations are associated with more severe cognitive impairments or more rapid cognitive deline in Parkinson's disease and Alzheimer's disease, but the association with specific cognitive disorders remains to be fully explored.
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Affiliation(s)
- G Fénelon
- Service de neurologie, Hôpital Henri Mondor, Créteil, France.
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Bassiony MM, Lyketsos CG. Delusions and hallucinations in Alzheimer's disease: review of the brain decade. PSYCHOSOMATICS 2003; 44:388-401. [PMID: 12954913 DOI: 10.1176/appi.psy.44.5.388] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors reviewed studies published from 1990 to 2001 that address the epidemiology, phenomenology, course, etiology, assessment, and treatment of delusions and hallucinations in Alzheimer's disease. The prevalence of delusions in Alzheimer's disease patients ranged from 16% to 70% (median=36.5%) in the reviewed reports, and the prevalence of hallucinations ranged from 4% to 76% (median=23%). Delusions and hallucinations tended to persist over time, tended to recur often during the course of Alzheimer's disease, and were associated with sociodemographic and clinical correlates that differed from one study to another and with substantial consequences such as functional impairment and aggression. Psychosocial methods and both typical and atypical antipsychotics are effective in the treatment of delusions and hallucinations in Alzheimer's disease.
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30
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An audit of psychotropic prescribing practice of general adult psychiatrists in elderly demented patients. Ir J Psychol Med 2003; 20:59-64. [PMID: 30440211 DOI: 10.1017/s0790966700007655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES In Ireland elderly patients with behavioural and psychological symptoms of dementia (BPSD) are frequently prescribed anti-psychotic and other psychotropic agents. Elderly patients with dementia are more sensitive to adverse effects of medications. Despite this, little is known of the psychotropic prescribing practice of psychiatrists who treat this population. General adult psychiatrists in the Republic of Ireland continue to treat elderly patients with BPSD. The aim of this audit was to identify the prescribing practice of general adult psychiatrists in elderly patients with BPSD. We compare this practice to that of old age psychiatrists in the UK and that recommended by the American Psychiatric Association in 1997. METHODS We devised a structured anonymous questionnaire, which was forwarded to all general adult psychiatrists in the Republic of Ireland. RESULTS Atypical anti-psychotics are frequently prescribed by general adult psychiatrists to manage BPSD in elderly patients. The anti-psychotic agent of first preference chosen to treat psychotic symptoms in dementia is risperidone. Overall, sedative typical anti-psychotics are still the most frequently chosen anti-psychotic agents, chosen to manage behavioural symptoms in dementia. Benzodiazepines and trazadone are the most frequently prescribed other psychotropic agents chosen to manage agitated behaviour. In general the median doses of antipsychotics and other psychotropic medication used are in keeping with both the APA guidelines and practice of old age psychiatrists in the UK. A minority of practitioners (10%) specified at least one dosage regime that was grossly outside recommended ranges. CONCLUSIONS Overall, prescribing practice in terms of choice of treatment and dosage regime, of general adult psychiatrists in BPSD is in keeping with the best practice guidelines. However, sedating typical anti-psychotics and on occasion extraordinarily high doses of anti-psychotics are still prescribed.
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Abstract
Psychotic symptoms--delusions, delusional misidentifications and hallucinations--are observed in a variety of organic or nonorganic conditions, and are, therefore, diagnostically nonspecific. Common patholophysiologic denominators of different organic diseases may offer insights into the origin of psychotic symptoms. This article reviews some of the clinical and neuroimaging findings in organic psychoses present in various organic disorders. It attempts to extract a number of hypotheses about underlying biologic factors contributing to the development of psychotic symptoms of organic origin.
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Affiliation(s)
- N T Lautenschlager
- Klinikum und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Klinikum rechts der Isar, Ismaningerstr. 2281675 München, Germany
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Ballard C, Neill D, O'Brien J, McKeith IG, Ince P, Perry R. Anxiety, depression and psychosis in vascular dementia: prevalence and associations. J Affect Disord 2000; 59:97-106. [PMID: 10837878 DOI: 10.1016/s0165-0327(99)00057-9] [Citation(s) in RCA: 163] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Little is known about psychiatric symptoms in Vascular dementia (VaD). METHOD 92 patients with VaD, and 92 patients with Alzheimer's disease (AD) are reported. The evaluation included standardised measures of mood and psychosis. RESULTS 72% of VaD patients and 38% of those with AD had two or more anxiety symptoms. VaD patients with severe dementia (94%) were the most likely to be anxious. Depression was also significantly more common in VaD patients (19% vs. 8%) whereas psychotic symptoms were prevalent in both dementias. CONCLUSION Psychiatric symptoms are common in VaD, especially in patients with moderate or severe dementia. Rigorous assessment of psychiatric symptoms in VaD should be part of good clinical practice.
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Affiliation(s)
- C Ballard
- MRC Neurochemical Pathology Unit, Newcastle General Hospital, Westgate Road, NE4 6BE, Newcastle upon Tyne, UK
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Abstract
Alzheimer's disease is a disorder which is typified by a deterioration in cognition and a range of behavioural problems which result in a loss of functional ability and often necessitate transfer to residential care. This article looks at a growing body of research which is revealing the presence of changes in vision, particularly contrast sensitivity and acuity. We discuss the possible pathological basis for such deficits, and examine the possibility that such changes in vision may impact on the behavioural and functional outcomes of the demented individual.
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Affiliation(s)
- F K Cormack
- Department of Psychology, University of Newcastle upon Tyne, UK
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Abstract
The increase in research studies focusing on neuropsychiatric symptoms over the last decade has greatly increased our knowledge base, particularly with regard to the frequency of these symptoms and their impact on both patients and carers. We still have a poor understanding of the natural course of these symptoms and their biologic correlates, however, and more specific treatment studies are needed to inform clinical management.
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Affiliation(s)
- C Ballard
- MRC Neurochemical Pathology Unit, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK
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Ballard C, Bannister C, Graham C, Oyebode F, Wilcock G. Associations of psychotic symptoms in dementia sufferers. Br J Psychiatry 1995; 167:537-40. [PMID: 8829726 DOI: 10.1192/bjp.167.4.537] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Psychotic symptoms in dementia have been considered as a single category which may have masked important associations. An exploratory analysis was undertaken to look separately at delusions, visual hallucinations and delusional misidentification. METHOD Psychotic symptoms were assessed with the Burns' Symptom Checklist in 124 patients with DSM-III-R dementia. RESULTS Eighty-three (66.9%) patients had psychotic symptoms. Deafness and life events were associated with delusions and visual impairment was associated with visual hallucinations, while senile dementia of Lewy body type and older age were associated with both. CONCLUSIONS Differences are evident in the associations of delusions and visual hallucinations. Sensory impairments were associated with both symptoms.
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Affiliation(s)
- C Ballard
- University of Birmingham, Queen Elizabeth Psychiatric Hospital
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