Characteristics of very late-onset schizophrenia-like psychosis as prodromal dementia with Lewy bodies: a cross-sectional study

Abstract

Background This study aimed to identify cases of potential prodromal DLB in very late-onset schizophrenia-like psychosis (VLOSLP), using indicative biomarkers of dementia with Lewy bodies (DLB), and to evaluate the characteristics of psychosis as prodromal DLB. Methods Data of patients with VLOSLP without dementia and Parkinsonism, who underwent testing for at least one indicative biomarker of DLB, were retrospectively collected from the database of the psychiatry clinic at the Osaka University Hospital. Patients were divided into two groups based on the positive (VLOSLP+LB) and negative (VLOSLP–LB) results of the indicative biomarkers of DLB. Age, gender, cognitive battery scores, prevalence of each type of delusions and hallucinations, cerebral volume, and cerebral perfusion were compared between the two groups. Results Eleven VLOSLP+LB and 23 VLOSLP–LB participants were enrolled. There were no significant differences in age, proportion of females, and MMSE scores between the two groups. The standardized score of the digit symbol substitution test was significantly lower in the VLOSLP+LB than in VLOSLP–LB group (6.9 [3.1] vs. 10.0 [2.7], p = 0.005). The prevalence of visual hallucinations was significantly higher in the VLOSLP+LB group than in the VLOSLP-LB group (81.8% vs. 26.1%, p = 0.003). Auditory hallucinations were prevalent in both groups (43.5% in VLOSLP–LB, and 45.5% in VLOSLP+LB). Among patients with auditory hallucinations, auditory hallucinations without coexistent visual hallucinations tended to be more prevalent in VLOSLP–LB (7 out of 10) than in VLOSLP+LB patients (1 out of 5). Although cerebral volume was not different in any region, cerebral perfusion in the posterior region, including the occipital lobe, was significantly lower in the VLOSLP+LB group. Conclusions Psychomotor slowing, visual hallucinations, and reduced perfusion in the occipital lobe may be suggestive of prodromal DLB in VLOSLP patients, even though the clinical manifestations were similar in many respects between VLOSLP+LB and VLOSLP–LB. Although auditory hallucinations were prevalent in both groups, most patients in VLOSLP+LB complained of auditory hallucinations along with visual hallucinations. Future studies with a larger number of patients without selection bias are desirable.

Contribution of amyloid and putative Lewy body pathologies in neuropsychiatric symptoms

“…These results indicate that the MBI affective dysregulation, impulse dyscontrol, and decreased motivation domains could be common in PD. In contrast, NPSs in prodromal DLB are characterized by hallucinations 30 and psychosis, 40,41 in addition to depression, anxiety, and apathy 30–32 . Since MBI in prodromal DLB might vary from MBI in PD; further studies are warranted.…”

Case report: Delusional infestation in dementia with Lewy bodies

“…If this hypothesis is correct, it is possible that some patients with delusional infestation without dementia may also have the psychiatric-onset type of prodromal DLB ( 12 ). We recently compared the characteristics of patients with very-late-onset schizophrenia-like psychosis with and without positive results for the indicative biomarkers of DLB and the prevalence of visual hallucination was higher in patients with very-late-onset schizophrenia-like psychosis and suspected prodromal DLB ( 20 ). Visual hallucinations may be a symptom suggestive of DLB, even in older patients with delusional infestation.…”

Schizophrenie im Alter

“…der SCI und MCI unter den milden Verhaltensauffälligkeiten den stärksten Prädiktor einer kognitiven Verschlechterung dar [12,30]. Die Häufigkeiten psychotischer Symptome wurden bei der Lewykörperchendemenz [31] mit bis zu 75%, der Parkinsondemenz mit 50%, der Alzheimerdemenz mit 41-50%, der vaskulären Demenz mit 15%, der Chorea Huntington mit 13% und der Frontotemporalen Demenz mit 10% angegeben [12,15,32].…”

“…organischen Erkrankungen -Medikamentenänderungen -Drogengebrauch ▪ frühe medikamentöse Therapieresistenz ▶ Tab. 5 Charakteristika von psychotischen Symptomen bei Demenzerkrankungen im Vergleich zur Schizophrenie unabhängig vom Alter der Erstmanifestation [17,23,29,30,31,64].…”