Characteristics of very late-onset schizophrenia-like psychosis classified with the biomarkers for Alzheimer’s disease: a retrospective cross-sectional study

Abstract

Objectives: We aimed to investigate the association between very late-onset schizophrenia-like psychosis (VLOSLP), a schizophrenia spectrum disorder with an onset of ≥60 years, and Alzheimer’s disease (AD) using biomarkers. Design: Retrospective cross-sectional study. Setting: Neuropsychology clinic of Osaka University Hospital in Japan. Participants: Thirty-three participants were classified into three groups: eight AD biomarker-negative VLOSLP (VLOSLP−AD), nine AD biomarker-positive VLOSLP (VLOSLP+AD), and sixteen amnestic mild cognitive impairment due to AD without psychosis (aMCI−P+AD) participants. Measurements: Phosphorylated tau levels in the cerebrospinal fluid and 18F-Florbetapir positron emission tomography results were used as AD biomarkers. Several scales (e.g. the Mini-Mental State Examination (MMSE), Wechsler Memory Scale-Revised (WMS-R) Logical Memory (LM) I and II, and Neuropsychiatric Inventory (NPI)-plus) were conducted to assess clinical characteristics. Results: Those in both VLOSLP−AD and +AD groups scored higher than those in aMCI−P+AD in WMS-R LM I. On the other hand, VLOSLP+AD participants scored in between the other two groups in the WMS-R LM II, with only VLOSLP−AD participants scoring significantly higher than aMCI−P+AD participants. There were no significant differences in sex distribution and MMSE scores among the three groups or in the subtype of psychotic symptoms between VLOSLP−AD and +AD participants. Four VLOSLP−AD and five VLOSLP+AD participants harbored partition delusions. Delusion of theft was shown in two VLOSLP−AD patients and five VLOSLP+AD patients. Conclusion: Some VLOSLP patients had AD pathology. Clinical characteristics were different between AD biomarker-positive and AD biomarker-negative VLOSLP, which may be helpful for detecting AD pathology in VLOSLP patients.

Cerebrospinal fluid amyloid beta with amyloid positron emission tomography concordance rates in a heterogeneous group of patients including late‐onset psychotic disorders: a retrospective cross‐sectional study

“…Recently, late‐onset psychiatric disorders, such as very late‐onset schizophrenia‐like psychosis, have attracted attention in association with neurodegenerative diseases 1,2 . At least some patients with late‐onset psychiatric disorders may be in the early phase of neurodegenerative diseases.…”

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Recently, late-onset psychiatric disorders, such as very late-onset schizophrenia-like psychosis, have attracted attention in association with neurodegenerative diseases. 1,2 At least some patients with late-onset psychiatric disorders may be in the early phase of neurodegenerative diseases. Amyloid beta (Aβ) in cerebrospinal fluid (CSF) has been well validated as a biomarker to assume Alzheimer's disease (AD) pathology before the onset of dementia phenotype.

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“…It is often reported that patients with late-onset psychiatric disorders may have neurodegenerative diseases such as Lewy body disease, 1 frontotemporal dementia, 7 and AD. 2 Disease-modifying agents are being developed for these neurodegenerative diseases, and future treatments are expected to vary with each underlying pathology. Therefore, it is important to know whether a particular patient with late-onset psychiatric disorder has any of these neurodegenerative pathologies.…”

Biomarkers of neurodegeneration among patients with very late-onset schizophrenia-like psychosis: future implications

“…The article by Satake and colleagues (Satake et al, 2022) further elaborates topics raised in a recent theme issue entitled "Serious Mental Illnesses in Older adults" featured by International Psychogeriatrics. For example, in a recent paper by Nagendra and colleagues based out of Australia, among 55 patients with delusional disorder followed prospectively over time, arguably a much more benign disorder than schizophrenia, four patients developed dementia and two patients developed cognitive decline (Nagendra and Snowdon, 2020).…”

“…Perhaps the most crucial element of the study conducted by Satake et al (2022) and colleagues is that approximately half of the patients with VLOSLP exhibited AD biomarkers. Previous studies examining the association between psychiatric symptoms and AD biomarkers have revealed similar conclusions.…”