Clinicopathological correlation of psychosis and brain vascular changes in Alzheimer’s disease

Abstract

Psychosis is common in Alzheimer’s disease (AD). However, studies on neuropathology in vascular etiology contributing to psychosis in AD is lacking to date. The aim of this study was to investigate neuropathological vascular related changes in Alzheimer’s disease with psychosis. Data of patients with AD from the National Alzheimer’s Coordinating Center between 2005 to September 2013 was accessed and reviewed. Presence of psychosis was determined based on Neuropsychiatric Inventory Questionnaire taken from the last visit within one year prior to death, and patients were divided into psychosis positive and negative group. Comparison of clinical details and neuropathological vascular changes between the groups was performed using Wilcoxon rank sum test and Chi-square/ Fisher’s exact test. Significant variables were further included in a multivariate logistic model. Overall, 145 patients was included. Of these, 50 patients were psychosis positive. Presence of one or more cortical microinfarcts and moderate to severe arteriosclerosis was found to be positively associated with psychosis. Our results suggest vascular changes correlate with psychosis in Alzheimer’s disease.

Neuropsychiatric symptoms in South‐East Asian patients with mild cognitive impairment and dementia: prevalence, subtypes, and risk factors

“…On the basis of previously established literature (Spalletta et al, ; Hackett et al, ; Senanarong et al, ; Steinberg et al, ; Treiber et al, ; Smith and Blumenthal, ; Apostolova et al, ; Kandiah et al, ; Ting et al, ), risk factors of interest included demographic characteristics, medical morbidity, and cognitive functioning.…”

“…Demographic characteristics have included a younger age, lower level of education, and male gender, with the exception of depression and anxiety observed more in women (Steinberg et al, 2006;Apostolova et al, 2014). Medical risks have included severity and duration of dementia (Piccininni et al, 2005) and vascular burden, such as hypertension, hypocholesterolemia, diabetes, history of stroke, and white matter hyperintensities (WMH) (Hackett et al, 2005;Treiber et al, 2008;Smith and Blumenthal, 2011;Kandiah et al, 2014;Ting et al, 2016). Lastly, global cognitive impairment has been associated with greater neuropsychiatric symptoms (Xu et al, 2015); however, the association between domain impairments, such as executive dysfunction, and neuropsychiatric symptoms remain inconsistent (Spalletta et al, 2004;Xu et al, 2015).…”

Neuropsychiatric Symptoms in Alzheimer Disease, Vascular Dementia, and Mixed Dementia

“…Our finding of a higher right frontal WMH volume in AD patients with delusions versus those without lends support to the findings of Shanks and Venneri [41], who showed delusions to be related to distinct localized pathologies, typically involving the anterior part of the right hemisphere. Ting et al [24] suggested that ischemic small vessel disease is likely associated with psychosis in AD, and patients with probable AD with small vessel disease have been shown to have significantly more delusions than those without small vessel disease [42]. Therefore, the vascular changes may be playing an important role in the delusional symptoms seen in AD.…”

“…Frontal WMH have also been shown to be associated with higher depression scores in patients with AD, VaD, and dementia with Lewy bodies [23]. Most recently, it has been suggested that ischemic small vessel disease is likely associated with psychosis in AD [24] Thus, by better understanding the underlying vascular changes that are associated with certain NPS, we can better target treatment options, arguing for more aggressive treatment for vascular disease. Langa et al [25] recently conducted a study in the USA that found a significantly decreased prevalence of dementia in the year 2012 when compared to the prevalence in 2000 for subjects aged 65 years or older.…”

Clinical and neurocognitive aspects of hallucinations in Alzheimer’s disease

“…A study has demonstrated that AD patients tend to develop visual hallucinations significantly later than patients with Dementia with Lewy bodies [28]. Thus, visual hallucinations may characterize the advanced stages of AD and the co-occurrence of vascular pathology rather than AD pathology [29, 30]. …”