Delusional Disorder in Old Age: A Hypothesis-Driven Review of Recent Work Focusing on Epidemiology, Clinical Aspects, and Outcomes

Abstract

The theme, strength, and duration of a delusion are considered important in distinguishing one psychosis of old age from another. Research results, however, are mostly based on studies conducted on one form of psychosis, namely schizophrenia. The aim of this hypothesis-driven narrative review is to gather clinically important information about the psychosis identified as delusional disorder (DD), as it affects persons of senior age. We hypothesized that DD becomes relatively prevalent in old age, especially in women; and that it is associated with demonstrable brain changes, which, in turn, are associated with cognitive defects and poor pharmacological response, thus increasing the risk of aggression and suicide. Computerized searches in PubMed and ClinicalTrials.gov were conducted using the following search terms: (delusional disorder) AND (elderly OR old OR aged OR psychogeriatrics). A total of 16 recent studies (including case reports) were reviewed. Our hypotheses could not be definitively confirmed because research evidence is lacking. In order to improve eventual outcomes, our literature search demonstrates the need for more targeted, well-designed studies.

Advances in the Diagnosis and Management of Psychotic Symptoms in Neurodegenerative Diseases: A Narrative Review

“…Hallucinations can occur in 16-41% of patients; simple VH predominate, although AH can also be present. 3,57,62 In a sample of 1,808 adults with AD and other major NCDs characterized neuropathologically, hallucinations were more common in patients with mixed AD/Lewy body disease pathology than in those with AD or Lewy body disease alone. 63 Presence of psychotic symptoms can skew clinical diagnosis.…”

“…1 The combined prevalence of the two most common primary psychotic disorders (schizophrenia and delusional disorder) and mood disorders with psychotic features in adults older than 65 is 5-6%, with secondary psychosis accounting for the remainder. 2,3 It is estimated that about 60% of new-onset psychotic symptoms in late life reflect underlying systemic medical or neurological conditions, most often neurodegenerative diseases. 4 In contrast to primary psychotic syndromes, visual hallucinations (VH) are more common than auditory hallucinations (AH) in neurodegenerative diseases, with a variable prevalence of delusions.…”

Primary and Secondary Prevention in Delusional Disorder

“…Older patients, post-menopausal women in particular, are at risk and require special attention. 39 Another potential community strategy to prevent the development of severe mental illness such as DD is to institute programs for family psychoeducation, so as to help family members address potential delusional beliefs. 40 A recent review pointed out that some family responses to psychiatric symptoms are more constructive than others.…”

Collaboration between Psychiatrists and Other Allied Medical Specialists for the Treatment of Delusional Disorders

“…Cognitive decline has been associated with a poor response to psychotropic medications in patients with DD. González-Rodríguez et al [ 23 ] conducted a recent review of DD in old age and concluded that cognitive defects in elderly DD patients were potentially associated with poor pharmacological response. This conclusion awaits confirmation by further research.…”