Late-Onset Psychosis; Is It Real?

Kwak, Yong Tae; Yang, YoungSoon; Koo, Min-Seong

doi:10.12779/dnd.2015.14.1.1

Cited by 5 publications

(3 citation statements)

References 84 publications

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“…The finding on the significant association of psychotic symptoms, across all the subtypes of dementia, is probably one of the less expected. Apart from in the context of dementia with Lewy Bodies [9], the association between psychotic symptoms and incident dementia has not been conclusively demonstrated among cognitively normal older persons [43][44][45]. This is possibly related to the relatively infrequent occurrence of psychotic symptoms in cognitively normal older persons and, consequently, the difficulties in capturing them in research settings.…”

Section: Interpretation Of Findingsmentioning

confidence: 99%

Neuropsychiatric symptoms in cognitively normal older persons, and the association with Alzheimer’s and non-Alzheimer’s dementia

Liew

2020

Alz Res Therapy

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Background: Neuropsychiatric symptoms (NPS) have been reported to be useful in predicting incident dementia among cognitively normal older persons. However, the literature has not been conclusive on the differential utilities of the various NPS in predicting the subtypes of dementia. This study compared the risks of Alzheimer's and non-Alzheimer's dementia associated with the various NPS, among cognitively normal older persons. Methods: This cohort study included 12,452 participants from the Alzheimer's Disease Centers across USA, who were ≥ 60 years and had normal cognition at baseline. Participants completed the Neuropsychiatric Inventory-Questionnaire at baseline and were followed up almost annually for incident dementia (median follow-up = 4.7 years). Symptom clusters of NPS-as identified from exploratory and confirmatory factor-analyses-were included in the Cox regression to investigate their associations with incident dementia. Results: The various NPS showed independent yet differential associations with incident dementia. Although psychotic symptoms were rarely endorsed by the participants, they predicted much higher risk of dementia (HR 3.6, 95% CI 2.0-6.4) than affective symptoms (HR 1.5, 95% CI 1.2-1.8) or agitation symptoms (HR 1.6, 95% CI 1.3-2.1). Psychotic symptoms predicted all dementia subtypes, while affective and agitation symptoms differentially predicted some subtypes. Across dementia subtypes, psychotic symptoms had relatively higher risk estimates than affective or agitation symptoms, with the risk estimates being particularly high in non-Alzheimer's dementia. Conclusions: Among cognitively normal individuals, the presence of NPS may warrant greater clinical vigilance as precursors to dementia and its subtypes. The findings highlight the need for further research to enrich our understanding on the neurobiological links between various NPS and dementia subtypes. They may also change the clinical approach in managing late-life psychotic symptoms, requiring a greater emphasis on dementia surveillance in the diagnostic criteria of late-life psychotic disorders.

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Section: Interpretation Of Findingsmentioning

confidence: 99%

Neuropsychiatric symptoms in cognitively normal older persons, and the association with Alzheimer’s and non-Alzheimer’s dementia

Liew

2020

Alz Res Therapy

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“…Nonetheless, other recent risk factors have been studied, giving rise to a potential multifactorial underlying aetiology and thus physiopathology. The differentiation between early and late onset psychosis in general, and also specifically in PD, is not currently validated, having some studies randomly set cut-off values at 2–4 years of PD onset to determine early versus late onset psychosis [ 71 ]. More interestingly, the assessment of psychosis as a potential prodromal feature could give rise to finding biomarkers in PD, in order to predict its occurrence and treat it at early stages.…”

Section: Pathophysiology and Potential Biomarkers Of Psychosis In mentioning

confidence: 99%

Management of Psychosis in Parkinson’s Disease: Emphasizing Clinical Subtypes and Pathophysiological Mechanisms of the Condition

Taddei

Çankaya

Dhaliwal

et al. 2017

Parkinson's Disease

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Investigation into neuropsychiatric symptoms in Parkinson's disease (PD) is sparse and current drug development is mainly focused on the motor aspect of PD. The tight association of psychosis with an impaired quality of life in PD, together with an important underreporting of this comorbid condition, contributes to its actual insufficient assessment and management. Furthermore, the withdrawal from access to readily available treatment interventions is unacceptable and has an impact on PD prognosis. Despite its impact, to date no standardized guidelines to the adequate management of PD psychosis are available and they are therefore highly needed. Readily available knowledge on distinct clinical features as well as early biomarkers of psychosis in PD justifies the potential for its timely diagnosis and for early intervention strategies. Also, its specific characterisation opens up the possibility of further understanding the underlying pathophysiological mechanisms giving rise to more targeted therapeutic developments in the nearer future. A literature review on the most recent knowledge with special focus on specific clinical subtypes and pathophysiological mechanisms will not only contribute to an up to date practical approach of this condition for the health care providers, but furthermore open up new ideas for research in the near future.

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“…In general, dementia-related psychotic symptoms require lower doses of antipsychotics than those with schizophrenia. [19][20][21] In younger patients with schizophrenia, antipsychotic are generally titrated as rapidly as tolerated to target doses presumed to be therapeutic. In practice, initial titration usually proceeds at a rate of one to two dose increases per week.…”

Section: Dose and Dose Titrationmentioning

confidence: 99%

Understanding of Antipsychotics in Elderly Patients with Dementia

Kwak

Yang

Jang

2015

Dement Neurocognitive Disord

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Elderly patients affected with dementia frequently accompany delusions, hallucinations and other psychotic symptoms. As such, these patients are commonly prescribed antipsychotic medications for the treatment of psychosis. However, in recent years, the use of antipsychotics has been widely debated for reasons concerning their efficacy and safety in these patients. Conventional antipsychotics have been widely used for behavioral psychological symptoms in dementia (BPSD) in the past. Atypical antipsychotics showed an efficacy superior to placebo in randomized studies in BPSD treatment, with a better tolerability profile versus conventional drugs. However, in 2002, the Food and Drug Administration alert the possible increase in cerebrovascular adverse events after using antipsychotics and consequent studies reported various adverse (including fatalities) events. Notwithstanding controversial data, antipsychotics are probably the best option for short-term treatment of severe BPSD. However, due to possible serious adverse events, long-term therapy is not recommended and clinician should decrease the dosage and discontinue treatment wherever a sufficient control of behavioral symptoms has been obtained. Before prescribing an antipsychotic drug, the possible risk factor should be structurally reviewed and monitored. The aim of this review is to asses systematically the efficacy and safety concern of antipsychotics in treating elderly patients with BPSD. And we also review how and what we should prescribe and monitor, if once antipsychotic medication is decided.

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Late-Onset Psychosis; Is It Real?

Cited by 5 publications

References 84 publications

Neuropsychiatric symptoms in cognitively normal older persons, and the association with Alzheimer’s and non-Alzheimer’s dementia

Neuropsychiatric symptoms in cognitively normal older persons, and the association with Alzheimer’s and non-Alzheimer’s dementia

Management of Psychosis in Parkinson’s Disease: Emphasizing Clinical Subtypes and Pathophysiological Mechanisms of the Condition

Understanding of Antipsychotics in Elderly Patients with Dementia

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