Psychosis in Alzheimer’s Disease

Ballard, Clive; Kales, Helen C.; Aarsland, Dag; Creese, Byron; Mills, Roger; Williams, Hilde; Sweet, Robert A.

doi:10.1007/s11910-020-01074-y

Cited by 37 publications

(41 citation statements)

References 93 publications

(114 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Delusions and hallucinations in dementia are often associated with other behavioral symptoms such as depression, agitation, and apathy. Differences have been shown in patients who have psychosis and agitation, whose occurrence might be a marker of severity [56,57]. Moreover, hallucinations are frequent in people with AD who also have depression [35].…”

Section: Definition Of Symptomsmentioning

confidence: 99%

“…Moreover, hallucinations are frequent in people with AD who also have depression [35]. It is still not clear whether the latent cluster association of the behavioral disorders represents a different phenotype in dementia [57]. Co-occurrence of different behavioral disorders may influence the individual responses to the pharmacological treatments.…”

Section: Definition Of Symptomsmentioning

confidence: 99%

See 1 more Smart Citation

Psychosis as a Treatment Target in Dementia: A Roadmap for Designing Interventions

Agüera-Ortíz

Babulal

Bruneau

et al. 2022

JAD

Self Cite

View full text Add to dashboard Cite

Psychotic phenomena are among the most severe and disruptive symptoms of dementias and appear in 30% to 50% of patients. They are associated with a worse evolution and great suffering to patients and caregivers. Their current treatments obtain limited results and are not free of adverse effects, which are sometimes serious. It is therefore crucial to develop new treatments that can improve this situation. We review available data that could enlighten the future design of clinical trials with psychosis in dementia as main target. Along with an explanation of its prevalence in the common diseases that cause dementia, we present proposals aimed at improving the definition of symptoms and what should be included and excluded in clinical trials. A review of the available information regarding the neurobiological basis of symptoms, in terms of pathology, neuroimaging, and genomics, is provided as a guide towards new therapeutic targets. The correct evaluation of symptoms is transcendental in any therapeutic trial and these aspects are extensively addressed. Finally, a critical overview of existing pharmacological and non-pharmacological treatments is made, revealing the unmet needs, in terms of efficacy and safety. Our work emphasizes the need for better definition and measurement of psychotic symptoms in dementias in order to highlight their differences with symptoms that appear in non-dementing diseases such as schizophrenia. Advances in neurobiology should illuminate the development of new, more effective and safer molecules for which this review can serve as a roadmap in the design of future clinical trials.

show abstract

Section: Definition Of Symptomsmentioning

confidence: 99%

Section: Definition Of Symptomsmentioning

confidence: 99%

Psychosis as a Treatment Target in Dementia: A Roadmap for Designing Interventions

Agüera-Ortíz

Babulal

Bruneau

et al. 2022

JAD

Self Cite

View full text Add to dashboard Cite

show abstract

“…Psychosis occurring over the course of Alzheimer’s disease (AD), comprising the idiopathic development of fixed false beliefs or disturbances of perception [ 1 ], represents a distinct phenotype [ 2 ] that is a harbinger of an accelerated velocity of cognitive and functional decline leading to hastened mortality [ 3 – 8 ]. Psychosis in AD, which has been reported to have a cross-sectional prevalence of 40% [ 9 ], adds to caregiver burden [ 10 ] as it is often complicated by agitation and aggression [ 1 ]. The challenge of coping with and responding to a loved one under the influence of psychotic symptoms is a common precipitant of long-term care placement [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Increased retention of tau PET ligand [18F]-AV1451 in Alzheimer’s Disease Psychosis

et al. 2022

View full text Add to dashboard Cite

Psychosis in Alzheimer’s disease (AD) represents a distinct disease subtype with a more rapid progression of illness evidenced by an increased velocity of cognitive decline and a hastened mortality. Previous biomarker and post-mortem studies have implicated tau neuropathology as a possible mediator of the accelerated decline in AD psychosis. Tau positron emission tomography (PET) neuroimaging provides the opportunity to evaluate tau pathology in-vivo, so that clinical symptomatology can be correlated with disease pathology. [18F]-AV1451 (Flortaucipir) is a PET ligand with high affinity for insoluble paired-helical filaments (PHFs) of hyperphosphorylated tau. In order to determine whether the development of psychosis and worsened prognosis in AD is associated with an increased burden of tau pathology that can be identified with tau imaging, we identified subjects within the Alzheimer’s disease neuroimaging initiative (ADNI) who had [18F]-AV1451 imaging at baseline and became psychotic over the course of the study (N = 17) and matched them 1:3 for gender, age, and education to subjects who had [18F]-AV1451 imaging at baseline and did not become psychotic (N = 50). We compared baseline [18F]-AV1451 retention, in addition to cognitive and functional baseline and longitudinal change, in those who became psychotic over the course of participation in ADNI with those who did not. Results suggest that increases in tau pathology in frontal, medial temporal, and occipital cortices, visualized with [18F]-AV1451 binding, are associated with psychosis and a more rapid cognitive and functional decline.

show abstract

“…If behavioral/environmental approaches are not fully effective in treating behavioral/psychiatric symptoms, pharmacotherapies can be considered with the goal of controlling behaviors that are resulting in significant stress for patients or safety concerns for patients and caregivers. 103 Both acetylcholinesterase inhibitors, primarily donepezil, and NMDA receptor antagonist have modest evidence for improving behavioral and psychological symptoms of dementia in mild to moderate AD 101,104 and should be considered first-line therapies. The next class of therapies to consider are selective serotonin reuptake inhibitors (SSRIs) and related compounds.…”

Section: Behavioral and Psychological Symptoms Of Dementiamentioning

confidence: 99%

Alzheimer Disease

McDade¹

2022

CONTINUUM: Lifelong Learning in Neurology

View full text Add to dashboard Cite

PURPOSE OF REVIEWAlzheimer disease (AD) is the most common cause of dementia in adults (mid to late life), highlighting the importance of understanding the risk factors, clinical manifestations, and recent developments in diagnostic testing and therapeutics.RECENT FINDINGSAdvances in fluid (CSF and blood-based) and imaging biomarkers are allowing for a more precise and earlier diagnosis of AD (relative to non-AD dementias) across the disease spectrum and in patients with atypical clinical features. Specifically, tau- and amyloid-related AD pathologic changes can now be measured by CSF, plasma, and positron emission tomography (PET) with good precision. Additionally, a better understanding of risk factors for AD has highlighted the need for clinicians to address comorbidities to maximize prevention of cognitive decline in those at risk or to slow decline in patients who are symptomatic. Recent clinical trials of amyloid-lowering drugs have provided not only some optimism that amyloid reduction or prevention may be beneficial but also a recognition that addressing additional targets will be necessary for significant disease modification.SUMMARYRecent developments in fluid and imaging biomarkers have led to the improved understanding of AD as a chronic condition with a protracted presymptomatic phase followed by the clinical stage traditionally recognized by neurologists. As clinical trials of potential disease-modifying therapies continue, important developments in the understanding of the disease will improve clinical care now and lead to more effective therapies in the near future.

show abstract

Psychosis in Alzheimer’s Disease

Cited by 37 publications

References 93 publications

Psychosis as a Treatment Target in Dementia: A Roadmap for Designing Interventions

Psychosis as a Treatment Target in Dementia: A Roadmap for Designing Interventions

Increased retention of tau PET ligand [18F]-AV1451 in Alzheimer’s Disease Psychosis

Alzheimer Disease

Contact Info

Product

Resources

About