Psychosis of Alzheimer's disease: Neuropsychological and neuroimaging longitudinal study

Abstract

Objectives Psychosis of Alzheimer's disease (AD) may represent a distinct disease phenotype; however, neuropsychological profile and neural basis linked to this phenotype have not yet been clarified. In this study, we aimed at detecting whether impairment in specific cognitive domains predicts the onset of psychosis in AD patients and what grey matter alterations, their location, and the rate of atrophy are associated with psychosis of AD. Methods Longitudinal neuropsychological data from AD patients with and without psychosis were analysed to determine whether the neuropsychological profile can predict the onset of psychosis. A voxel‐based morphometry (VBM) on longitudinal T1‐weighted images was used to explore differences in grey matter volume and in the rate of atrophy between groups. Results Noncognitive domain predicted the psychosis onset. However, AD patients with psychosis exhibited greater atrophy in the right anterior‐inferior temporal lobe, including the fusiform gyrus (cluster‐p‐family‐wise error [pfwe] < 0.05; peak‐p uncorrected [pUNC] < 0.001) as well as greater rate of atrophy in the right insula than nonpsychotic patients (cluster‐pFWE = 0.075; peak‐pUNC < 0.001). The anterior‐inferior temporal lobe is part of the ventral visual stream, and the insula plays a key role in the salience network. Conclusions This finding suggests that damage in these areas underpins an impairment in the visual processing of the objects and an impairment in the attribution of salience to the misperceived stimuli, which in turn leads to the onset of psychosis. These findings tie in well with the neuropsychological model of psychosis, according to which the simultaneous presence of two factors, namely misperception and misattribution, underlies psychosis in dementia.

Cortical complexity alterations in the medial temporal lobe are associated with Alzheimer’s disease psychosis

“…These results suggest that AD psychosis may represent a distinct phenotype that is associated with specific structural alterations, in line with previous studies (Ismail et al, 2012; Y. M. Lee et McLachlan et al, 2018). These results also suggest a pivotal role of the ventral visual stream in AD psychosis, consistent with previous studies from our group (D'Antonio, Di Vita et al, 2019;. Thus, our findings provide additional evidence that structural alterations in functionally specialized visuoperceptual regions may underpin cognitive alterations in the perception and interpretation of visual stimuli, which may contribute to psychosis onset (D'Antonio, Di Vita et al, 2019).…”

“…Neuroimaging studies have reported that AD patients with psychosis (AD-P) show gray matter (GM) alterations mainly in fronto-temporal regions, as summarized by Ismail and colleagues in their review (Ismail et al, 2012). Recent longitudinal studies have reported that psychosis in AD may be associated with a greater rate of atrophy in fronto-temporal regions and in regions of the inferior temporal lobe and insula, suggesting that the co-occurrence of misperception and misattribution may underpin psychosis in AD (D'Antonio, Di Vita et al, 2019). A study that investigated cortical thickness in AD psychosis reported that AD-P patients have a greater reduction in bilateral hippocampal volume than AD patients without psychosis (K. Lee et al, 2019).…”

Older Adults Diagnosed With Schizophrenia in Long-term Care Facilities: Life Course Theory for Holistic Nursing Research and Practice

“…OADWS can experience periods of agitation in long-term care facilities, generated in part by cognitive confusion and labile mood (APA, 2013; NIMH, 2018). Many OADWS experience psychosis, a condition that can be related to schizophrenia or other comorbid diagnoses such as Alzheimer's disease (Connors et al, 2018; D’Antonio et al, 2019; Reeves et al, 2017; Roberton & Daffern, 2020). Although OADWS have human agency and may express agitation , they are also bound by the social constraints of long-term care facilities, which require their protection as well as the protection of others with whom they live.…”

Integration of Imaging Genomics Data for the Study of Alzheimer's Disease Using Joint-Connectivity-Based Sparse Nonnegative Matrix Factorization

“…8, the escape rate of module 1 is the smallest among the three types of data, so we choose module 1 for further analysis. [24], Angular Gyrus [25], Fusiform Gyrus [26], Inferior Occipital Gyrus [27], Inferior Temporal Gyrus [28], Lingual Gyrus [29], Middle Frontal Gyrus [30], Middle Temporal Gyrus [31], Precuneus [32], Postcentral Gyrus [33], Precentral Gyrus [34], Supramarginal Gyrus [35], Superior Parietal Lobule [36], Superior Temporal Gyrus [37] have been confirmed to be risk brain regions for AD. Also, we identify a total of 47 risk genes from the SNPs data in the first module.…”