The frequency of psychotic symptoms in types of dementia: a systematic review

Abstract

The frequency of psychotic symptoms in older adults is high, mainly in neurocognitive cognitions of the most varied etiologies. Objectives: This study aimed to review the studies that analyze the frequency of the types of delusions, hallucinations, and misidentifications in dementia conditions of different etiologies. Methods: A systematic review was conducted on August 9, 2021, in the PubMed, PsycInfo, Embase, Web of Science, and Scopus databases with the following descriptors: (dementia OR alzheimer disease OR dementia with Lewy bodies OR frontotemporal dementia OR mixed dementia OR vascular dementia OR major neurocognitive disorder OR parkinson disease dementia) AND (psychotic symptoms OR psychosis OR hallucinations OR delusions OR psychopathology OR misidentification) AND (prevalence OR epidemiology). Results: A total of 5,077 articles were found, with a final inclusion of 35. The overall frequency of psychotic symptoms ranged from 34 to 63% in dementia conditions of the most varied etiologies. Alzheimer’s disease (AD) presents more delusions and hallucinations and has a higher frequency regarding the presence of misidentifications. On the contrary, Dementia with Lewy bodies (DLB) seems to present more hallucinations, even auditory, when compared to the other dementias, concomitantly with delusions. Vascular and frontotemporal dementia present fewer psychotic symptoms than DLB and AD. Conclusions: We identified a gap in the literature on the description of the psychotic symptoms of dementia, mainly in those of non-AD etiologies. Studies that assess the neuropsychiatric symptoms of dementias deeply might contribute in a more definite manner to the causal diagnosis of dementia.

Aspects of Clinical Neuropsychology Related to the Psychotic Spectrum. A Comprehensive Systematic Review

“…Dementia is a neurological condition characterized by a progressive deterioration of cognitive functions and impairment in daily activities. Psychosis, characterized by hallucinations and delusions, is a commonly reported phenomenon in individuals with various forms of dementia, such as Alzheimer's disease, dementia with Lewy bodies, and Parkinson's disease dementia [27][28][29]. Understanding the cognitive processes of individuals with dementia and psychosis is crucial for the development and implementation of efficacious treatments aimed at managing and treating their condition.…”

Integrating Clinical Neuropsychology and Psychotic Spectrum Disorders: A Systematic Analysis of Cognitive Dynamics, Interventions, and Underlying Mechanisms

“…Cognitive decline and daily activity impairment characterize dementia, a neurological condition. People with Alzheimer's, Lewy body, and Parkinson's disease dementia often experience psychosis, which involves hallucinations and delusions [27][28][29]. Understanding dementia and psychosis patients' cognitive processes is essential to developing and implementing effective treatments.…”

“…In contrast, psychotic symptoms in dementia patients may indicate a more severe cognitive decline. This bidirectional relationship highlights the need for a more accurate diagnostic method to distinguish dementia-induced psychosis from primary psychotic disorders [27,33].…”

Psychosis detection in dementia: a systematic review of diagnostic test accuracy studies

“…Psychosis, characterized by delusions and hallucinations, is part of a clinically relevant group of symptoms referred to as behavioural and psychological symptoms of dementia (BPSD) (Rayner et al, 2006 ). Between 34 and 63% of persons with dementia are estimated to experience psychotic symptoms at some point in their illness (Pessoa et al, 2023 ). Psychosis is associated with faster cognitive decline, higher caregiver burden, and greater risk of long-term care placement (Ropacki and Jeste, 2005 ; Allegri et al, 2006 ; Toot et al, 2017 ; Connors et al, 2018 ; Walsh et al, 2021 ).…”