The Pathology of Paraphrenia

Abstract

The term paraphrenia refers to a condition characterized by a strong delusional component with preservation of thought and personality. Most affected patients are women. Although a late age at onset (> 60 years) has been proposed in the literature, evidence for this assertion remains debatable. Deterioration of cognitive functions occurs very slowly but may lead to mild dementia over a period of years. Pathological studies indicate the presence of neurofibrillary tangles (NFTs), primarily within the entorhinal cortex. Compared with the severity of neuritic changes, amyloid deposition remains scant. Pyramidal cells affected by NFTs appear to be preserved. Both the clinical history and neuropathology of paraphrenia are similar to those aspects described for NFT-predominant senile dementia. Risk factors, including organic lesions, may precipitate an earlier onset of symptomatology in patients exhibiting this pathology. Many of the symptoms in paraphrenia can be explained by involvement of the entorhinal cortex.

Late-Onset Psychosis; Is It Real?

“…78,80 Amyloid plaques are sparse, with no significant cell loss compared to controls. These pathological findings are compatible with neurofibrillary tangle-predominant form of senile dementia, 81 which is associated with slowly progressive cognitive decline resulting in dementia in extreme old age. However, due to methodological limitations (retrospective study design, lack of exclusion criteria and potential confounder of age), this finding should be confirmed.…”

Paraphrenia and Persecutory Delusions: Brief Reflection about Neuropsychology Evaluation in the Elderly without Dementia

“…This data corroborates the ideas discussed by Caixeta et al [4] rise the attention to the risk of developing dementia in patients with a diagnosis of paraphrenia. The hypothesis raised by Casanova 10 of the existence of neurofibrillary entanglements in the hippocampal region explains the risk of these patients to evolve to dementia. The follow-up of our cases did not indicate cognitive decline, perhaps due to the fact that they are followed up for about only 8 months.…”

“…7,10,11 It was verified in the literature that the case is considered paraphrenia when there is presence of a strong component of illusion well detailed, with relative preservation on the personality and cognitive functions, affects with more incidence with women, around 60 years old. 10 It differs from dementia syndromes because it does not show an evident decline in cognitive and daily life functions 11 and it differs from the classic schizophrenia syndrome because symptoms do not appear in early adulthood, as described in DSM-5. 6,11 Paraphrenia is a pathology located on the frontier among neuropsychology, psychiatry and neurology, it may not be recognized and causes great suffering for the patient.…”

“…In literature, considering aging paraphrenia is a poorly discussed subject, even though it is included in DSM-5 with another terminology ("Delusional Disorder") 5 and appears in case studies such as "paraphrenia" and "late-onset paraphrenia". 7,10,11 It was verified in the literature that the case is considered paraphrenia when there is presence of a strong component of illusion well detailed, with relative preservation on the personality and cognitive functions, affects with more incidence with women, around 60 years old. …”

Theta-Burst Stimulation for Auditory-Verbal Hallucination in Very-Late-Onset Schizophrenia-Like Psychosis—A Functional Magnetic Resonance Imaging Case Study

“…Very-late-onset schizophrenia-like psychosis (VLOSLP) was first described as paraphrenia senilis (1). With its 12-month prevalence of 0.6 %, VLOSLP represents a relatively common mental illness in individuals aged above 60 years (2).…”