Treatment of Delusions in Alzheimer’s Disease – Response to Pharmacotherapy

Abstract

Delusions are commonly encountered symptoms in patients with Alzheimer’s disease and may lead to significant morbidity. The purpose of this article is to review all clinical trials to date focusing on the management of delusions in patients with Alzheimer’s disease to determine the level of evidence for treatment. To achieve this objective, Medline was searched using the key words delusions, dementia, Alzheimer’s disease and psychosis. Three main categories of treatment were identified: atypical antipsychotics, cholinesterase inhibitors, and other miscellaneous treatments. It was concluded that all forms of treatment were effective although the greatest burden of evidence existed for risperidone and donepezil. Side effects were noted in all forms of treatment and included somnolence and extrapyramidal effects for antipsychotic medications, whereas gastrointestinal effects were more prevalent in studies involving cholinesterase inhibitors. Further large scale, double-blind, randomized, controlled studies are required before a definitive conclusion can be reached. To our knowledge this is the only systematic review of this area.

Frontotemporal atrophy associated with paranoid delusions in women with Alzheimer's disease

“…Frontotemporal atrophy is a putative model for delusions in AD, affecting key structures involved in social and emotional processing. At present, risperidone and donepezil have shown the greatest effect in the management of delusions (Fischer et al, 2006), though differential drug effects on different types of delusions have not been examined. The association of orbitofrontal atrophy with delusions in the present study may underlie the beneficial effects of atypical antipsychotics on delusions, which impact on extrastriatal or corticostriatal domapine pathways.…”

“…Clinical management of delusions and other psychotic symptoms is difficult in AD; antipsychotics have historically been the mainstay of management of psychotic symptoms in nursing homes, but are not without risk in this group (Schneider et al, 2005). Cholinesterase inhibitors have shown efficacy in reducing delusions and other psychotic symptoms, though data is currently limited (Fischer et al, 2006). Understanding the pathophysiology of delusions in AD is important, as this may provide clues to specific and targeted treatments to manage these distressing symptoms.…”

Delusions Increase Functional Impairment in Alzheimer’s Disease

“…Cognitive enhancers and AD-specific treatments should be administered as soon as possible, and change in function should be used to gauge improvement. Antipsychotic medications that have shown benefit in the treatment of delusions in AD and related dementias [36,37] should be administered where appropriate. The high correlation between the presence of delusions, caregiver burden and other behavioural symptoms suggests that this subgroup may require more aggressive psychiatric management compared to other subtypes.…”

Psychotic Events in Alzheimer's Disease: Application of the PLST Model

“…In AD, delusions are associated with accelerated cognitive decline, increased aggressive behavior toward the caregiver, higher levels of caregiver stress, and earlier institutionalization (Fischer, Bozanovic, Atkins, & Rourke, 2006; Fischer et al, 2004). Delusional patients with AD have been found to be more aggressive, severe wanderers, and engage in more purposeless and/or inappropriate activities (Bassiony & Lyketsos, 2003).…”