Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-22T08:01:13.572Z Has data issue: false hasContentIssue false
  • English
  • Français

Neuropathological Correlates of Psychotic Phenomena in Confirmed Alzheimer's Disease

Published online by Cambridge University Press:  02 January 2018

Hans Förstl ,
Alistair Burns ,
Raymond Levy  and
Nigel Cairns
Hans Förstl*
Affiliation:
Section of Old Age Psychiatry
Alistair Burns
Affiliation:
Section of Old Age Psychiatry
Raymond Levy
Affiliation:
Section of Old Age Psychiatry
Nigel Cairns
Affiliation:
Department of Neuropathology; Institute of Psychiatry, De Crespigny Park, London SE5 8AF
*
Dr H. Förstl, Central Institute of Mental Health, J5, PO Box 122 120, 68159 Mannheim 1, Germany
Get access Rights & Permissions [Opens in a new window]

Extract

Background

The prevalence of psychotic phenomena in confirmed Alzheimer's disease (AD) and their potential neuropathological correlates have rarely been the subject of prospective investigation.

Method

Psychopathological disturbances were recorded prospectively according to the Geriatric Mental State Schedule and the CAMDEX. The frequency of these phenomena and neuropathological changes were examined in 56 patients with definite AD.

Results

Hallucinations had been documented in 13 patients, paranoid delusions in 9 and delusional misidentification (e.g. the Capgras-type and the ‘phantom boarder’ symptoms) in 14 patients. Misidentifications were associated with lower neurone counts in the area CA1 of the hippocampus. Delusions and hallucinations were observed in patients with less severe cell loss in the parahippocampal gyrus and with lower cell counts in the dorsal raphe nucleus. A decrease of neurones in the locus coeruleus in a subset of depressed patients with AD had been reported earlier. Delusions and delusional misidentification were common in 5 patients with basal ganglia mineralisation, but there was no statistically significant association of these symptoms with the presence of Lewy bodies in the brainstem and neocortex of our patient sample.

Conclusions

These findings are compatible with the view that morphological changes in certain brain areas may promote the development of psychotic phenomena in AD. AD may offer a model for the understanding of pathomechanisms underlying the development of psychopathological disturbances in other psychoses with more discrete neuropathological changes.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 165 , Issue 1 , July 1994 , pp. 53 - 59
Copyright
Copyright © Royal College of Psychiatrists, 1994 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexander, M. P., Stuss, D. T. & Benson, D. F. (1979) Capgras' syndrome: a reduplicative phenomenon. Neurology, 29, 334–339.Google Scholar
Ardila, A. & Rossi, M. (1988) Temporal lobe involvement in Capgras syndrome. International Journal of Neuroscience, 43, 219–224.CrossRefGoogle ScholarPubMed
Ballard, C. G., Chithiramohan, R. N., Bannister, C., et al (1991) Paranoid features in the elderly with dementia. International Journal of Geriatric Psychiatry, 6, 155–157.CrossRefGoogle Scholar
Berrios, G. E. (1990) Alzheimer's disease: a conceptual history. International Journal of Geriatric Psychiatry, 5, 355–365.CrossRefGoogle Scholar
Berrios, G. E. & Brook, P. (1984) Visual hallucinations and sensory delusions in the elderly. British Journal of Psychiatry, 144, 662–664.Google Scholar
Burns, A., Jacoby, R. & Levy, R. (1990) Psychiatric phenomena in Alzheimer's disease. British Journal of Psychiatry, 157, 72–94.CrossRefGoogle ScholarPubMed
Chaouloff, F. (1993) Physiopharmacological interactions between stress hormones and central serotonergic systems. Brain Research Reviews, 18, 1–32.Google Scholar
Chen, J.-Y., Stern, Y., Sano, M., et al (1991) Cumulative risks of developing extrapyramidal signs, psychosis, or myoclonus in the course of Alzheimer's disease. Archives of Neurology, 48, 1141–1143.Google Scholar
Cooper, J. K., Mungas, D. & Weiler, P. G. (1990) Relation of cognitive status and abnormal behaviours in Alzheimer's disease. Journal of the Geriatric Society, 38, 867–870.Google Scholar
Cummings, J. L. (1985) Organic delusions: phenomenology, anatomical correlates, and review. British Journal of Psychiatry, 146, 184–197.Google Scholar
Deutsch, L. H., Bylsma, F. W., Rovner, B. W., et al (1991) Psychosis and physical aggression in probable Alzheimer's disease. American Journal of Psychiatry, 148, 1159–1163.Google Scholar
Doty, R. W. (1989) Schizophrenia: a disease of interhemispheric processes at forebrain and brainstem levels. Behavioral Brain Research, 34, 1–33.Google Scholar
Drevets, W. C. & Rubin, E. H. (1989) Psychotic symptoms and the longitudinal course of senile dementia of the Alzheimer type. Biological Psychiatry, 25, 39–48.Google Scholar
Förstl, H., Almeida, O. P., Owen, A., et al (1991a) Psychiatric, neurological and medical aspects of misidentification syndromes: a review of 260 cases. Psychological Medicine, 21, 905–910.CrossRefGoogle Scholar
Förstl, H., Krumm, B., Eden, S., et al (1991b) What is the psychiatric significance of bilateral basal ganglia mineralization? Biological Psychiatry, 29, 827–833.Google Scholar
Förstl, H., Burns, A., Levy, R., et al (1992a) Neurologic signs in Alzheimer's disease. Archives of Neurology, 49, 1038–1042.Google Scholar
Förstl, H., Burns, A., Luthert, P., et al (1992b) Clinical and neuropathological correlates of depression in Alzheimer's disease. Psychological Medicine, 22, 877–884.Google Scholar
Förstl, H., Burns, A., Luthert, P., et al (1993a) The Lewy body variant of Alzheimer's disease. British Journal of Psychiatry, 162, 385–392.Google Scholar
Förstl, H., Besthorn, C., Geiger-Kabisch, C., et al (1993b) Psychotic features and the course of Alzheimer's disease: relationship to cognitive, electroencephalographic and computerized tomography findings. Acta Psychiatrica Scandinavica, 87, 395–399.CrossRefGoogle Scholar
Ichimaya, Y., Arai, H., Kosaka, K., et al (1986) Morphological and biochemical changes in the cholinergic and monoaminergic systems in Alzheimer's disease. Acta Neuropathologica, 70, 112–116.Google Scholar
Jacoby, R. & Levy, R. (1980) Computed tomography in the elderly-2. Senile dementia. British Journal of Psychiatry, 136, 256–269.Google Scholar
Jeste, D. S., Wragg, R. E., Salmon, D. P., et al (1992) Cognitive deficits of patients with Alzheimer's disease with and without delusions. American Journal of Psychiatry, 149, 184–189.Google Scholar
Klein, R. (1929) Über eine eigenartige Spiegelreaktion im Rahmen einer senilen Demenz und über ihre Beziehung zum Gesamtbilde. Z Ges Neurol Psychiat, 118, 789–797.CrossRefGoogle Scholar
Kumar, A., Koss, E., Metzler, D., et al (1988) Behavioral symptomatology in dementia of the Alzheimer type. Alzheimer Disease and Associated Disorders, 2, 363–365.Google Scholar
Lopez, O. L., Becker, J. T., Brenner, R. P., et al (1991) Alzheimer's disease with delusions and hallucinations: neuropsychological and electroencephalographic correlates. Neurology, 41, 906–912.Google Scholar
Mann, D. M. A. (1988) Calcification of the basal ganglia in Down's syndrome and Alzheimer's disease. Acta Neuropathologica, 76, 595–598.Google Scholar
Mann, D. M. A. & Yates, P. O. (1983) Serotonin nerve cells in Alzheimer's disease. Journal of Neurological and Neurosurgical Psychiatry, 46, 96–98.CrossRefGoogle ScholarPubMed
Merriam, A. E., Aronson, M. K., Gaston, P., et al (1988) The psychiatric symptoms of Alzheimer's disease. Journal of the American Geriatric Society, 36, 7–12.CrossRefGoogle ScholarPubMed
Mortimer, J. A., Ebbitt, S. -P., et al (1992) Predictors of cognitive and functional progression in patients with probable Alzheimer's disease. Neurology, 42, 1689–1696.CrossRefGoogle ScholarPubMed
Perry, E. K., Kerwin, J., Perry, R. H., et al (1990) Visual hallucinations and the cholinergic system in dementia. Journal of Neurological and Neurosurgical Psychiatry, 53, 88.Google Scholar
Pick, A. (1903) Zur Pathologie des Bekanntheitsgefühls (Bekanntheitsqualität). Neurol Cbl, 22, 2–7.Google Scholar
Pick, A. (1905) Calcification of the finer cerebral vessels with remarks upon its clinical significance. American Journal of Insanity, 61, 417–436.Google Scholar
Pick, A. (1906) Clinical studies. Brain, 26, 242–267.Google Scholar
Reisberg, B., Franssen, E., Sclan, S. G., et al (1989) Stage specific incidence of potentially remediable behavioral symptoms in aging and Alzheimer's disease: a study of 120 patients using BEHAVE–AD. Bulletin of Clinical Neuroscience, 54, 95–112.Google Scholar
Rosen, J. & Zubbnko, G. S. (1991) Emergence of psychosis and depression in the longitudinal evaluation of Alzheimer's disease. Biological Psychiatry, 29, 224–232.Google Scholar
Rubin, E. H., Drevets, W. C. & Burke, W. J. (1988) The nature of psychotic symptoms in senile dementia of the Alzheimer type. Journal of Geriatric Psychiatry and Neurology, 1, 16–20.CrossRefGoogle ScholarPubMed
Rubin, E. H., & Kinscherf, D. (1989) Psychopathology of very mild dementia of the Alzheimer type. American Journal of Psychiatry, 146, 1017–1021.Google ScholarPubMed
Staton, R. D., Brumback, R. A. & Wilson, H. (1982) Reduplication paramnesia: a disconnection syndrome. Cortex, 18, 23–36.CrossRefGoogle Scholar
Stern, Y., Mayeux, R., Sano, M., et al (1987) Predictors of disease course in patients with probable Alzheimer's disease. Neurology, 37, 1649–1653.Google Scholar
Wbstphal, K. (1927) Über reduplizierende Paramnesie (Pick) und verwandte Symptome bei progressiver Paralyse. Z Ges Neurol Psychiat, 110, 585–607.Google Scholar
Whitford, G. M. (1986) Alzheimer's disease and serotinin: a review. Neuropsychobiology, 15, 1–10.Google Scholar
Zubenko, G. S., Moossy, J., Martinez, J., et al (1991) Neuropathologic and neurochemical correlates of psychosis in primary dementia. Archives of Neurology, 48, 619–624.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.