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psychosis in Alzheimer's disease
Also see psychosis & agitation in the elderly
Epidemiology:
- prevalence rate for psychosis in patients with Alzheimer disease is ~50%.
- it is most common in the middle stages of the disease
History:
- no prior history of psychosis
Diagnostic criteria:
- presence of hallucinations (intermittent or continual), delusions, or both, of >= 1 month duration that disrupts the life of the patient or others
- psychosis cannot be attributable to delirium, drug effects, schizophrenia, or other psychiatric disorder
- background of cognitive impairment consistent with Alzheimer's disease
Clinical manifestations:
- visual hallucinations are more common than auditory hallucinations
- hallucinations usually involve people from the past (dead relatives), intruders, animals, or objects
- hallucinations generally occur in mid-stage Alzheimer's disease
- delusions typically involve beliefs of theft, infidelity, abandonment, not living in their home, & persecutions
- lack of bizarre or complex delusions
- delusions decrease in later stages of disease
- cognitive impairment & other manifestations of Alzheimer's disease
Differential diagnosis:
- late onset schizophrenia
- bizarre or complex delusions,
- prior history of psychosis
- more frequent auditory hallucinations
- cognition may be unimpaired
- psychosis in Alzheimer's disease
- more frequent visual hallucinations
- cognitive impairment
- shuffling gair
- dementia with Lewy bodies
- rigidity
- parkinsonian gait (festination, retropulsion, & en bloc turning)
Management:
- nonpharmacologic interventions are 1st line
- when these fail, risperidone, olanzapine, & aripiprazole are most effective for aggression, anger, & paranoia but may be associated with significant morbidity & mortality
Related
psychosis, agitation & difficult behavior in the elderly
General
psychosis
Alzheimer's disease (AD)
References
- Geriatric Review Syllabus, 11th edition (GRS11)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2022