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Psychosis and dementia: risk factor, prodrome, or cause?

Published online by Cambridge University Press:  31 May 2017

Corinne E. Fischer  and
Luis Agüera-Ortiz
Corinne E. Fischer*
Affiliation:
Keenan Research Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada Faculty of Medicine, Department of Psychiatry, University of Toronto, Canada
Luis Agüera-Ortiz
Affiliation:
Department of Psychiatry & Instituto de Investigación Sanitaria (imas12), Hospital Universitario 12 de Octubre, Madrid, Spain Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM
*
Correspondence should be addressed to: Corinne E. Fischer, Faculty of Medicine, Department of Psychiatry, University of Toronto, M5S 1A8, Canada. Phone: +(416) 864-6060, ext 2680; Fax: (416) 864-5320. Email: [email protected].
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Abstract

Background:

Progression of dementia is often associated with the emergence of neuropsychiatric symptoms (NPS), though there is recent evidence that NPS may occur in prodromal dementia (PrD) and impact clinical course. Mood and anxiety symptoms are the NPS that tend to occur most frequently in PrD and thus have been most extensively studied. Comparatively, there has been little focus on psychotic symptoms in PrD.

Methods:

The authors review the existing literature on psychosis in PrD, including the functional psychosis of early and late onset, with a focus on epidemiology, phenomenology, and clinical course and treatment considerations.

Results:

Patients with psychotic disorders at baseline such as schizophrenia may be more at risk for developing dementia over time, although this is not completely clear. Psychotic symptoms are likely more common in PrD than previously understood based on factor analysis studies, although they are much more common in established dementia. Variability in findings may reflect the heterogeneous nature of PrD studies to date and the lack of inclusion of patients with late onset psychosis in most clinical studies. The presence of psychosis in patients with PrD may be associated with a worse prognosis in terms of mortality and conversion to dementia.

Conclusions:

Research to date suggests that psychosis in PrD may be more common than previously thought and impact clinical course negatively. Future studies incorporating patients with late onset psychotic disorders, and focusing on the impact of early recognition and treatment, are required to more fully understand the role of psychosis in PrD.

Keywords

psychosisdementiamild cognitive impairmentmild behavioral impairmentdelusionshallucinationsAlzheimer's disease
Type
Review Article
Information
International Psychogeriatrics , Volume 30 , Special Issue 2: Mild Behavioral Impairment , February 2018 , pp. 209 - 219
Copyright
Copyright © International Psychogeriatric Association 2017 

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