Psychosis Related to Alzheimer Disease


Early Career Psychiatrists of Rio Grande do Sul, Porto Alegre, Brazil


Introduction and Theoretical Foundation: Alzheimer’s disease (AD) has a prevalence of 10-30% in the population> 65 years, and it is the most prevalent type of dementia. The core pathophysiological mechanism of AD is the accumulation of amyloid-β peptide and tau protein due to the failure to clear it in the brain interstices. Over 80% demented patients have neuropsychiatric symptoms during the course of the disease. The neuropsychiatric symptoms in dementia can be classified in three main syndromes: psychotic, emotional and behavioral. Psychotic symptoms are subdivided into delusions and hallucinations; affective, into agitation, irritability, depression and anxiety; and behavioral, into euphoria, disinhibition, aberrant motor behavior and apathy. The patients that develop psychosis seem to have a more severe phenotype.

Methodology: A search was conducted on Pubmed and COCHRANE using as keywords “Psychotic Disorders” and “Alzheimer’s Disease”. Additional articles were gathered and chosen by their relevance and number of citations.

Discussion and Conclusion: There is psychosis report in AD (AD + P) since the first case description of Alzheimer by Alois Alzheimer. Delusions can be subdivided into paranoid and misidentification. Among paranoid delusions, theft delusion is the most prevalent. Paranoid delusions, in opposition to misidentification delusions, occur in earlier stages and are not associated to significant cognitive decline. Among hallucinations, visual are the most common. AD + P is prevalent and more severe than AD without psychosis, has greater institutionalization rates, more rapid progression, association with aggression and agitation and burden to caregiver. It is important to be aware of nonpharmacological management. In the pharmacological treatment, it is important to outweigh risk versus benefit.”