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Cognitive neuroscience of delusions in aging

By Anna EM Holt and Martin L Albert

Abstract

Assessments and clinical understanding of late-onset delusions in the elderly are inconsistent and often incomplete. In this review, we consider the prevalence, neurobehavioral features, and neuroanatomic correlations of delusions in elderly persons – those with documented cognitive decline and those with no evidence of cognitive decline. Both groups exhibit a common phenotype: delusions are either of persecution or of misidentification. Late-onset delusions show a nearly complete absence of the grandiose, mystical, or erotomanic content typical of early onset psychoses. Absent also from both elderly populations are formal thought disorders, thought insertions, and delusions of external control. Neuroimaging and behavioral studies suggest a frontotemporal localization of delusions in the elderly, with right hemispheric lateralization in delusional misidentification and left lateralization in delusions of persecution. We propose that delusions in the elderly reflect a common neuroanatomic and functional phenotype, and we discuss applications of our proposal to diagnosis and treatment

Topics: Reviews
Publisher: Dove Medical Press
OAI identifier: oai:pubmedcentral.nih.gov:2671775
Provided by: PubMed Central
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    Citations

    1. (1992). 2000.Delusions and hallucinations in Alzheimer’s disease:prevalence and clinical correlates.
    2. (2003). A case of delusional disorder, somatic type with remarkable improvement of clinical symptoms and single photon emission computed tomography findings following modified electroconvulsive therapy. Prog Neuropsychopharmacol Biol Psychiatry,
    3. (1996). A case of late-onset psychosis:integrating neuropsychological and SPECT data.
    4. (1994). A SPECT study of delusions in Alzheimer’s disease.
    5. (1996). Abnormal glucose metabolism in the delusional misidentification syndromes:a positron emission tomography study in Alzheimer’s disease.
    6. (2001). Alteration of rCBF in Alzheimer’s disease patients with delusions of theft.
    7. (1998). Alteration of regional cerebral glucose utilization with delusions in Alzheimer’s disease.
    8. (2002). Association between neuropsychiatric and autonomic dysfunction in Alzheimer’s Disease. Clin Auton Res,
    9. (1995). Associations of psychotic symptoms in dementia sufferers.
    10. (1992). Behavioral syndromes in Alzheimer’s disease.
    11. (2003). Case series with late-onset psychosis hospitalized in a geriatric psychiatry unit in Turkey: experience in 9 years. Int Psychogeriatr,
    12. (2000). Cerebral correlates of psychotic symptoms in Alzheimer’s disease.
    13. (1996). Chronic subdural hematoma in the elderly:a case report.
    14. (1995). Classification of psychotic symptoms in dementia sufferers. Acta Psychiatr Scand,
    15. (1995). Clinical and cognitive diversity of psychotic states arising in late life (late paraphrenia). Psychol Med,
    16. (1994). Clinical Diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA work group under the auspices of department of Health and Human Services Task Force on Alzheimer’s dDisease.
    17. (1992). Cognitive deficits of patients with Alzheimer’s disease with and without delusions.
    18. (2004). Cognitive test performance in relation to psychotic symptoms and paranoid ideation in non-demented 85-year-olds. Psychol Med,
    19. (1992). Computer-assisted CT measurements in late paraphrenics with and without Schneiderian firstrank symptoms.
    20. (1997). Delusional jealousy in dementia.
    21. (1995). Delusional misidentification and subsequent dementia:a clinical and neuropathological study.
    22. (1994). Delusional misidentification in Alzheimer’s disease:a summary of clinical and biological aspects.
    23. (2003). Delusional thoughts and regional frontal/temporal cortex metabolism in Alzheimer’s disease.
    24. (1999). Delusions and Alzheimer’s disease:SPECT evidence of right hemisphere dysfunction.
    25. (1996). Delusions and hallucinations in Alzheimer’s disease:results from a two year longitudinal study. Geriatr Psychiatry,
    26. (1998). Delusions and hallucinations in an adult day care population:a longitudinal study.
    27. (1998). Delusions in Alzheimer’s disease:a review.
    28. (2001). delusions of capgras and intermetamorphosis in a patient with right-hemisphere whitematter pathology.
    29. (2003). Delusions of Japanese patients with Alzheimer’s disease.
    30. (1997). Delusions of theft in dementia of the Alzheimer type:a preliminary report. Alzheimer Dis Assoc Disor,
    31. (1985). Dementia and depression among the elderly living in the Hobart community:the effect of the diagnostic criteria on the prevalence rates. Psychol Med,
    32. (1992). Disturbances of person identification in Alzheimer’s disease:a retrospective study.
    33. (1996). Episodic memory deficit in elderly adults with suspected delusional disorder. Acta Psychiatr Scand,
    34. (2003). Erotomania variants in dementia.
    35. (1992). First-rank symptoms of Schneider in late paraphrenia:Cortical structural correlates.
    36. (1994). Health Organization.
    37. (2000). HMPAO SPECT imaging of Alzheimer’s disease patients with similar content-specific autobiographical delusion:comparison using statistical parametric mapping.
    38. (1998). Late-life onset of psychotic symptoms.
    39. (1992). Late-life paranoia:possible association with early trauma and infertility.
    40. (2003). Long-term follow-up and phenomenologic differences distinguish among late-onset schizophrenia, late-life depression and progressive dementia.
    41. Lyketsos CG. 2003.Delusions and hallucinations in Alzheimer’s disease:a review of the brain decade.
    42. (1995). Magnetic resonance imaging volumetric measurements of the superior temporal gyrus, hippocampus, parahippocampal gyrus, frontal and temporal lobes in late paraphrenia. Psychol Med,
    43. (2001). Mirrored-self misidentification:two cases of focal onset dementia.
    44. (1991). Neuroanatomical correlates of clinical misidentification and misperception in senile dementia of the Alzheimer’s type.
    45. (2000). Neurobiological basis of behavioral and psychological symptoms in dementia of the Alzheimer type. Psychiatry Clin Neurosci,
    46. (1994). Neuropathological correlates of psychotic phenomena in confirmed Alzheimer’s disease.
    47. (1997). Neuropsychiatric factors in the illusion of visitors among geriatric patients:a case series.
    48. (2000). Nurturing syndrome:a form of pathological bereavement with delusions in Alzheimer’s disease.
    49. (1994). Organic factors and the clinical features of late paranoid psychosis:a comparison with Alzheimer’s disease and normal aging.
    50. (2002). Paranoia with late onset:psychopathology and psychodynamics.
    51. (2003). Phantom boarder symptom in dementia.
    52. (1994). Phenomenology, demography and diagnosis in late paraphrenia. Psychol Med,
    53. (1999). Pimozide in the treatment of litigious delusions. Psychiatr Serv,
    54. (1999). Prevalence and correlates of Capgras syndrome in Alzheimer’s disease.
    55. (2000). Psychiatric Association.
    56. (1990). Psychiatric phenomena in Alzheimer’s disease I:disorders of thought content.
    57. (1990). Psychiatric symptoms and nursing home placement of patients with Alzheimer’s disease.
    58. (1999). Psychiatry morbidity in dementia with Lewy bodies:a prospective clinical and neuropathological comparative study with Alzheimer’s disease.
    59. (1999). Psychoses in the elderly:a spectrum of disorders.
    60. (2002). Psychotic symptoms and paranoid ideation in a nondemented population-based sample of the very old. Arch Gen Psychiatry,
    61. (2003). Psychotic symptoms in Alzheimer disease:evidence for subtypes.
    62. (1998). Psychotic symptoms in the elderly:a prospective study in a population sample.
    63. (1995). Quantitative magnetic resonance imaging of the brain in late-life schizophrenia.
    64. (2002). Regional brain atrophy in patients with mild Alzheimer’s disease and delusions. Int Psychogeriatr,
    65. (2004). Review of delusions in dementia.
    66. (2001). Schizophrenia and delusions in middle aged and elderly patients. Epidemiology and etiological hypothesis.
    67. (1993). Sex differences in the psychiatric manifestations of Alzheimer’s disease.
    68. (2000). Temporal lobe asymmetry in patients with Alzheimer’s disease with delusions.
    69. (1997). The epidemiology of functional psychoses of late onset.
    70. (2003). The epidemiology of psychosis in dementia.
    71. (1994). The frontal lobes and content specific delusions.
    72. (1994). The frontal-lobes and content-specific delusions.
    73. (2001). The psychotic phenomenon in probable Alzheimer’s disease:a positron emission tomography study.
    74. (1994). Uprooting and late-life psychosis.

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