The Association Between Distinct Delusional Ideations and Depressive Symptoms in Alzheimer's Disease: A Re-Analysis of CATIE-AD

Overview

Journal J Alzheimers Dis

Publisher Sage Publications

Specialties Geriatrics
Neurology

Date 2024 Aug 30

PMID 39213078

Authors

Tomoyuki Nagata

Shinichiro Nakajima

Shinsuke Kito

Shunichiro Shinagawa

Affiliations

Soon will be listed here.

Abstract

Background: Delusional ideations, one of neuropsychiatric symptoms (NPSs), are frequently shown in the long-term progression of Alzheimer's disease (AD), and comorbid with other NPSs including depression or agitation. Despite various types of delusional ideations, the comorbidity between each delusional ideation and depressive symptoms has not been discussed.

Objective: The present cross-sectional study is aimed at testing the hypothetical mechanism of comorbid pattern in AD.

Methods: Among 421 patients with AD, we analyzed the dataset of the Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer's Disease to compare age, sex, racial type, Mini-Mental State Examination (MMSE) scores, and Neuropsychiatric Inventory (NPI) depression score of between the presence and absence of each delusional ideation (delusion of persecution, theft, jealousy, abandonment, phantom boarder, Capgras syndrome, misidentification of place, or television sign). Next, with the stratification based on MMSE score of < or > = 15 points, we further explored association between delusional ideation and depressive symptom that was found significances in the primary analysis.

Results: Among eight subtypes of delusional ideations, depression score was higher in those with persecution delusion or Capgras syndrome. Moreover, the Capgras syndrome was associated with presence of depression in severer global cognitive impairment status.

Conclusions: As comorbid NPSs of delusional ideation in AD, depressive severity is associated with specific delusional subtype: persecution delusion and Capgras syndrome. Capgras syndrome may be attributable to severe cognitive impairment in addition to depressive symptom. The consideration of pathogenetic differences in the distinct delusional ideations may be helpful for clinicians to select the treatment strategy.

References

Nagata T, Nakajima S, Shinagawa S, Plitman E, Graff-Guerrero A, Mimura M . Psychosocial or clinico-demographic factors related to neuropsychiatric symptoms in patients with Alzheimer's disease needing interventional treatment: analysis of the CATIE-AD study. Int J Geriatr Psychiatry. 2016; 32(12):1264-1271. DOI: 10.1002/gps.4607. View

Mizrahi R, Starkstein S, Jorge R, Robinson R . Phenomenology and clinical correlates of delusions in Alzheimer disease. Am J Geriatr Psychiatry. 2006; 14(7):573-81. DOI: 10.1097/01.JGP.0000214559.61700.1c. View

Reeves S, Gould R, Powell J, Howard R . Origins of delusions in Alzheimer's disease. Neurosci Biobehav Rev. 2012; 36(10):2274-87. DOI: 10.1016/j.neubiorev.2012.08.001. View

Wang P, Schneeweiss S, Avorn J, Fischer M, Mogun H, Solomon D . Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med. 2005; 353(22):2335-41. DOI: 10.1056/NEJMoa052827. View

Nomura K, Kazui H, Wada T, Sugiyama H, Yamamoto D, Yoshiyama K . Classification of delusions in Alzheimer's disease and their neural correlates. Psychogeriatrics. 2012; 12(3):200-10. DOI: 10.1111/j.1479-8301.2012.00427.x. View

Pearce D, Gould R, Roughley M, Reynolds G, Ward E, Bhome R . Paranoid and misidentification subtypes of psychosis in dementia. Neurosci Biobehav Rev. 2022; 134:104529. DOI: 10.1016/j.neubiorev.2022.104529. View

Murphy K, Khan A, Bachu A, Tampi R . Treatment of behavioral and psychological symptoms of dementia using transcranial magnetic stimulation: a systematic review. Int Psychogeriatr. 2023; 35(11):611-622. DOI: 10.1017/S1041610223000091. View

Cummings J . The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology. 1997; 48(5 Suppl 6):S10-6. DOI: 10.1212/wnl.48.5_suppl_6.10s. View

Perez-Madrinan G, Cook S, Saxton J, Miyahara S, Lopez O, Kaufer D . Alzheimer disease with psychosis: excess cognitive impairment is restricted to the misidentification subtype. Am J Geriatr Psychiatry. 2004; 12(5):449-56. DOI: 10.1176/appi.ajgp.12.5.449. View

10.

Bassiony M, Steinberg M, Warren A, Rosenblatt A, Baker A, Lyketsos C . Delusions and hallucinations in Alzheimer's disease: prevalence and clinical correlates. Int J Geriatr Psychiatry. 2000; 15(2):99-107. DOI: 10.1002/(sici)1099-1166(200002)15:2<99::aid-gps82>3.0.co;2-5. View

11.

Schneider L, Tariot P, Dagerman K, Davis S, Hsiao J, Ismail M . Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. N Engl J Med. 2006; 355(15):1525-38. DOI: 10.1056/NEJMoa061240. View

12.

Inamura K, Shinagawa S, Tsuneizumi Y, Nagata T, Tagai K, Nukariya K . Sex differences in the severity of neuropsychiatric symptoms and their relationship with clinico-demographic and psychosocial factors in patients with amnestic mild cognitive impairment and mild Alzheimer's disease. Aging Ment Health. 2018; 24(3):431-438. DOI: 10.1080/13607863.2018.1539834. View

13.

Cipriani G, Vedovello M, Ulivi M, Lucetti C, Di Fiorino A, Nuti A . Delusional misidentification syndromes and dementia: a border zone between neurology and psychiatry. Am J Alzheimers Dis Other Demen. 2013; 28(7):671-8. PMC: 10852797. DOI: 10.1177/1533317513506103. View

14.

Jedidi H, Daury N, Capa R, Bahri M, Collette F, Feyers D . Brain Metabolic Dysfunction in Capgras Delusion During Alzheimer's Disease: A Positron Emission Tomography Study. Am J Alzheimers Dis Other Demen. 2013; 30(7):699-706. PMC: 10852786. DOI: 10.1177/1533317513495105. View

15.

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

16.

Kitamura T, Kitamura M, Hino S, Tanaka N, Kurata K . Gender differences in clinical manifestations and outcomes among hospitalized patients with behavioral and psychological symptoms of dementia. J Clin Psychiatry. 2013; 73(12):1548-54. DOI: 10.4088/JCP.11m07614. View

17.

Hwang J, Yang C, Tsai S . Phantom boarder symptom in dementia. Int J Geriatr Psychiatry. 2003; 18(5):417-20. DOI: 10.1002/gps.853. View

18.

Sink K, Holden K, Yaffe K . Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA. 2005; 293(5):596-608. DOI: 10.1001/jama.293.5.596. View

19.

Chen G, Liu S, Wu H, Gan J, Wang X, Ji Y . Analysis of clinical characteristics of mirror and TV signs in Alzheimer's disease and dementia with Lewy bodies. J Int Med Res. 2023; 51(2):3000605231156098. PMC: 9936532. DOI: 10.1177/03000605231156098. View

20.

Nagata T, Ishii K, Ito T, Aoki K, Ehara Y, Kada H . Correlation between a reduction in Frontal Assessment Battery scores and delusional thoughts in patients with Alzheimer's disease. Psychiatry Clin Neurosci. 2009; 63(4):449-54. DOI: 10.1111/j.1440-1819.2009.01968.x. View