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@ARTICLE{Naasan:157757,
author = {Naasan, Georges and Shdo, Suzanne M and Morenas Rodriguez,
Estrella and Spina, Salvatore and Grinberg, Lea and Lopez,
Lucia and Karydas, Anna and Seeley, William W and Miller,
Bruce L and Rankin, Katherine P},
title = {{P}sychosis in neurodegenerative disease: differential
patterns of hallucination and delusion symptoms.},
journal = {Brain},
volume = {144},
number = {3},
issn = {1460-2156},
address = {Oxford},
publisher = {Oxford Univ. Press},
reportid = {DZNE-2021-01214},
pages = {999 - 1012},
year = {2021},
abstract = {Although psychosis is a defining feature of Lewy body
disease, psychotic symptoms occur in a subset of patients
with every major neurodegenerative disease. Few studies,
however, have compared disease-related rates of psychosis
prevalence in a large autopsy-based cohort, and it remains
unclear how diseases differ with respect to the nature or
content of the psychosis. We conducted a retrospective chart
review of 372 patients with autopsy-confirmed
neurodegenerative pathology: 111 with Alzheimer's disease,
59 with Lewy body disease and concomitant Alzheimer's
disease, 133 with frontotemporal lobar degeneration (FTLD)
with tau inclusions (including progressive supranuclear
palsy, corticobasal degeneration or Pick's disease), and 69
with FTLD and TDP inclusions (FTLD-TDP, including types
A-C). Psychosis content was classified by subtype, and the
frequency of each subtype was compared among pathological
diagnoses using logistic regression. A total of 111 of 372
patients had psychosis. Compared to other groups, patients
with Lewy body disease/Alzheimer's disease pathology were
significantly more likely to have hallucinations and were
more likely to have more than one subtype of hallucination.
Patients with Braak Parkinson stage 5-6 Lewy body disease
were significantly more likely than those with no Lewy body
disease to have visual hallucinations of misperception,
peripheral hallucinations, hallucinations that moved,
hallucinations of people/animals/objects, as well as
delusions regarding a place and delusions of
misidentification. The feeling of a presence occurred
significantly more frequently in patients with Lewy body
disease/Alzheimer's disease than all other pathologies.
Patients with FTLD-TDP were significantly more likely to
have delusions, and for the delusions to occur in the first
3 years of the disease, when compared to patients with
Alzheimer's disease and FTLD-tau, though rates were not
significantly greater than patients with Lewy body
disease/Alzheimer's disease. Paranoia occurred more
frequently in the FTLD-TDP and Lewy body disease/Alzheimer's
disease categories compared to patients with Alzheimer's
disease or FTLD-tau. Patients with FTLD-TDP pathology had
delusions of misidentification as frequently as patients
with Lewy body disease/Alzheimer's disease, and were
significantly more likely to have self-elevating delusions
such as grandiosity and erotomania compared to patients with
other pathologies including FTLD-tau. These data show that
the nature and content of psychosis can provide meaningful
information about the underlying neurodegenerative
pathology, emphasizing the importance of characterizing
patients' psychoses for prediction of the neuropathological
diagnosis, regardless of a patient's clinical syndrome.},
keywords = {Aged / Delusions: epidemiology / Delusions: etiology /
Female / Hallucinations: epidemiology / Hallucinations:
etiology / Humans / Male / Middle Aged / Neurodegenerative
Diseases: complications / Prevalence / Psychotic Disorders:
epidemiology / Psychotic Disorders: etiology / Lewy body
disease (Other) / TDP-43 (Other) / frontotemporal dementia
(Other) / pathology (Other) / psychosis (Other)},
cin = {AG Haass old},
ddc = {610},
cid = {I:(DE-2719)1110007},
pnm = {352 - Disease Mechanisms (POF4-352)},
pid = {G:(DE-HGF)POF4-352},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:33501939},
pmc = {pmc:PMC8041322},
doi = {10.1093/brain/awaa413},
url = {https://pub.dzne.de/record/157757},
}