Delusions in Patients with Alzheimer’s Disease: A Multidimensional Approach

Article type: Research Article

Authors: D’Onofrio, Grazia^{a; *} | Panza, Francesco^{a; b; *} | Sancarlo, Daniele^a | Paris, Francesco F.^a | Cascavilla, Leandro^a | Mangiacotti, Antonio^a | Lauriola, Michele^a | Paroni, Giulia H.^a | Seripa, Davide^a | Greco, Antonio^a

Affiliations: [a] Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia, Italy | [b] Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy

Correspondence: [*] Correspondence to: Francesco Panza, MD, PhD, Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; and Department of Clinical Research in Neurology, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy. E-mail: geriat.dot@geriatria.uniba.it.

Correspondence: [*] Correspondence to: Grazia D’Onofrio, PsyD, Geriatric Unit & Gerontology-Geriatrics Research Laboratory, IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, 71013 San Giovanni Rotondo, Foggia, Italy. Tel./Fax: +39 0882 410271; E-mail: g.donofrio@operapadrepio.it.

Abstract: In Alzheimer’s disease (AD) patients with delusions, clinical outcomes and mortality result from a combination of psychological, biological, functional, and environmental factors. We determined the effect of delusions on mortality risk, clinical outcomes linked to comprehensive geriatric assessment (CGA), cognitive, depressive, and neuropsychiatric symptoms (NPS) in 380 consecutive AD patients with Mini-Mental State Examination, Clinical Dementia Rating scale, 15-item Geriatric Depression Scale, and Neuropsychiatric Inventory (NPI), assessing one-year mortality risk using the Multidimensional Prognostic Index (MPI). We included 121 AD patients with delusions (AD-D) and 259 AD patients without delusions (AD-noD). AD-D patients were significantly older, with higher age at onset and cognitive impairment, a more severe stage of dementia, and more depressive symptoms than AD-noD patients. Disease duration was slightly higher in AD-D patients than in those without delusions, although this difference was not statistically significant. At CGA, AD-D patients showed a higher grade of disability in basic and instrumental activities of daily living, and an increased risk of malnutrition and bedsores. The two groups of patients significantly differed in MPI score (AD-D: 0.65 versus AD-noD: 0.51, p <  0.0001) and MPI grade. AD-D patients showed also a significant higher score in NPI of the following NPS than AD-noD patients: hallucinations, agitation/aggression, depression mood, apathy, irritability/lability, aberrant motor activity, sleep disturbances, and eating disorders. Therefore, AD-D patients showed higher dementia severity, and higher impairment in cognitive and depressive symptoms, and several neuropsychiatric domains than AD-noD patients, and this appeared to be associated with higher multidimensional impairment and increased risk of mortality.

Keywords: Alzheimer’s disease, comprehensive geriatric assessment, delusions, depressive symptoms, functional status, mortality, Multidimensional Prognostic Index, neuropsychiatric symptoms

DOI: 10.3233/JAD-150944

Journal: Journal of Alzheimer's Disease, vol. 51, no. 2, pp. 427-437, 2016