Psychosis in Neurodegenerative Dementias: A Systematic Comparative Review

Article type: Systematic Review

Authors: Cressot, Coralie^{a; b} | Vrillon, Agathe^{a; b} | Lilamand, Matthieu^{a; e} | Francisque, Hélène^b | Méauzoone, Aurélie^b | Hourregue, Claire^b | Dumurgier, Julien^{a; c} | Marlinge, Emeline^d | Paquet, Claire^{a; b} | Cognat, Emmanuel^{a; b; *}

Affiliations: [a] Université Paris Cité, UMRS 1144, INSERM, Paris, France | [b] Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France | [c] Université Paris Cité, Inserm U1153, Paris, France | [d] Département de Psychiatrie, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France | [e] Service de Gériatrie, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France

Correspondence: [*] Correspondence to: Dr. Emmanuel Cognat, Centre de Neurologie Cognitive, GHU AP-HP.Nord, Site Lariboisière Fernand-Widal, 200 rue du Faubourg Saint-Denis, 75010 Paris, France. Tel.: +33140054954; E-mail: emmanuel.cognat@aphp.fr.

Abstract: Background:Psychosis, characterized by delusions and/or hallucinations, is frequently observed during the progression of Alzheimer’s disease (AD) and other neurodegenerative dementias (ND) (i.e., dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD)) and cause diagnostic and management difficulties. Objective:This review aims at presenting a concise and up-to-date overview of psychotic symptoms that occur in patients with ND with a comparative approach. Methods:A systematic review was conducted following the PRISMA guidelines. 98 original studies investigating psychosis phenotypes in neurodegenerative dementias were identified (40 cohort studies, 57 case reports). Results:Psychosis is a frequently observed phenomenon during the course of ND, with reported prevalence ranging from 22.5% to 54.1% in AD, 55.9% to 73.9% in DLB, and 18% to 42% in FTD. Throughout all stages of these diseases, noticeable patterns emerge depending on their underlying causes. Misidentification delusions (16.6–78.3%) and visual hallucinations (50–69.6%) are frequently observed in DLB, while paranoid ideas and somatic preoccupations seem to be particularly common in AD and FTD, (respectively 9.1–60.3% and 3.10–41.5%). Limited data were found regarding psychosis in the early stages of these disorders. Conclusions:Literature data suggest that different ND are associated with noticeable variations in psychotic phenotypes, reflecting disease-specific tendencies. Further studies focusing on the early stages of these disorders are necessary to enhance our understanding of early psychotic manifestations associated with ND and help in differential diagnosis issues.

Keywords: Alzheimer’s disease, delusion, dementia, dementia with Lewy bodies, frontotemporal degeneration, hallucinations, neurodegenerative disease, psychosis

DOI: 10.3233/JAD-231363

Journal: Journal of Alzheimer's Disease, vol. 99, no. 1, pp. 85-99, 2024