Three symptoms complicating Alzheimer's disease - delusions, hallucinations, and depression - are discussed from a biological perspective. Relevant clinical, radiological and pathological data are reviewed and hypotheses are advanced regarding the possible biological mechanisms of these phenomena. In addition, pharmacological and physical treatments of delusions, hallucinations and depression in Alzheimer's disease are discussed. Areas for future research are suggested.
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References
1.
1. Flint AJ: Delusions in dementia: a review. The Journal of Neuropsychiatry and Clinical Neurosciences, in press
2.
2. Wragg RE, Jeste DV: Overview of depression and psychosis in Alzheimer's disease. American Journal of Psychiatry, 1989;146:577-587
3.
3. Christenson R, Blazer D: Epidemiology of persecutory ideation in an elderly population in the community. American Journal of Psychiatry, 1984;141:1088-1091
4.
4. Grahame PS: Schizophrenia in old age (lateparaphrenia). British Journal of Psychiatry, 1984;145:493-495
5.
5. Kumar A, Koss E, Metzler D, Moore A, Friedland RP: Behavioural symptomatology in dementia of the Alzheimer type. Alzheimer Disease and Associated Disorders, 1988;2(4):363-365
6.
6. Cummings JL, Miller B, Hill MA, Neshkes R: Neuropsychiatric aspects of multi-infarct dementia and dementia of the Alzheimer type. Archives of Neurology, 1987;44:389-393
7.
7. Teri L, Larson EB, Reifler BV: Behavioural disturbance in dementia of the Alzheimer's type. Journal of the American Geriatrics Society, 1988;36:1-6
8.
8. Gustafson L: Psychiatric symptoms in dementia with onset in the presenile period. Acta Psychiatrica Scandinavia, 1975;257, (suppl):8-35
9.
9. Merriam AE, Aronson MK, Gaston P, Wey S-L, Katz I: The psychiatric symptoms of Alzheimer's disease. Journal of the American Geriatric Society, 1988;36:7-12
10.
10. Burns A, Jacoby R, Levy R: Psychiatric phenomena in Alzheimer's disease. British Journal of Psychiatry, 1990;157:72-94
11.
11. Mendez MF, Martin RJ, Smyth KA, Whitehouse PJ: Psychiatric symptoms associated with Alzheimer's disease. The Journal of Neuropsychiatry and Clinical Neurosciences, 1990;2:28-33
12.
12. Jacoby RJ, Levy R: Computed tomography in the elderly 2. Senile dementia: diagnosis and functional impairment. British Journal of Psychiatry, 1980;136:256-269
13.
13. Mayeux R, Stern Y, Sano M: Psychosis in patients with dementia of the Alzheimer type. Annals of Neurology, 1985;18:144-144
14.
14. Stem Y, Mayeux R, Sano M, Sauser WA, Bush T: Predictors of disease course in patients with probable Alzheimer's disease. Neurology, 1987;37:1649-1653
15.
15. Rubin EH, Kinscherf DA: Psychopathology of very mild dementia, of the Alzheimer type. American Journal of Psychiatry, 1989;146:1017-1021
16.
16. Patterson M, Schnell AH, Martin RJ, Mendez MF, Smyth KA, Whitehouse PJ: Assessment of behavioural and affective symptoms in Alzheimer's disease. Journal of Geriatric Psychiatry and Neurology, 1990;3:21-30
17.
17. Berrios GE, Brook P: Delusions and the psychopathology of the elderly with dementia. Acta Psychiatrica Scandinavia, 1985;72:296-301
18.
18. Drevets WC, Rubin EH: Psychotic symptoms and the longitudinal course of senile dementia of the Alzheimer type. Biological Psychiatry, 1989;25:39-48
19.
19. Perry EK: Acetylcholine and Alzheimer's disease. British Journal of Psychiatry, 1988;152:737-740
20.
20. Corbin SL, Eastwood MR: Sensory deficits and mental disorder of old age: causal or coincidental associations?Psychological Medicine, 1986;16:251-256
21.
21. Leuchter AF, Spar JE: The late-onset psychoses: clinical and diagnostic features. Journal of Nervous and Mental Disorders, 1985;173:488-494
22.
22. Berrios GE, Brook P: Visual hallucinations and sensory delusions in the elderly. British Journal of Psychiatry, 1984;144:662-664
23.
23. Cummings JL: Clinical Neuropsychiatry. Orlando, Grune and Stratton, 1985:221-233
24.
24. Gustafson L, Risberg I: Regional cerebral blood flow related to psychiatric symptoms in dementia with onset in the pre-senile period. Acta Psychiatrica Scandinavia, 1974;50:516-538
25.
25. Naguib M, Levy R: Late paraphrenia: neuropsychological impairment and structural brain abnormalities on computed tomography. International Journal of Geriatric Psychiatry, 1987;2:83-90
26.
26. Zweig RM, Ross CA, Hedreen JC, Steele C, Cardillo JE, Whitehouse PJ, Folstein MF, Price DL: The neuropathology of aminergic nuclei in Alzheimer's disease. Annals of Neurology, 1988;24:233-242
27.
27. Cummings JL: Organic psychoses: delusional disorders and secondary mania. Psychiatric Clinics of North American, 1986;9:293-311
28.
28. McKenna PJ: Pathology, phenomenology and the dopamine hypothesis of schizophrenia. British Journal of Psychiatry, 1987;151:288-301
29.
29. Crow TJ, Johnstone EC, McClelland HA: The coincidence of schizophrenia and Parkinsonism: Some neurochemical implications. Psychological Medicine, 1976;6:227-233
30.
30. Zubenko GS, Moossy J. Major depression and primary dementia: clinical and neuropathological correlates. Archives of Neurology, 1988;45:1182-1186
31.
31. American Psychiatric Association DSMI: Diagnostic and Statistical Manual, 3rd edition. Washington, D.C, American Psychiatric Association, 1980
32.
32. Swartz MS, Blazer DG: The distribution of affective disorders inold age, inMurphy E (ed): Affective Disorders in the Elderly, Edinburgh, Churchill Livingstone, 1986:13-39
33.
33. Lopez OL, Boller F, Becker JT, Miller M, Reynolds CF: Alzheimers' disease and depression: neuropsychological impairment and progression of the illness. American Journal of Psychiatry, 1990;147:855-860
34.
34. Reifler BV, Larson E, Hanley R: Coexistence of cognitive impairment and depression in geriatric outpatients. American Journal of Psychiatry, 1982;139:623-626
35.
35. Reifler BV, Larson E, Teri L, Poulsen M: Dementia of the Alzheimer's type and depression. Journal of the American Geriatrics Society, 1986;34:855-859
36.
36. Reifler BV, Teri L, Raskind M, Veith R, Barnes R, White E, McLean P: Double-blind trial of imipramine in Alzheimer's disease patients with and without depression. American Journal of Psychiatry, 1989;146:45-49
37.
37. Pearlson GD, Ross CA, Lohr WD, Rovner BW, Chase GA, Folstein M: Association between family history of affective disorder and the depressive syndrome of Alzheimer's disease. American Journal of Psychiatry, 1990;147:452-456
38.
38. Rovner BW, Broadhead J, Spencer M, Carson K, Folstein MF: Depression and Alzheimer's disease. American Journal of Psychiatry, 1989;146:350-353
39.
39. Copeland JRM, Kelleher MJ, Kelett JM, Gourlay AJ, Gurland BJ, Fleiss JL, Sharpe L: A semi-structured clinical interview for the assessment of diagnosis and mental state in the elderly: the Geriatric Mental State Schedule. I. Development and reliability. Psychological Medicine,1976;6:439-449
40.
40. Jacoby RJ, Dolan RJ, Levy R, Baldy R: Quantitative computed tomography in elderly depressed patients. British Journal of Psychiatry, 1983;143:124-127
41.
41. Zubenko GS, Moossy J, Kopp U: Neurochemical correlates of major depression in primary dementia. Archives of Neurology, 1990;47:209-214
42.
42. Zis AP, Goodwin FK: The amine hypothesis. In Paykel ES (ed) Handbook of Affective Disorders, New York, Guilford Press, 1982:175-190
43.
43. Jimmerson DC: Role of dopamine mechanisms in the affective disorders. In: Meltzer HK (ed) Psychopharmacology: the Third Generation of Progress. New York, NY: Raven Press, 1987:505-511
44.
44. Robinson RG, Starkstein SE: Current research in affective disorders following stroke. The Journal of Neuropsychiatry and Clinical Neurosciences, 1990;2:1-14
45.
45. Mayeux R, Stern Y, Williams JBW, Sano M, Cote L: Depression and Parkinson's disease. Advances in Neurology, 1986;45:451-455
46.
46. Davis KL, Hollander E, Davidson M, Davis DM, Mohs RC, Horvath TB: Induction of depression with oxotremorine in patients with Alzheimer's disease. American Journal of Psychiatry, 1987;144:468-471
47.
47. Tsuang MM, Lu LM, Stotsky BA, Cole JA: Haloperidol versus thioridazine for hospitalized psychogeriatric patients: double-blind study. Journal of the American Geriatric Society, 1971;19:593-600
48.
48. Smith GR, Taylor CW, Linkous P: Haloperidol versus thioridazine for the treatment of psychogeriatric patients: a double-blind clinical trial. Psychosomatics, 1974;15:134-138
49.
49. Cowley LM, Glen RS: Double-blind study of thioridazine and haloperidol in geriatric patients with a psychosis associated with organic brain syndrome. Journal of Clinical Psychiatry, 1979;10:41-419
50.
50. Gotestam KG, Ljunghall S, Olsson B: A double-blind comparison of the effects of haloperidol and cis (Z) - clopenthixol in senile dementia. Acta Psychiatrica Scandinavia, 1981;294 (suppl):46-63
51.
51. Rada RT, Kellner R: Thiothixene in the treatment of geriatric patients with chronic organic brain syndrome. Journal of the American Geriatrics Society, 1976;24:105-107
52.
52. Barnes R, Veith R, Oldmoto J, Raskind M, Gumbrecht G: Efficacy of antipsychotic medications in behaviourally disturbed dementia patients. Am J Psychiatry, 1982;139:1170-1174
53.
53. Petrie WM, Ban TA, Berney S, Fujmori M, Guy W, Ragheb M, Wilson WH, Schaffer JD: Loxapine in psychogeriatrics: a placebo- and standard-controlled clinical investigation. Journal of Clinical Psychopharmacology, 1982;2:122-126
54.
54. Overall JE, Gorham DR: The Brief Psychiatric Rating Scale. Psychological Reports, 1962;10:799-812
55.
55. Jenike MA: Monoamine oxidase inhibitors as treatment for depressed patients with primary degenerative dementia (Alzheimer's disease). Am J Psychiatry, 1985;142:763-764
56.
56. Snow SS, Wells CE: Case studies inneuropsychiatry: diagnosis and treatment of coexistent dementia and depresion. Journal of Clinical Psychiatry, 1981;42:439-441
57.
57. Liang RA, Lam RW, Ancill RJ: ECT in the treatment of mixed depression and dementia. Br J Psychiatry, 1988; 152:281-284