Psychiatric phenomena in Alzheimer's disease; III: disorders of mood

Article Abstract:

Alzheimer's disease is considered primarily a disorder of cognition, but this form of dementia frequently involves psychiatric problems, such as mood disorders (depression). The relationship between cognitive impairment and depressive symptoms is difficult to assess. A study was conducted of 178 patients with Alzheimer's disease to measure the prevalence of affective (emotional) disorders. Both depression and mania were measured, according to three methods of inquiry: reports from a trained interviewer, from a relative, and from the patient. Previous history was also taken into account. Almost two-thirds of the patients reported one or more symptoms of depression, and half of the subjects were considered depressed by their relatives. Nevertheless, none of the patients met the criteria for major depressive disorder as outlined in the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R). As to the relation between depressive symptoms and cognitive testing, it was found that those who self-reported depression were in fact less impaired than the others. Depression observed by interviewer or relative could not be correlated with cognitive functioning. Four main characteristics of the study results emerged: although depressive symptoms occurred in the Alzheimer's patients, depressive syndromes (disorders) were uncommon; mania was rare; patients who reported depressive symptoms tended to have less cognitive impairment, but the progression of the disease did not differ; when evaluated in conjunction with CT scans of the brain, mood changes were statistically correlated with measurable neuroanatomical features. These findings indicate that Alzheimer's patients with depressive symptoms may be suffering from a less severe form of the illness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Depression, Mental, Depression (Mood disorder)

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Psychiatric phenomena in Alzheimer's disease; I: Disorders of thought content

Article Abstract:

The psychiatric symptoms and behavioral disturbances associated with Alzheimer's disease, a form of dementia of unknown cause, have been acknowledged since Alzheimer himself characterized the disorder in 1907. However, these features have been paid scant attention in the literature relative to the more obvious cognitive features, such as loss of memory. A study was conducted of 178 subjects with Alzheimer's disease to determine the prevalence of disorders of thought content, namely delusions and notions of persecution. Delusions were defined as firmly held ideas that were impervious to factual evidence to the contrary; delusions had to persist for at least seven days, in order to rule out the possibility that they were symptomatic of delirium. Of the patients studied, 38 (21 percent) were men, and the average age was 80.4 years. It was found that 16 percent had experienced delusions since the onset of Alzheimer's disease; 11 percent had experienced them in the prior year. The most common types of delusions were those of theft, which occurred primarily among men, followed by those of suspicion (usually of a spouse's behavior or fidelity). When the results were correlated with physiological evidence from computed tomographic (CT) scans of the patient's brains, it was observed that some types of delusions were associated with calcification of the basal ganglia; the size of the brain ventricles was not particularly enlarged. It should be noted that the sample size is small for reaching firm conclusions. The authors also point out that there were problems in the study design, regarding the ways in which the severity of illness and other phenomena were assessed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Delusions

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Psychiatric phenomena in Alzheimer's disease; II: Disorders of perception

Article Abstract:

Most previous research on Alzheimer's disease, a form of dementia with no known cause, has tended to focus upon cognitive deficits, such as loss of memory. However, perceptual disturbances (hallucinations and misidentifications) are also common among patients with this disease. To ascertain the prevalence of perceptual disorders, 178 Alzheimer patients, with an average age of 80.4 years, were evaluated. Both auditory and visual hallucinations and misidentification syndromes were included. Four classes of misidentification syndromes were observed: believing people to be in the house; not recognizing one's reflection in a mirror; perceiving action on television as being 'real'; and misidentification of known people (e.g. mistaking a friend for a relative). Visual hallucinations were experienced by 13 percent of the patients, while auditory hallucinations were reported in 10 percent. Misidentification was common, affecting over 30 percent, and was more common among men. One curious fact was observed at 30-month follow-up, namely that patients with misidentification syndromes were generally younger and had been younger when first afflicted with Alzheimer's, but these victims of Alzheimer's disease also had a lower death rate (18.5 percent versus 42.7 percent of those without misidentification symptoms.) It was also noted that Alzheimer patients who experienced hallucinations tended to suffer a more rapid decline in cognitive functions as the disease progressed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hallucinations and illusions, Hallucinations

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