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Cressot C, Vrillon A, Lilamand M, Francisque H, Méauzoone A, Hourregue C, Dumurgier J, Marlinge E, Paquet C, Cognat E. Psychosis in Neurodegenerative Dementias: A Systematic Comparative Review. J Alzheimers Dis 2024; 99:85-99. [PMID: 38669539 DOI: 10.3233/jad-231363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
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.
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Affiliation(s)
- Coralie Cressot
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Agathe Vrillon
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Matthieu Lilamand
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Service de Gériatrie, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Hélène Francisque
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Aurélie Méauzoone
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Claire Hourregue
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Julien Dumurgier
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Université Paris Cité, Inserm U1153, Paris, France
| | - Emeline Marlinge
- Département de Psychiatrie, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Claire Paquet
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Emmanuel Cognat
- Université Paris Cité, UMRS 1144, INSERM, Paris, France
- Centre de Neurologie Cognitive, AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
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Parand L, Niu K, Yerstein O, Mendez MF. Fantastic Thinking and Frontal Cerebrovascular Disease. J Neuropsychiatry Clin Neurosci 2020; 32:201-203. [PMID: 31331214 DOI: 10.1176/appi.neuropsych.19040086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Leila Parand
- The Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles (Parand, Yerstein, Mendez); the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles (Parand, Yerstein, Mendez); the V.A. Greater Los Angeles Healthcare System (Mendez); and the Neuropsychiatry Program, University of Massachusetts, Worcester, Mass (Niu)
| | - Kathy Niu
- The Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles (Parand, Yerstein, Mendez); the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles (Parand, Yerstein, Mendez); the V.A. Greater Los Angeles Healthcare System (Mendez); and the Neuropsychiatry Program, University of Massachusetts, Worcester, Mass (Niu)
| | - Oleg Yerstein
- The Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles (Parand, Yerstein, Mendez); the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles (Parand, Yerstein, Mendez); the V.A. Greater Los Angeles Healthcare System (Mendez); and the Neuropsychiatry Program, University of Massachusetts, Worcester, Mass (Niu)
| | - Mario F Mendez
- The Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles (Parand, Yerstein, Mendez); the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles (Parand, Yerstein, Mendez); the V.A. Greater Los Angeles Healthcare System (Mendez); and the Neuropsychiatry Program, University of Massachusetts, Worcester, Mass (Niu)
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Frontolimbic affective bias and false narratives from brain disease. Med Hypotheses 2019; 128:13-16. [PMID: 31203901 DOI: 10.1016/j.mehy.2019.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/28/2019] [Indexed: 11/23/2022]
Abstract
Since the nineteenth century, clinicians and investigators have systematically evaluated the origin of delusions and psychotic thinking. One major clue to understanding the neurobiological underpinnings of delusions is the emergence of false narratives from brain disease. In addition to delusions themselves, there are a range of other false narratives not due to deliberate lying and resulting from neurological disorders, including provoked confabulations, fantastic confabulations, false memories, magical thinking, dream delusions, and "fantastic thinking". A comparison of their characteristics, similarities, and differences suggest a hypothesis: despite different sources for their false narrative experiences, such as unusual thoughts or perceptions, all false narratives from brain disease involve erroneous or mismatched "affective biases" applied to the experiences. Affective labels usually signal the sense of rightness, sense of familiarity, and the external vs. internal origin of an experience, and they can be altered by limbic neuropathology. The location and involvement of neuropathology that facilitates false narratives involves frontolimbic regions and their connections, particularly on the right. Future investigations can focus on frontolimbic mechanisms involved in the provision of the intrinsically-linked affective biases, which indicate the nature and external/internal origin of experiences.
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Dalla Barba G, La Corte V. A neurophenomenological model for the role of the hippocampus in temporal consciousness. Evidence from confabulation. Front Behav Neurosci 2015; 9:218. [PMID: 26379515 PMCID: PMC4549641 DOI: 10.3389/fnbeh.2015.00218] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 08/03/2015] [Indexed: 11/13/2022] Open
Abstract
Confabulation, the production of statements or actions that are unintentionally incongruous to the subject's history, background, present and future situation, is a rather infrequent disorder with different aetiologies and anatomical lesions. Although they may differ in many ways, confabulations show major similarities. Their content, with some minor exceptions, is plausible and therefore indistinguishable from true memories, unless one is familiar with the patient's history, background, present and future situation. They extend through the whole individuals' temporality, including their past, present and future. Accordingly, we have proposed that rather than a mere memory disorder; confabulation reflects a distortion of Temporal Consciousness (TC), i.e., a specific form of consciousness that allows individuals to locate objects and events according to their subjective temporality. Another feature that confabulators share is that, regardless of their lesion's location, they all have a relatively preserved hippocampus (Hip), at least unilaterally. In this article, we review data showing differences and similarities among forms of confabulation. We then describe a model showing that the hippocampus is crucial both for the normal functioning of TC and as the generator of confabulations, and that different types of confabulation can be traced back to a distortion of TC resulting from damage or disconnection of brain areas directly or indirectly connected to the hippocampus. We conclude by comparing our model with other models of memory and confabulation.
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Affiliation(s)
- Gianfranco Dalla Barba
- INSERMParis, France
- Département de Neurologie, Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Hôpital de la Salpêtrière,Paris, France
- Dipartimento di Scienze della Vita, Università degli Studi di TriesteTrieste, Italy
| | - Valentina La Corte
- Département de Neurologie, Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Hôpital de la Salpêtrière,Paris, France
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013Paris, France
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The false memory syndrome: experimental studies and comparison to confabulations. Med Hypotheses 2010; 76:492-6. [PMID: 21177042 DOI: 10.1016/j.mehy.2010.11.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 11/22/2010] [Accepted: 11/26/2010] [Indexed: 11/21/2022]
Abstract
False memories, or recollections that are factually incorrect but strongly believed, remain a source of confusion for both psychiatrists and neurologists. We propose model for false memories based on recent experimental investigations, particularly when analyzed in comparison to confabulations, which are the equivalent of false memories from neurological disease. Studies using the Deese/Roedinger-McDermott experimental paradigm indicate that false memories are associated with the need for complete and integrated memories, self-relevancy, imagination and wish fulfillment, familiarity, emotional facilitation, suggestibility, and sexual content. In comparison, confabulations are associated with the same factors except for emotional facilitation, suggestibility, and sexual content. Both false memories and confabulations have an abnormal sense of certainty for their recollections, and neuroanatomical findings implicate decreased activity in the ventromedial frontal lobe in this certainty. In summary, recent studies of false memories in comparison to confabulations support a model of false memories as internally-generated but suggestible and emotionally-facilitated fantasies or impulses, rather than repressed memories of real events. Furthermore, like confabulations, in order for false memories to occur there must be an attenuation of the normal, nonconscious, right frontal "doubt tag" regarding their certainty.
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