Late-Onset Psychosis; Is It Real?

Neuropsychiatric symptoms in cognitively normal older persons, and the association with Alzheimer's and non-Alzheimer's dementia

Background

Neuropsychiatric symptoms (NPS) have been reported to be useful in predicting incident dementia among cognitively normal older persons. However, the literature has not been conclusive on the differential utilities of the various NPS in predicting the subtypes of dementia. This study compared the risks of Alzheimer’s and non-Alzheimer’s dementia associated with the various NPS, among cognitively normal older persons.

Methods

This cohort study included 12,452 participants from the Alzheimer’s Disease Centers across USA, who were ≥ 60 years and had normal cognition at baseline. Participants completed the Neuropsychiatric Inventory-Questionnaire at baseline and were followed up almost annually for incident dementia (median follow-up = 4.7 years). Symptom clusters of NPS—as identified from exploratory and confirmatory factor-analyses—were included in the Cox regression to investigate their associations with incident dementia.

Results

The various NPS showed independent yet differential associations with incident dementia. Although psychotic symptoms were rarely endorsed by the participants, they predicted much higher risk of dementia (HR 3.6, 95% CI 2.0–6.4) than affective symptoms (HR 1.5, 95% CI 1.2–1.8) or agitation symptoms (HR 1.6, 95% CI 1.3–2.1). Psychotic symptoms predicted all dementia subtypes, while affective and agitation symptoms differentially predicted some subtypes. Across dementia subtypes, psychotic symptoms had relatively higher risk estimates than affective or agitation symptoms, with the risk estimates being particularly high in non-Alzheimer’s dementia.

Conclusions

Among cognitively normal individuals, the presence of NPS may warrant greater clinical vigilance as precursors to dementia and its subtypes. The findings highlight the need for further research to enrich our understanding on the neurobiological links between various NPS and dementia subtypes. They may also change the clinical approach in managing late-life psychotic symptoms, requiring a greater emphasis on dementia surveillance in the diagnostic criteria of late-life psychotic disorders.

Late-onset psychosis and very-late-onset-schizophrenia-like-psychosis: an updated systematic review

Psychotic disorders have long been known to be a condition that peaks during adolescence and early adulthood. A considerable proportion of patients have their first onset at or after the age of 40, but little is known about this population. The current systematic review examined the clinical presentation of late-onset psychosis (LOP) and very-late-onset-schizophrenia-like psychosis (VLOSLP) with focus on their psychopathological, neuropsychological, neurobiological, psychosocial and psychological correlates. A systematic search of studies published from 2000 to 2019 from Cochrane Library, Pubmed, Medline, Embase, PsycINFO, and Scopus yielded 27 original studies that were included in this review. Results revealed there is a dearth of empirical research on the conditions in the current literature and inconsistencies in the findings reported may be associated with the lack of uniformity in the definitions for LOP and VLOSLP. Future research on the topic shall (i) specify the onset age criteria for LOP and VLOSLP; (ii) study the conditions independently; (iii) involve a larger sample size, and iv) account for potential confounding variables. A comprehensive evaluation of the risks and benefits of pharmacological treatment may also be needed.

Management of Psychosis in Parkinson's Disease: Emphasizing Clinical Subtypes and Pathophysiological Mechanisms of the Condition

Investigation into neuropsychiatric symptoms in Parkinson's disease (PD) is sparse and current drug development is mainly focused on the motor aspect of PD. The tight association of psychosis with an impaired quality of life in PD, together with an important underreporting of this comorbid condition, contributes to its actual insufficient assessment and management. Furthermore, the withdrawal from access to readily available treatment interventions is unacceptable and has an impact on PD prognosis. Despite its impact, to date no standardized guidelines to the adequate management of PD psychosis are available and they are therefore highly needed. Readily available knowledge on distinct clinical features as well as early biomarkers of psychosis in PD justifies the potential for its timely diagnosis and for early intervention strategies. Also, its specific characterisation opens up the possibility of further understanding the underlying pathophysiological mechanisms giving rise to more targeted therapeutic developments in the nearer future. A literature review on the most recent knowledge with special focus on specific clinical subtypes and pathophysiological mechanisms will not only contribute to an up to date practical approach of this condition for the health care providers, but furthermore open up new ideas for research in the near future.