Neuropathologic and Neurochemical Correlates of Psychosis in Primary Dementia

doi:10.1001/archneur.1991.00530180075020

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Vol. 48 No. 6, June 1991

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Neuropathologic and Neurochemical Correlates of Psychosis in Primary Dementia

George S. Zubenko, MD, PhD; John Moossy, MD; A. Julio Martinez, MD; Gutti Rao, MD; Diana Claassen, MD; Jules Rosen, MD; Ursula Kopp

Arch Neurol. 1991;48(6):619-624.

Abstract

• Neuropathologic and neurochemical correlates of psychosiswere determined using brain tissue from 27 autopsy-confirmedcases of Alzheimer's disease. The densities of senile plaquesand neurofibrillary tangles were determined in the middle frontaland superior temporal cortex, the prosubiculum, and the entorhinalcortex of the hippocampus. The concentrations of norepinephrine,dopamine, and serotonin, the metabolites of these biogenic amines,and the specific activity of choline acetyltransferase werealso determined in these four cortical regions as well as inthe substantia nigra, thalamus, amygdala, and caudate nucleus.Psychosis was associated with significantly increased densitiesof senile plaques and neurofibrillary tangles in the prosubiculumand middle frontal cortex, respectively, with trends towardincreased densities of these lesions in the other areas examined.This finding is consistent with the increased rate of cognitivedecline that accompanies this behavioral disorder. Psychosiswas also associated with the relative preservation of norepinephrinein the substantia nigra, with trends in this direction for fiveof the remaining seven brain regions examined, and a significantreduction of serotonin in the prosubiculum that was accompaniedby trends toward reduced levels of serotonin and 5 hydroxyindoleaceticacid in the remaining regions. The profile of neuropathologicand neurochemical changes associated with psychosis is distinctfrom that previously reported for major depression in the contextof primary dementia.

Author Affiliations

From the Geriatric Health Services, Department of Psychiatry and Western Psychiatric Institute and Clinic (Drs Zubenko and Rosen and Ms Kopp); and Division of Neuropathology, Department of Pathology, University of Pittsburgh School of Medicine (Drs Moossy, Martinez, Rao, and Claassen), Pittsburgh, Pa.

Footnotes

Accepted for publication December 13, 1990.

Reprint requests to the Geriatric Health Services, Western PsychiatricInstitute and Clinic, Room E-1230, 3811 O'Hara St, Pittsburgh,PA 15213 (Dr Zubenko).

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