 |
|
Delusions and Hallucinations Are Associated With Worse Outcome in Alzheimer Disease
Nikolaos Scarmeas, MD;
Jason Brandt, PhD;
Marilyn Albert, PhD;
Georgios Hadjigeorgiou, MD;
Alexandros Papadimitriou, MD;
Bruno Dubois, MD;
Maria Sarazin, MD;
Davangere Devanand, MD;
Lawrence Honig, MD, PhD;
Karen Marder, MD, MPH;
Karen Bell, MD;
Domonick Wegesin, PhD;
Deborah Blacker, MD, ScD;
Yaakov Stern, PhD
Arch Neurol. 2005;62:1601-1608.
Background Delusions and hallucinations are common in Alzheimer disease (AD) and there are conflicting reports regarding their ability to predict cognitive decline, functional decline, and institutionalization. According to all previous literature, they are not associated with mortality.
Objective To examine whether the presence of delusions or hallucinations has predictive value for important outcomes in AD.
Design, Setting, and Participants A total of 456 patients with AD at early stages (mean Folstein Mini-Mental State Examination [MMSE] score of 21 of 30 at entry) were recruited and followed up semiannually for up to 14 years (mean, 4.5 years) in 5 university-based AD centers in the United States and Europe. Using the Columbia University Scale for Psychopathology in AD (administered every 6 months, for a total of 3266 visit-assessments, average of 7.2 per patient), the presence of delusions and hallucinations was extracted and examined as time-dependent predictors in Cox models. The models controlled for cohort effect, recruitment center, informant status, sex, age, education, a comorbidity index, baseline cognitive and baseline functional performance, behavioral symptoms, and use of neuroleptics and cholinesterase inhibitors.
Main Outcome Measures Cognitive (Columbia MMSE score of  20/57 [approximate Folstein MMSE score of 10/30]), functional (Blessed Dementia Rating Scale [parts I and II] score of  10), institutionalization equivalent index, and death.
Results During the full course of follow-up, 38% of patients reached the cognitive, 41% the functional, 54% the institutionalization, and 49% the mortality end point. Delusions were noted for 34% of patients at baseline and 70% at any evaluation. Their presence was associated with increased risk for cognitive (risk ratio [RR], 1.50; 95% confidence interval [CI], 1.07-2.08) and functional decline (RR, 1.41; 95% CI, 1.02-1.94). Hallucinations were present in 7% of patients at initial visit and in 33% at any visit. Their presence was associated with increased risk for cognitive decline (RR, 1.62; 95% CI, 1.06-2.47), functional decline (RR, 2.25; 95% CI, 1.54-2.27), institutionalization (RR, 1.60; 95% CI, 1.13-2.28), and death (RR, 1.49; 95% CI, 1.03-2.14).
Conclusions Delusions and hallucinations are very common in AD and predict cognitive and functional decline. Presence of hallucinations is also associated with institutionalization and mortality.
Author Affiliations: Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, the Gertrude H. Sergievsky Center, and the Departments of Neurology and Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY (Drs Scarmeas, Devanand, Honig, Marder, Bell, Wegesin and Stern); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Md (Drs Brandt and Albert); Departments of Psychiatry and Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (Dr Blacker); Department of Neurology, Hospital de la Salpetriere, Paris, France (Drs Dubois and Sarazin); and Department of Neurology, University of Thessaly, Larissa, Greece (Dr Papadimitriou).
RELATED LETTER
Delusions and Hallucinations in Alzheimer Disease
Sudeep S. Gill
Arch Neurol. 2006;63(4):627.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Race/ethnic differences in AD survival in US Alzheimer's Disease Centers
Mehta et al.
Neurology 2008;70:1163-1170.
ABSTRACT
| FULL TEXT
Disruptive Behavior as a Predictor in Alzheimer Disease
Scarmeas et al.
Arch Neurol 2007;64:1755-1761.
ABSTRACT
| FULL TEXT
Antipsychotic Drug Use and Mortality in Older Adults with Dementia
Gill et al.
ANN INTERN MED 2007;146:775-786.
ABSTRACT
| FULL TEXT
The effects of commonly prescribed drugs in patients with Alzheimer's disease on the rate of deterioration
Ellul et al.
J. Neurol. Neurosurg. Psychiatry 2007;78:233-239.
ABSTRACT
| FULL TEXT
Treatment of Cognitive Decline and Psychiatric Disturbances Associated With Alzheimer's Dementia
Blaszczyk and Mathys
Journal of Pharmacy Practice 2007;20:13-28.
ABSTRACT
Pharmacotherapy for behavioral and psychological symptoms of dementia in the elderly
Beier
Am J Health Syst Pharm 2007;64:S9-S17.
ABSTRACT
| FULL TEXT
Mediterranean Diet, Alzheimer Disease, and Vascular Mediation
Scarmeas et al.
Arch Neurol 2006;63:1709-1717.
ABSTRACT
| FULL TEXT
The progression of cognition, psychiatric symptoms, and functional abilities in dementia with lewy bodies and Alzheimer disease.
Stavitsky et al.
Arch Neurol 2006;63:1450-1456.
ABSTRACT
| FULL TEXT
Longitudinal study of effects of patient characteristics on direct costs in Alzheimer disease
Zhu et al.
Neurology 2006;67:998-1005.
ABSTRACT
| FULL TEXT
Delusions and hallucinations in Alzheimer disease.
Gill
Arch Neurol 2006;63:627-627.
FULL TEXT
|
