Examining the presence and nature of delusions in Alzheimer's disease and frontotemporal dementia syndromes

Kumfor, Fiona, Liang, Cheng Tao, Hazelton, Jessica L., Leyton, Cristian E., Kaizik, Cassandra, Devenney, Emma, Connaughton, Emily, Langdon, Robyn, Mioshi, Eneida, Kwok, John B., Dobson-Stone, Carol, Halliday, Glenda M., Piguet, Olivier, Hodges, John R. and Landin-Romero, Ramon (2022) Examining the presence and nature of delusions in Alzheimer's disease and frontotemporal dementia syndromes. International Journal of Geriatric Psychiatry, 37 (3). ISSN 0885-6230

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Abstract

Objectives Abnormal beliefs and delusions have been reported in some people with dementia, however, the prevalence of delusions, and their neurocognitive basis has been underexplored. This study aimed to examine the presence, severity, content and neural correlates of delusions in a large, well-characterised cohort of dementia patients using a transdiagnostic, cross-sectional approach. Methods Four-hundred and eighty-seven people with dementia were recruited: 102 Alzheimer's disease, 136 behavioural-variant frontotemporal dementia, 154 primary progressive aphasia, 29 motor neurone disease, 46 corticobasal syndrome, 20 progressive supranuclear palsy. All patients underwent neuropsychological assessment and brain magnetic resonance imaging, and the Neuropsychiatric Inventory was conducted with an informant, by an experienced clinician. Results In our cohort, 48/487 patients (10.8%) had delusions. A diagnosis of behavioural-variant frontotemporal dementia (18.4%) and Alzheimer's disease (11.8%) were associated with increased risk of delusions. A positive gene mutation was observed in 11/27 people with delusions. Individuals with frequent delusions performed worse on the Addenbrooke's Cognitive Examination (p = 0.035), particularly on the orientation/attention (p = 0.022) and memory (p = 0.013) subtests. Voxel-based morphometry analyses found that increased delusional psychopathology was associated with reduced integrity of the right middle frontal gyrus, right planum temporale and left anterior temporal pole. Conclusion Our results demonstrate that delusions are relatively common in dementia and uncover a unique cognitive and neural profile associated with the manifestation of delusions. Clinically, delusions may lead to delayed or misdiagnosis. Our results shed light on how to identify individuals at risk of neuropsychiatric features of dementia, a crucial first step to enable targeted symptom management.

Item Type: Article
Additional Information: Funding Information: The authors are grateful to all the patients and their families for supporting our research. This work was supported in part by funding to ForeFront, a collaborative research group dedicated to the study of frontotemporal dementia and motor neuron disease, from the National Health and Medical Research Council (NHMRC) (GNT1037746, GNT1095127) and the Australian Research Council (ARC) Centre of Excellence in Cognition and its Disorders Memory Program (CE11000102), including a Cross Program Support Scheme grant. Fiona Kumfor is supported by an NHMRC Career Development Fellowship (GNT1158762). Jessica L. Hazelton is supported by an NHMRC Postgraduate Scholarship (GNT1168597). Olivier Piguet is supported by an NHMRC Senior Research Fellowship (GNT1103258). John B. Kwok is supported by an NHMRC Dementia Research Team Grant (GNT1095127). Carol Dobson-Stone is supported by an NHMRC Boosting Dementia Research Leadership Fellowship (GNT1138223). Glenda M. Halliday is a NHMRC Senior Principal Research Fellow (GNT1079679). Ramon Landin-Romero is supported by the Appenzeller Neuroscience Fellowship in Alzheimer's Disease and the ARC Centre of Excellence in Cognition and its Disorders Memory Program (CE110001021). The authors acknowledge the Sydney Informatics Hub at the University of Sydney for providing access to High Performance Computing resources. Open access publishing facilitated by The University of Sydney, as part of the Wiley ? The University of Sydney agreement via the Council of Australian University Librarians. Ethics Approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the South Eastern Sydney Local Health District Human Research Ethics Committee (HREC ref no. 10/126 & 13/177).
Uncontrolled Keywords: alzheimer's disease,c9orf72,cognitive impairment,frontotemporal dementia,primary progressive aphasia,psychosis,research domain criteria (rdoc),structural imaging,geriatrics and gerontology,psychiatry and mental health ,/dk/atira/pure/subjectarea/asjc/2700/2717
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
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Depositing User: LivePure Connector
Date Deposited: 25 Feb 2022 13:30
Last Modified: 11 May 2022 00:44
URI: https://ueaeprints.uea.ac.uk/id/eprint/83699
DOI: 10.1002/gps.5692

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