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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2000 Aug;69(2):172–177. doi: 10.1136/jnnp.69.2.172

Hallucinations, delusions, and cognitive decline in Alzheimer's disease

R Wilson 1, D Gilley 1, D Bennett 1, L Beckett 1, D Evans 1
PMCID: PMC1737043  PMID: 10896689

Abstract

OBJECTIVES—To examine the occurrence of hallucinations and delusions in Alzheimer's disease over a 4 year period and their association with rate of cognitive decline.
METHODS—A cohort of 410 persons with clinically diagnosed Alzheimer's disease underwent annual clinical evaluations over a 4 year period. Participation in follow up exceeded 90% in survivors. Evaluations included structured informant interview, from which the presence or absence of hallucinations and delusions was ascertained, and detailed testing of cognitive function. The primary cognitive outcome measure was a composite cognitive score based on 17 individual performance tests. The mini mental state examination (MMSE) and summary measures of memory, visuoconstruction, repetition, and naming were used in secondary analyses.
RESULTS—At baseline, hallucinations (present in 41%) and delusions (present in 55%) were common and associated with lower cognitive function. In analyses that controlled for baseline level of cognitive function, demographic variables, parkinsonism, and use of antipsychotic medications, hallucinations, but not delusions, were associated with more rapid cognitive decline on each cognitive measure. In the primary model, there was a 47% increase in the average annual rate of decline on a composite cognitive measure in those with baseline hallucinations compared with those without them. This effect was mainly due to a subgroup with both auditory and visual hallucinations.
CONCLUSION—These findings suggest that the presence of hallucinations is selectively associated with more rapid cognitive decline in Alzheimer's disease.



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Selected References

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  1. Bennett D. A., Shannon K. M., Beckett L. A., Goetz C. G., Wilson R. S. Metric properties of nurses' ratings of parkinsonian signs with a modified Unified Parkinson's Disease Rating Scale. Neurology. 1997 Dec;49(6):1580–1587. doi: 10.1212/wnl.49.6.1580. [DOI] [PubMed] [Google Scholar]
  2. Bennett D. A., Shannon K. M., Beckett L. A., Wilson R. S. Dimensionality of parkinsonian signs in aging and Alzheimer's disease. J Gerontol A Biol Sci Med Sci. 1999 Apr;54(4):M191–M196. doi: 10.1093/gerona/54.4.m191. [DOI] [PubMed] [Google Scholar]
  3. Burns A., Jacoby R., Levy R. Psychiatric phenomena in Alzheimer's disease. I: Disorders of thought content. Br J Psychiatry. 1990 Jul;157:72-6, 92-4. doi: 10.1192/bjp.157.1.72. [DOI] [PubMed] [Google Scholar]
  4. Burns A., Jacoby R., Levy R. Psychiatric phenomena in Alzheimer's disease. II: Disorders of perception. Br J Psychiatry. 1990 Jul;157:76-81, 92-4. doi: 10.1192/bjp.157.1.76. [DOI] [PubMed] [Google Scholar]
  5. Chen J. Y., Stern Y., Sano M., Mayeux R. Cumulative risks of developing extrapyramidal signs, psychosis, or myoclonus in the course of Alzheimer's disease. Arch Neurol. 1991 Nov;48(11):1141–1143. doi: 10.1001/archneur.1991.00530230049020. [DOI] [PubMed] [Google Scholar]
  6. Chui H. C., Lyness S. A., Sobel E., Schneider L. S. Extrapyramidal signs and psychiatric symptoms predict faster cognitive decline in Alzheimer's disease. Arch Neurol. 1994 Jul;51(7):676–681. doi: 10.1001/archneur.1994.00540190056015. [DOI] [PubMed] [Google Scholar]
  7. Devanand D. P., Jacobs D. M., Tang M. X., Del Castillo-Castaneda C., Sano M., Marder K., Bell K., Bylsma F. W., Brandt J., Albert M. The course of psychopathologic features in mild to moderate Alzheimer disease. Arch Gen Psychiatry. 1997 Mar;54(3):257–263. doi: 10.1001/archpsyc.1997.01830150083012. [DOI] [PubMed] [Google Scholar]
  8. Drevets W. C., Rubin E. H. Psychotic symptoms and the longitudinal course of senile dementia of the Alzheimer type. Biol Psychiatry. 1989 Jan;25(1):39–48. doi: 10.1016/0006-3223(89)90145-5. [DOI] [PubMed] [Google Scholar]
  9. Folstein M. F., Folstein S. E., McHugh P. R. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6. [DOI] [PubMed] [Google Scholar]
  10. Galasko D., Abramson I., Corey-Bloom J., Thal L. J. Repeated exposure to the Mini-Mental State Examination and the Information-Memory-Concentration Test results in a practice effect in Alzheimer's disease. Neurology. 1993 Aug;43(8):1559–1563. doi: 10.1212/wnl.43.8.1559. [DOI] [PubMed] [Google Scholar]
  11. Galasko D., Corey-Bloom J., Thal L. J. Monitoring progression in Alzheimer's disease. J Am Geriatr Soc. 1991 Sep;39(9):932–941. doi: 10.1111/j.1532-5415.1991.tb04463.x. [DOI] [PubMed] [Google Scholar]
  12. Gilley D. W., Wilson R. S., Beckett L. A., Evans D. A. Psychotic symptoms and physically aggressive behavior in Alzheimer's disease. J Am Geriatr Soc. 1997 Sep;45(9):1074–1079. doi: 10.1111/j.1532-5415.1997.tb05969.x. [DOI] [PubMed] [Google Scholar]
  13. Jeste D. V., Wragg R. E., Salmon D. P., Harris M. J., Thal L. J. Cognitive deficits of patients with Alzheimer's disease with and without delusions. Am J Psychiatry. 1992 Feb;149(2):184–189. doi: 10.1176/ajp.149.2.184. [DOI] [PubMed] [Google Scholar]
  14. Kukull W. A. Problems in measuring and interpreting cognitive decline. J Am Geriatr Soc. 1998 Dec;46(12):1578–1579. doi: 10.1111/j.1532-5415.1998.tb01547.x. [DOI] [PubMed] [Google Scholar]
  15. Laird N. M., Ware J. H. Random-effects models for longitudinal data. Biometrics. 1982 Dec;38(4):963–974. [PubMed] [Google Scholar]
  16. Levy M. L., Cummings J. L., Fairbanks L. A., Bravi D., Calvani M., Carta A. Longitudinal assessment of symptoms of depression, agitation, and psychosis in 181 patients with Alzheimer's disease. Am J Psychiatry. 1996 Nov;153(11):1438–1443. doi: 10.1176/ajp.153.11.1438. [DOI] [PubMed] [Google Scholar]
  17. Lopez O. L., Becker J. T., Brenner R. P., Rosen J., Bajulaiye O. I., Reynolds C. F., 3rd Alzheimer's disease with delusions and hallucinations: neuropsychological and electroencephalographic correlates. Neurology. 1991 Jun;41(6):906–912. doi: 10.1212/wnl.41.6.906. [DOI] [PubMed] [Google Scholar]
  18. Lopez O. L., Brenner R. P., Becker J. T., Ulrich R. F., Boller F., DeKosky S. T. EEG spectral abnormalities and psychosis as predictors of cognitive and functional decline in probable Alzheimer's disease. Neurology. 1997 Jun;48(6):1521–1525. doi: 10.1212/wnl.48.6.1521. [DOI] [PubMed] [Google Scholar]
  19. Lopez O. L., Wisniewski S. R., Becker J. T., Boller F., DeKosky S. T. Psychiatric medication and abnormal behavior as predictors of progression in probable Alzheimer disease. Arch Neurol. 1999 Oct;56(10):1266–1272. doi: 10.1001/archneur.56.10.1266. [DOI] [PubMed] [Google Scholar]
  20. McKhann G., Drachman D., Folstein M., Katzman R., Price D., Stadlan E. M. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology. 1984 Jul;34(7):939–944. doi: 10.1212/wnl.34.7.939. [DOI] [PubMed] [Google Scholar]
  21. Miller T. P., Tinklenberg J. R., Brooks J. O., 3rd, Fenn H. H., Yesavage J. A. Selected psychiatric symptoms associated with rate of cognitive decline in patients with Alzheimer's disease. J Geriatr Psychiatry Neurol. 1993 Oct-Dec;6(4):235–238. doi: 10.1177/089198879300600410. [DOI] [PubMed] [Google Scholar]
  22. Morris J. C., Drazner M., Fulling K., Grant E. A., Goldring J. Clinical and pathological aspects of parkinsonism in Alzheimer's disease. A role for extranigral factors? Arch Neurol. 1989 Jun;46(6):651–657. doi: 10.1001/archneur.1989.00520420071025. [DOI] [PubMed] [Google Scholar]
  23. Mortimer J. A., Ebbitt B., Jun S. P., Finch M. D. Predictors of cognitive and functional progression in patients with probable Alzheimer's disease. Neurology. 1992 Sep;42(9):1689–1696. doi: 10.1212/wnl.42.9.1689. [DOI] [PubMed] [Google Scholar]
  24. Rosen J., Zubenko G. S. Emergence of psychosis and depression in the longitudinal evaluation of Alzheimer's disease. Biol Psychiatry. 1991 Feb 1;29(3):224–232. doi: 10.1016/0006-3223(91)91284-x. [DOI] [PubMed] [Google Scholar]
  25. Stern Y., Albert M., Brandt J., Jacobs D. M., Tang M. X., Marder K., Bell K., Sano M., Devanand D. P., Bylsma F. Utility of extrapyramidal signs and psychosis as predictors of cognitive and functional decline, nursing home admission, and death in Alzheimer's disease: prospective analyses from the Predictors Study. Neurology. 1994 Dec;44(12):2300–2307. doi: 10.1212/wnl.44.12.2300. [DOI] [PubMed] [Google Scholar]
  26. Stern Y., Mayeux R., Sano M., Hauser W. A., Bush T. Predictors of disease course in patients with probable Alzheimer's disease. Neurology. 1987 Oct;37(10):1649–1653. doi: 10.1212/wnl.37.10.1649. [DOI] [PubMed] [Google Scholar]
  27. Teri L., McCurry S. M., Edland S. D., Kukull W. A., Larson E. B. Cognitive decline in Alzheimer's disease: a longitudinal investigation of risk factors for accelerated decline. J Gerontol A Biol Sci Med Sci. 1995 Jan;50A(1):M49–M55. doi: 10.1093/gerona/50a.1.m49. [DOI] [PubMed] [Google Scholar]
  28. Wilson R. S., Gilley D. W., Bennett D. A., Beckett L. A., Evans D. A. Person-specific paths of cognitive decline in Alzheimer's disease and their relation to age. Psychol Aging. 2000 Mar;15(1):18–28. doi: 10.1037//0882-7974.15.1.18. [DOI] [PubMed] [Google Scholar]
  29. Wragg R. E., Jeste D. V. Overview of depression and psychosis in Alzheimer's disease. Am J Psychiatry. 1989 May;146(5):577–587. doi: 10.1176/ajp.146.5.577. [DOI] [PubMed] [Google Scholar]

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