Department of Neurology, Hyoja Geriatric Hospital, Gyeonggi, Korea.
Geriatr Gerontol Int. 2013 Apr;13(2):307-13. doi: 10.1111/j.1447-0594.2012.00897.x. Epub 2012 Jun 15.
Although delusions are one of the most prominent psychiatric symptoms in Alzheimer's disease (AD), research on the subtypes, prevalence and associated factors of delusions, especially in drug (psychotropic)-naïve patients, has been limited.
Patients (n = 230) with psychotropic-naïve (drug-naïve) probable AD were assessed with the Korean Neuropsychiatric Inventory (K-NPI) delusion subscale at the time of initial presentation. After determining the four delusion subtypes (paranoid, misidentification, mixed and expansive delusion), clinical characteristics and prevalence of each type were compared.
Delusions were present in 63 patients (27.4%). Among those patients, paranoid delusions were the most common type of delusion (38, 60.3%), followed by misidentification delusions (12, 19.0%), then mixed delusions (11, 17.5%). Expansive delusions are rare in drug-naïve probable AD patients. Compared with paranoid delusions, misidentification and mixed delusions appeared at a later stage, and were associated with greater cognitive impairment. Mixed delusions were associated with hallucinations.
This study showed that delusions are associated with global cognitive dysfunction. Although paranoid delusions are the most common, misidentification and mixed delusions comprised significant portions of delusions in AD patients, and appeared in the later stages of dementia.
尽管妄想是阿尔茨海默病（AD）中最突出的精神症状之一，但对妄想的亚型、患病率和相关因素的研究，特别是在药物（精神类药物）初治患者中，一直很有限。
在初次就诊时，对 230 名未经精神药物治疗（药物初治）的可能 AD 患者使用韩国神经精神病学问卷（K-NPI）妄想分量表进行评估。在确定了妄想的四种亚型（偏执型、身份识别障碍型、混合型和夸大妄想型）后，比较了每种类型的临床特征和患病率。
63 名患者（27.4%）存在妄想。在这些患者中，偏执型妄想最常见（38 例，占 60.3%），其次是身份识别障碍型妄想（12 例，占 19.0%），然后是混合型妄想（11 例，占 17.5%）。在药物初治的可能 AD 患者中，扩张型妄想很少见。与偏执型妄想相比，身份识别障碍型和混合型妄想出现在更晚期，与认知功能障碍更严重相关。混合型妄想与幻觉有关。
本研究表明，妄想与整体认知功能障碍有关。虽然偏执型妄想最常见，但身份识别障碍型和混合型妄想在 AD 患者的妄想中占相当大的比例，并且出现在痴呆症的晚期。
