Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA.
The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA.
Brain. 2021 Apr 12;144(3):999-1012. doi: 10.1093/brain/awaa413.
Although psychosis is a defining feature of Lewy body disease, psychotic symptoms occur in a subset of patients with every major neurodegenerative disease. Few studies, however, have compared disease-related rates of psychosis prevalence in a large autopsy-based cohort, and it remains unclear how diseases differ with respect to the nature or content of the psychosis. We conducted a retrospective chart review of 372 patients with autopsy-confirmed neurodegenerative pathology: 111 with Alzheimer's disease, 59 with Lewy body disease and concomitant Alzheimer's disease, 133 with frontotemporal lobar degeneration (FTLD) with tau inclusions (including progressive supranuclear palsy, corticobasal degeneration or Pick's disease), and 69 with FTLD and TDP inclusions (FTLD-TDP, including types A-C). Psychosis content was classified by subtype, and the frequency of each subtype was compared among pathological diagnoses using logistic regression. A total of 111 of 372 patients had psychosis. Compared to other groups, patients with Lewy body disease/Alzheimer's disease pathology were significantly more likely to have hallucinations and were more likely to have more than one subtype of hallucination. Patients with Braak Parkinson stage 5-6 Lewy body disease were significantly more likely than those with no Lewy body disease to have visual hallucinations of misperception, peripheral hallucinations, hallucinations that moved, hallucinations of people/animals/objects, as well as delusions regarding a place and delusions of misidentification. The feeling of a presence occurred significantly more frequently in patients with Lewy body disease/Alzheimer's disease than all other pathologies. Patients with FTLD-TDP were significantly more likely to have delusions, and for the delusions to occur in the first 3 years of the disease, when compared to patients with Alzheimer's disease and FTLD-tau, though rates were not significantly greater than patients with Lewy body disease/Alzheimer's disease. Paranoia occurred more frequently in the FTLD-TDP and Lewy body disease/Alzheimer's disease categories compared to patients with Alzheimer's disease or FTLD-tau. Patients with FTLD-TDP pathology had delusions of misidentification as frequently as patients with Lewy body disease/Alzheimer's disease, and were significantly more likely to have self-elevating delusions such as grandiosity and erotomania compared to patients with other pathologies including FTLD-tau. These data show that the nature and content of psychosis can provide meaningful information about the underlying neurodegenerative pathology, emphasizing the importance of characterizing patients' psychoses for prediction of the neuropathological diagnosis, regardless of a patient's clinical syndrome.
虽然精神病是路易体病的一个特征，但精神病症状发生在每一种主要神经退行性疾病的一部分患者中。然而，很少有研究比较过大样本量尸检队列中与疾病相关的精神病患病率，也不清楚疾病在精神病的性质或内容上有何不同。我们对 372 名经尸检证实的神经退行性病变患者进行了回顾性图表审查：111 名患有阿尔茨海默病，59 名患有路易体病和阿尔茨海默病并存，133 名患有伴有 tau 包涵体的额颞叶变性（包括进行性核上性麻痹、皮质基底节变性或 Pick 病），69 名患有伴有 TDP 包涵体的额颞叶变性（FTLD-TDP，包括 A-C 型）。通过亚型对精神病内容进行分类，并使用逻辑回归比较病理诊断中每种亚型的频率。372 名患者中共有 111 名患有精神病。与其他组相比，路易体病/阿尔茨海默病患者更有可能出现幻觉，并且更有可能出现多种类型的幻觉。患有 Braak 帕金森病 5-6 期路易体病的患者出现错觉性幻觉、周边幻觉、移动性幻觉、人/动物/物体幻觉以及对地点的妄想和身份识别障碍的妄想的可能性明显高于没有路易体病的患者。在路易体病/阿尔茨海默病患者中，存在感的感觉明显比所有其他病理学更频繁。FTLD-TDP 患者出现妄想的可能性明显高于阿尔茨海默病和 FTLD-tau 患者，并且妄想出现在疾病的前 3 年，尽管与路易体病/阿尔茨海默病患者相比，这种发生率并没有明显更高。偏执狂在 FTLD-TDP 和路易体病/阿尔茨海默病类别中比在阿尔茨海默病或 FTLD-tau 患者中更常见。FTLD-TDP 患者出现身份识别障碍的妄想与路易体病/阿尔茨海默病患者一样频繁，与包括 FTLD-tau 在内的其他病理学患者相比，出现自我提升妄想（如夸大狂和钟情妄想）的可能性明显更高。这些数据表明，精神病的性质和内容可以为潜在的神经退行性病理学提供有意义的信息，强调了为预测神经病理学诊断而对患者精神病进行特征描述的重要性，而不论患者的临床综合征如何。
