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, Landin-Romero Ramon
School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.
Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.
Int J Geriatr Psychiatry. 2022 Mar;37(3). doi: 10.1002/gps.5692.
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.
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.
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.
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.
已有报道称部分痴呆患者存在异常信念和妄想，但妄想的患病率及其神经认知基础尚未得到充分研究。本研究旨在采用跨诊断、横断面研究方法，对一大群特征明确的痴呆患者队列中的妄想的存在情况、严重程度、内容及神经相关性进行研究。
招募了487名痴呆患者：102例阿尔茨海默病患者、136例行为变异型额颞叶痴呆患者、154例原发性进行性失语患者、29例运动神经元病患者、46例皮质基底节综合征患者、20例进行性核上性麻痹患者。所有患者均接受了神经心理学评估和脑磁共振成像检查，由经验丰富的临床医生对知情者进行神经精神科量表测评。
在我们的队列中，487名患者中有48名（10.8%）存在妄想。行为变异型额颞叶痴呆（18.4%）和阿尔茨海默病（11.8%）的诊断与妄想风险增加相关。在27名有妄想的患者中，有11名检测到阳性基因突变。妄想频繁的个体在Addenbrooke认知检查中的表现较差（p = 0.035），尤其是在定向/注意力（p = 0.022）和记忆（p = 0.013）子测试中。基于体素的形态学分析发现，妄想性精神病理学的增加与右侧额中回、右侧颞平面和左侧颞极前部完整性降低有关。
我们的研究结果表明，妄想在痴呆中相对常见，并揭示了与妄想表现相关的独特认知和神经特征。临床上，妄想可能导致诊断延迟或误诊。我们的研究结果有助于了解如何识别有痴呆神经精神特征风险的个体，这是实现针对性症状管理的关键第一步。
