Department of Psychology, Kyungpook National University, Daegu, Republic of South Korea.
Department of Neuropsychiatry, Good Samsun Hospital, Busan, Republic of South Korea.
PeerJ. 2024 Sep 13;12:e18026. doi: 10.7717/peerj.18026. eCollection 2024.
Delusions in neurocognitive disorder due to Alzheimer's disease (AD) worsen patients' cognitive functions and activities of daily living (ADL), increasing caregiver burden and the risk of mortality. AD patients with delusions tend to experience a more rapid decline in cognition and have demonstrated poorer performance on various cognitive function tests. Considering the prognosis of delusion in AD patients, it tends to be more favorable with appropriate treatment. However, there is a lack of neuropsychological research, specifically examining the impact of delusions in AD, characterized by progressive deterioration of cognitive function. This study investigates the impact of delusions on cognitive function and ADL under conditions controlling for disease severity.
We compared cognitive function and ADL in AD patients aged 65 years or older according to the presence of delusions. To assess longitudinal change, we analyzed data from patients monitored for an average of 15 to 16 months. We assessed cognitive function and ADL using the Seoul Neuropsychological Screening Battery-Second Edition (SNSB-II) and delusions using the Neuropsychiatric Inventory (NPI). We used IBM SPSS Statistics version 25.0 for all statistical analyses. The analysis was not adjusted for multiple comparisons. We investigated how delusions impact cognitive function and ADL, controlling for age, educational level, and disease severity.
The delusions group exhibited poorer immediate recall of verbal memory than the non-delusions group. In the follow-up evaluation, patients who developed delusions had lower baseline cognitive function than those who did not, and their language fluency declined over time. In addition, we found the presence of delusions associated with worse functional impairment in ADL as the disease progressed.
While controlling for the severity of AD, we found no significant negative impacts of delusions on most cognitive functions. Nevertheless, it is noteworthy that the immediate recall of verbal memory and the Controlled Oral Word Association Test (COWAT)_animal sensitively detected the negative impact of delusions. Furthermore, since delusions are associated with worsening ADL, we understand that delusion treatment is important for improving the quality of life for patients and caregivers.
阿尔茨海默病（AD）所致神经认知障碍患者的妄想会恶化其认知功能和日常生活活动（ADL），增加照护者负担和死亡率。有妄想的 AD 患者认知功能下降更快，且在各种认知功能测试中表现更差。鉴于 AD 患者妄想的预后，适当治疗往往更有利。然而，目前缺乏神经心理学研究，专门研究认知功能逐渐恶化的 AD 患者的妄想的影响。本研究在控制疾病严重程度的情况下，研究妄想对认知功能和 ADL 的影响。
我们根据是否存在妄想，比较了年龄在 65 岁或以上的 AD 患者的认知功能和 ADL。为了评估纵向变化，我们分析了平均监测 15 至 16 个月的患者的数据。我们使用首尔神经心理学筛查量表第二版（SNSB-II）评估认知功能和 ADL，使用神经精神问卷（NPI）评估妄想。我们使用 IBM SPSS Statistics 版本 25.0 进行所有统计分析。分析未调整多重比较。我们调查了在控制年龄、教育水平和疾病严重程度的情况下，妄想如何影响认知功能和 ADL。
妄想组的言语记忆即时回忆比非妄想组差。在随访评估中，出现妄想的患者的基线认知功能低于未出现妄想的患者，且他们的语言流畅性随时间下降。此外，我们发现随着疾病的进展，存在妄想与 ADL 的功能障碍恶化相关。
在控制 AD 严重程度的情况下，我们发现妄想对大多数认知功能没有显著的负面影响。然而，值得注意的是，言语记忆的即时回忆和词语流畅性测试中的动物命名（COWAT）敏感地检测到了妄想的负面影响。此外，由于妄想与 ADL 的恶化相关，我们理解妄想的治疗对于提高患者和照护者的生活质量很重要。
