Tampi Rajesh R, Joshi Pallavi, Jeste Dilip V
Department of Psychiatry, Creighton University School of Medicine, 7710 Mercy Road, Suite 601, Omaha, NE 68124, USA; Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA.
Banner Alzheimer's Institute, 901 E Willetta St, Phoenix, AZ 85006, USA; Department of Psychiatry, University of Arizona College of Medicine-Phoenix, 475 N 5th, Phoenix, AZ 85004, USA.
Schizophr Res. 2025 Jul;281:82-90. doi: 10.1016/j.schres.2025.04.022. Epub 2025 May 3.
Dementia is one of the most common neurodegenerative disorders in the world, and 34-63 % of individuals with dementia have psychotic symptoms. Neurobiological correlates of dementia with psychosis include significantly increased densities of senile plaques and neurofibrillary tangles and higher D3 receptor density. Limitations of proposed diagnostic criteria include a lack of specificity for psychotic symptoms in individuals with dementia, a lack of consistent differentiation between symptoms, late recognition, and not accounting for comorbid depression or agitation that may be the primary symptom, which makes diagnosis challenging. This review aims to provide clinicians, researchers, and policymakers with a comprehensive evaluation of psychosis in dementia, covering its epidemiology, neurobiology, diagnosis, and treatment strategies. We review both psychosocial and pharmacological interventions for dementia-related psychosis. Psychosocial treatments such as meaningful communication between persons with dementia and their caregivers, simplifying the living environment, and optimizing tasks can help reduce the adverse impact of psychosis. Evidence from meta-analyses indicates modest efficacy for cholinesterase inhibitors, antidepressants, and antipsychotics for psychosis in dementia. The use of antipsychotic medications is limited by increased risks for serious adverse effects including cerebrovascular events and death. Emerging therapies such as xanomeline-trospium present promising avenues for treatment. By synthesizing current evidence and clinical guidelines, this review provides a framework for improving diagnosis and treatment of psychosis in dementia, helping clinicians and researchers refine patient care strategies while informing future research directions.
痴呆症是世界上最常见的神经退行性疾病之一，34%至63%的痴呆症患者有精神病性症状。伴有精神病性症状的痴呆症的神经生物学相关因素包括老年斑和神经原纤维缠结的密度显著增加以及D3受体密度升高。所提出的诊断标准的局限性包括对痴呆症患者的精神病性症状缺乏特异性、症状之间缺乏一致的区分、识别较晚，以及未考虑可能是主要症状的共病抑郁症或激越，这使得诊断具有挑战性。本综述旨在为临床医生、研究人员和政策制定者提供对痴呆症中精神病性症状的全面评估，涵盖其流行病学、神经生物学、诊断和治疗策略。我们综述了针对痴呆症相关精神病性症状的社会心理和药物干预措施。社会心理治疗，如痴呆症患者与其照顾者之间有意义的沟通、简化生活环境和优化任务，有助于减少精神病性症状的不良影响。荟萃分析的证据表明，胆碱酯酶抑制剂、抗抑郁药和抗精神病药对痴呆症中的精神病性症状有一定疗效。抗精神病药物的使用受到严重不良反应风险增加的限制，包括脑血管事件和死亡。新兴疗法如西诺美林-曲司氯铵为治疗提供了有前景的途径。通过综合当前证据和临床指南，本综述提供了一个改善痴呆症中精神病性症状诊断和治疗的框架，帮助临床医生和研究人员完善患者护理策略，同时为未来的研究方向提供信息。
