Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Dec;77(12):e1564-e1569.
doi: 10.4088/JCP.15m10617.

Incident Psychosis in Subjects With Mild Cognitive Impairment or Alzheimer's Disease

Elise A Weamer  1 , Mary Ann A DeMichele-Sweet  2 , Yona K Cloonan  3 , Oscar L Lopez  1   2 , Robert A Sweet  4   1   2   5
Affiliations

Incident Psychosis in Subjects With Mild Cognitive Impairment or Alzheimer's Disease

Elise A Weamer et al. J Clin Psychiatry. 2016 Dec.

Abstract

Objective: To estimate the incidence of psychotic symptoms in Alzheimer's disease.

Methods: The study consists of 776 elderly subjects presenting to the Alzheimer Disease Research Center at the University of Pittsburgh (Pittsburgh, Pennsylvania) between May 9, 2000, and August 19, 2014. All participants were diagnosed with mild cognitive impairment (National Institute on Aging-Alzheimer's Association workgroup criteria) or possible or probable Alzheimer's disease (National Institute of Neurologic and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association criteria) and were without psychosis at entry. Psychotic symptoms were evaluated using the Consortium to Establish a Registry for Alzheimer's Disease Behavioral Rating Scale every 6 months. One-, 3- and 5-year cumulative incidences of psychosis were calculated.

Results: The 1-year psychosis incidence was 10% (95% CI, 8%-12%), and this annual rate remained remarkably consistent at 3 and 5 years. Psychosis incidence was related to cognitive status at all time points. However, the incidence rate reached a plateau during the disease course. Cumulative psychosis incidence at 5 years was 61% (95% CI, 52%-69%) in individuals with moderate to severe Alzheimer's disease, not statistically significantly different from the cumulative incidence at 3 years in this group, which was 48% (95% CI, 40%-55%) or from the 5-year incidence in individuals who entered the study with mild Alzheimer's disease, which was 48% (95% CI, 41%-56%).

Conclusions: Psychosis in Alzheimer's disease has been associated with a number of adverse clinical outcomes. We provide estimates of the risk of psychosis onset within clinically defined subgroups of individuals, a tool clinicians can use in treatment planning. Anticipating which subjects are at high risk for psychosis and the poor outcomes associated with it can help with family education and support decisions to implement nonpharmacologic strategies that may reduce or prevent symptoms.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Durations of Follow-Up and Number of Psychosis Assessments in 776 Elderly Outpatients With Mild Cognitive Impairment and Alzheimer’s Disease
A. Time From Study Entry to Last Psychosis Assessment For All Participants. B. Number of Assessments for Psychosis per Participant.
Figure 2
Figure 2
Cumulative Incidence of Psychosis and Recurrent/Multiple Psychosis
See this image and copyright information in PMC

References

    1. Murray PS, Kumar S, DeMichele-Sweet MA, et al. Psychosis in Alzheimer’s Disease. Biol Psychiatry. 2014;75:542–552. - PMC - PubMed
    1. Emanuel JE, Lopez OL, Houck PR, et al. Trajectory of cognitive decline as a predictor of psychosis in early Alzheimer disease in the cardiovascular health study. Am J Geriatr Psychiatry. 2011;19:160–168. - PMC - PubMed
    1. Seltman HJ, Mitchell S, Sweet RA. A Bayesian model of psychosis symptom trajectory in Alzheimer’s disease. Int J Geriatr Psychiatry. 2015 - PMC - PubMed
    1. Peters ME, Schwartz S, Han D, et al. Neuropsychiatric symptoms as predictors of progression to severe Alzheimer’s dementia and death: the Cache County Dementia Progression Study. Am J Psychiatry. 2015;172:460–465. - PMC - PubMed
    1. Scarmeas N, Brandt J, Albert M, et al. Delusions and hallucinations are associated with worse outcome in Alzheimer disease. Arch Neurol. 2005;62:1601–1608. - PMC - PubMed