Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-26T22:04:08.929Z Has data issue: false hasContentIssue false
  • English
  • Français

Content of delusional thoughts in Alzheimer's disease and assessment of content-specific brain dysfunctions with BEHAVE-AD-FW and SPECT

Published online by Cambridge University Press:  22 February 2013

Masahiro Nakatsuka ,
Kenichi Meguro ,
Hiroshi Tsuboi ,
Kei Nakamura ,
Kyoko Akanuma  and
Satoshi Yamaguchi
Masahiro Nakatsuka
Affiliation:
Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
Kenichi Meguro*
Affiliation:
Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan The Osaki-Tajiri SKIP Center, Osaki, Miyagi, Japan
Hiroshi Tsuboi
Affiliation:
Department of Radiology, Osaki Citizen's Hospital, Osaki, Miyagi, Japan
Kei Nakamura
Affiliation:
Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
Kyoko Akanuma
Affiliation:
Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan The Osaki-Tajiri SKIP Center, Osaki, Miyagi, Japan
Satoshi Yamaguchi
Affiliation:
The Osaki-Tajiri SKIP Center, Osaki, Miyagi, Japan
*
Correspondence should be addressed to: Kenichi Meguro, MD, PhD, Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, 980-8575 Sendai, Japan. Phone: +81-22-717-7359; Fax: +81-22-717-7339. Email: k-meg@umin.ac.jp.
Get access

Abstract

Background: A consensus on the brain dysfunction(s) underlying the delusions of Alzheimer's Dementia (AD) remains to be achieved. The aim of the present study was to test the hypothesis that content-based categorization of delusional ideas manifests as dysfunction of category-specific brain regions.

Methods: Fifty-nine consecutive first-visit AD outpatients underwent Single Photon Emission Computed Tomography (SPECT), Mini-Mental State Examination, and Behavioral Pathology in Alzheimer's Disease Frequency-Weighted Severity scale (BEHAVE-AD-FW) to assess cerebral blood flow (CBF), cognitive function, and delusion, respectively. SPECT images were analyzed by SPM5.

Results: CBF decreased at the temporal poles and right inferior temporal gyrus in “delusion of theft,” at the temporal poles in “suspiciousness/paranoia,” at the right parahippocampal gyrus and insula in “abandonment,” and at the right amygdala in “Residence is not home.”

Conclusions: Our findings offer a perspective on the discrete categories of the pathological thoughts of AD patients that have previously been lumped together as “delusions.” Dysfunction of the temporal poles may be associated with a socioemotional deterioration that may include pathological suspiciousness. Delusion of theft may be a manifestation of socioemotional deterioration and poor insight. Emotional factors may be essential for delusions of abandonment and “not home.”

Keywords

dementiapsychosisbehaviorheterogeneity
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 6 , June 2013 , pp. 939 - 948
Copyright
Copyright © International Psychogeriatric Association 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Addis, D. R., McIntosh, A. R., Moscovitch, M., Crawley, A. P. and McAndrews, M. P. (2004). Characterizing spatial and temporal features of autobiographical memory retrieval networks: a partial least squares approach. Neuroimage, 23, 1460–1471.CrossRefGoogle ScholarPubMed
Aldhafeeri, F. M., Mackenzie, I., Kay, T., Alghamdi, J. and Sluming, V. (2012). Regional brain responses to pleasant and unpleasant IAPS pictures: different networks. Neuroscience Letter, 512, 94–98.CrossRefGoogle ScholarPubMed
Asada, T., Homma, A., Kimura, M. and Uno, M. (1999). Study on the reliability of the Japanese version of the BEHAVE-AD (in Japanese). Japanese Journal of Geriatric Psychiatry, 10, 825–834.Google Scholar
Ballard, C.et al. (2009). The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomized placebo-controlled trial. Lancet Neurology, 8, 151–157.CrossRefGoogle Scholar
Bruen, P. D., McGeown, W. J., Shanks, M. F. and Venneri, A. (2008). Neuroanatomical correlates of neuropsychiatric symptoms in Alzheimer's disease. Brain, 131, 2455–2463.CrossRefGoogle ScholarPubMed
Burns, A., Jacoby, R. and Levy, R. (1990). Psychiatric phenomena in Alzheimer's disease. I: disorders of thought content. British Journal of Psychiatry, 157, 72–6, 92–94.CrossRefGoogle ScholarPubMed
Cook, S. E.et al. (2003). Psychotic symptoms in Alzheimer disease: evidence for subtypes. American Journal of Geriatric Psychiatry, 11, 406–413.CrossRefGoogle ScholarPubMed
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
Etkin, A., Prater, K. E., Schatzberg, A. F., Menon, V. and Greicius, M. D. (2009). Disrupted amygdalar subregion functional connectivity and evidence of a compensatory network in generalized anxiety disorder. Archives of General Psychiatry, 66, 1361–1372.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatry Research, 12, 189–198.CrossRefGoogle Scholar
Fukuhara, R.et al. (2001). Alteration of rCBF in Alzheimer's disease patients with delusions of theft. Neuroreport, 12, 2473–2476.CrossRefGoogle ScholarPubMed
Gabrieli, J. D., Brewer, J. B., Desmond, J. E. and Glover, G. H. (1997). Separate neural bases of two fundamental memory processes in the human medial temporal lobe. Science, 276, 264–266.CrossRefGoogle ScholarPubMed
Hirono, N.et al. (1998). Alteration of regional cerebral glucose utilization with delusions in Alzheimer's disease. Journal of Neuropsychiatry and Clinical Neurosciences, 10, 433–439.CrossRefGoogle ScholarPubMed
Hwang, J. P., Tsai, S. J., Yang, C. H., Liu, K. M. and Lirng, J. F. (1999). Persecutory delusions in dementia. Journal of Clinical Psychiatry, 60, 550–553.CrossRefGoogle ScholarPubMed
Imon, Y., Matsuda, H., Ogawa, M., Kogure, D. and Sunohara, N. (1999). SPECT image analysis using statistical parametric mapping in patients with Parkinson's disease. Journal of Nuclear Medicine, 40, 1583–1589.Google ScholarPubMed
Ismail, Z., Nguyen, M. Q., Fischer, C. E., Schweizer, T. A., Mulsant, B. H. and Mamo, D. (2011). Neurobiology of delusions in Alzheimer's disease. Current Psychiatry Report, 13, 211–218.CrossRefGoogle ScholarPubMed
Jeste, D. V. and Finkel, S. I. (2000). Psychosis of Alzheimer's disease and related dementias. Diagnostic criteria for a distinct syndrome. American Journal of Geriatric Psychiatry, 8, 29–34.CrossRefGoogle ScholarPubMed
Jeste, D. V., Wragg, R. E., Salmon, D. P., Harris, M. J. and Thal, L. J. (1992). Cognitive deficits of patients with Alzheimer's disease with and without delusions. American Journal of Psychiatry, 149, 184–189.Google ScholarPubMed
Kales, H. C.et al. (2007). Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications. American Journal of Psychiatry, 164, 1568–1576; quiz 1623.CrossRefGoogle ScholarPubMed
Kalin, N. H., Shelton, S. E. and Davidson, R. J. (2004). The role of the central nucleus of the amygdala in mediating fear and anxiety in the primate. Journal of Neuroscience, 24, 5506–5515.CrossRefGoogle ScholarPubMed
Kross, E., Berman, M. G., Mischel, W., Smith, E. E. and Wager, T. D. (2011). Social rejection shares somatosensory representations with physical pain. Proceedings of Natural Academy of Science in USA, 108, 6270–6275.CrossRefGoogle ScholarPubMed
LeDoux, J. (2007). The amygdala. Current Biology, 17, R868–R874.CrossRefGoogle ScholarPubMed
Lopez, O. L., Smith, G., Becker, J. T., Meltzer, C. C. and DeKosky, S. T. (2001). The psychotic phenomenon in probable Alzheimer's disease: a positron emission tomography study. Journal of Neuropsychiatry and Clinical Neurosciences, 13, 50–55.CrossRefGoogle ScholarPubMed
Matsuoka, T.et al. (2010). Insular hypoperfusion correlates with the severity of delusions in individuals with Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 29, 287–293.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
Mega, M. S., Lee, L., Dinov, I. D., Mishkin, F., Toga, A. W. and Cummings, J. L. (2000). Cerebral correlates of psychotic symptoms in Alzheimer's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 69, 167–171.CrossRefGoogle ScholarPubMed
Monteiro, I. M., Boksay, I., Auer, S. R., Torossian, C., Ferris, S. H. and Reisberg, B. (2001). Addition of a frequency-weighted score to the behavioral pathology in Alzheimer's Disease Rating Scale: the BEHAVE-AD-FW: methodology and reliability. European Psychiatry, 16 (Suppl. 1), 5s–24s.CrossRefGoogle Scholar
Mychack, P., Kramer, J. H., Boone, K. B. and Miller, B. L. (2001). The influence of right frontotemporal dysfunction on social behavior in frontotemporal dementia. Neurology, 56, S11–S15.CrossRefGoogle ScholarPubMed
Nakano, S., Yamashita, F., Matsuda, H., Kodama, C. and Yamada, T. (2006). Relationship between delusions and regional cerebral blood flow in Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 21, 16–21.CrossRefGoogle ScholarPubMed
Nomura, K.et al. (2012). Classification of delusions in Alzheimer's disease and their neural correlates. Psychogeriatrics, 12, 200–210.CrossRefGoogle ScholarPubMed
Olson, I. R., Plotzker, A. and Ezzyat, Y. (2007). The enigmatic temporal pole: a review of findings on social and emotional processing. Brain, 130, 1718–1731.CrossRefGoogle Scholar
Paulsen, J. S.et al. (2000). Incidence of and risk factors for hallucinations and delusions in patients with probable AD. Neurology, 54, 1965–1971.CrossRefGoogle ScholarPubMed
Salmon, E.et al. (2006). Neural correlates of anosognosia for cognitive impairment in Alzheimer's disease. Human Brain Mapping, 27, 588–597.CrossRefGoogle ScholarPubMed
Shanks, M. F. and Venneri, A. (2004). Thinking through delusions in Alzheimer's disease. British Journal of Psychiatry, 184, 193–194.CrossRefGoogle ScholarPubMed
Staff, R. T., Shanks, M. F., Macintosh, L., Pestell, S. J., Gemmell, H. G. and Venneri, A. (1999). Delusions in Alzheimer's disease: SPECT evidence of right hemispheric dysfunction. Cortex, 35, 549–560.CrossRefGoogle ScholarPubMed
Staff, R. T., Venneri, A., Gemmell, H. G., Shanks, M. F., Pestell, S. J. and Murray, A. D. (2000). HMPAO SPECT imaging of Alzheimer's disease patients with similar content-specific autobiographic delusion: comparison using statistical parametric mapping. Journal of Nuclear Medicine, 41, 1451–1455.Google ScholarPubMed
Starkstein, S. E.et al. (1994). A SPECT study of delusions in Alzheimer's disease. Neurology, 44, 2055–2059.CrossRefGoogle ScholarPubMed
Sultzer, D. L.et al. (2003). Delusional thoughts and regional frontal/temporal cortex metabolism in Alzheimer's disease. American Journal of Psychiatry, 160, 341–349.CrossRefGoogle ScholarPubMed
Talairach, J. and Tournoux, P. (1988). Co-Planar Stereotactic Atlas of the Human Brain: 3-Dimensional Proportional System: An Approach to Cerebral Imaging. Stuttgart: Thieme.Google Scholar
Teng, E. L.et al. (1994). The Cognitive Abilities Screening Instrument (CASI): a practical test for cross-cultural epidemiological studies of dementia. International Psychogeriatric, 6, 45–58; discussion 62.CrossRefGoogle Scholar
Thompson, S. A., Patterson, K. and Hodges, J. R. (2003). Left/right asymmetry of atrophy in semantic dementia: behavioral-cognitive implications. Neurology, 61, 1196–1203.CrossRefGoogle ScholarPubMed
Wei, D. T., Qiu, J., Du, X. and Luo, Y. J. (2011). Emotional arousal to negative information after traumatic experiences: an event-related brain potential study. Neuroscience, 192, 391–397.CrossRefGoogle ScholarPubMed
Yoo, J. J.et al. (2012). When the brain is prepared to learn: enhancing human learning using real-time fMRI. Neuroimage, 59, 846–852.CrossRefGoogle ScholarPubMed