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Neurobiology of delusions, memory, and insight in Alzheimer disease.
- Source :
-
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry [Am J Geriatr Psychiatry] 2014 Nov; Vol. 22 (11), pp. 1346-55. Date of Electronic Publication: 2013 Sep 08. - Publication Year :
- 2014
-
Abstract
- Objective: Delusional thoughts are common among patients with Alzheimer disease (AD) and may be conceptually linked to memory deficits (cannot recall accurate information, which leads to inaccurate beliefs) and poor insight (unable to appreciate the illogic of beliefs). This study's goals were to examine the clinical associations among delusions, memory deficits, and poor insight; explore neurobiologic correlates for these symptoms; and identify shared mechanisms.<br />Methods: In a cross-sectional analysis, 88 outpatients with AD (mean Mini-Mental State Exam score: 19.3) were studied. Delusional thoughts were assessed with the Neuropsychiatric Inventory, level of inaccurate insight was assessed with the Neurobehavioral Rating Scale, and memory was assessed with the Mattis Dementia Rating Scale memory subscale. (18)F-fluorodeoxyglucose positron emission tomography was used to measure regional cortical metabolism. Relationships between clinical ratings and regional cortical metabolic activity (voxel-based) were assessed using SPM2.<br />Results: Patients with delusions had lower Dementia Rating Scale memory subscale scores. Neurobehavioral Rating Scale inaccurate insight scores were no different in those with and without delusions. Cortical metabolic activity was lower in the right lateral frontal cortex, orbitofrontal cortex, and bilateral temporal cortex in patients with delusions. Low cortical metabolic activity in the right lateral, inferior, and medial temporal cortex was associated with poorer memory. This region partially overlapped the region of hypometabolism associated with delusions. In contrast, low cortical metabolic activity in bilateral medial frontal cortex was associated with poor insight.<br />Conclusion: Delusions in AD are associated with dysfunction in specific frontal and temporal cortical regions. Delusions are partially clinically and neurobiologically linked to memory deficits but not to poor insight.<br /> (Published by Elsevier Inc.)
- Subjects :
- Aged
Alzheimer Disease complications
Alzheimer Disease metabolism
Brain metabolism
Comprehension
Cross-Sectional Studies
Delusions metabolism
Delusions psychology
Female
Humans
Male
Memory Disorders metabolism
Memory Disorders psychology
Neuroimaging
Neuropsychological Tests
Positron-Emission Tomography
Alzheimer Disease psychology
Delusions etiology
Memory Disorders etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1545-7214
- Volume :
- 22
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
- Publication Type :
- Academic Journal
- Accession number :
- 24021220
- Full Text :
- https://doi.org/10.1016/j.jagp.2013.06.005