Current Psychiatry Reports

, Volume 1, Issue 1, pp 49–60 | Cite as

Neuropsychiatric aspects of alzheimer’s disease

  • Clive Ballard
  • Matthew Walker


The increase in research studies focusing on neuropsychiatric symptoms over the last decade has greatly increased our knowledge base, particularly with regard to the frequency of these symptoms and their impact on both patients and carers. We still have a poor understanding of the natural course of these symptoms and their biologic correlates, however, and more specific treatment studies are needed to inform clinical management.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Finkel S, Costa J, Silva E, et al.: Behavioural and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment. Int J Geriatr Psychiatry 1997, 12:1060–1061.CrossRefGoogle Scholar
  2. 2.
    Hope T, Keene J, Fairburn C, et al.: Behavioural changes in dementia 2: are there behavioural syndromes? Int J Geriatr Psychiatry 1997, 12:1074–1078.PubMedCrossRefGoogle Scholar
  3. 3.
    Gilley DW, Whalen ME, Wilson RS, et al.: Hallucinations and associated factors in Alzheimer’s disease. J Neuropsychiatry 1991, 3:371–376.Google Scholar
  4. 4.
    Rabins PV, Mace NL, Lucas MJ: The impact of dementia on the family. J Am Med Soc 1982, 248:333–335.Google Scholar
  5. 5.
    Deimling GT, Bass DM: Symptoms of mental impairment among elderly adults and their effects on family caregivers. J Gerontol 1986, 41:778–784.PubMedGoogle Scholar
  6. 6.
    Rockwell E, Jackson E, Vilke G, et al.: A study of delusions in a large cohort of Alzheimer’s disease patients. Am J Psychiatry 1994, 2:157–164.Google Scholar
  7. 7.
    Steele C, Rovner B, Chase GA, et al.: Psychiatric symptoms and nursing home placement of patients with Alzheimer’s disease. Am J Psychiatry 1990, 147:1049–1051.PubMedGoogle Scholar
  8. 8.
    Haupt M, Romero B, Kurz A: Psychotic symptoms in Alzheimer’s disease: results from a two year longitudinal study. Int J Geriatr Psychiatry 1996, 965–972.Google Scholar
  9. 9.
    Drevets WC, Rubin EH: Psychotic symptoms and the longitudinal course of senile dementia of the Alzheimer type. Biol Psychiatry 1989, 25:39–48.PubMedCrossRefGoogle Scholar
  10. 10.
    Rosen J, Zubenko GS: Emergence of psychosis and depression in the longitudinal evaluation of Alzheimer’s disease. Biol Psychiatry 1991, 29:2224–2232.CrossRefGoogle Scholar
  11. 11.
    Förstl H, Besthorn C, Geiger-Kabisch C, et al.: Psychotic features and the course of Alzheimer’s disease: relationship to cognitive electroencephalographic and computerised tomography. Acta Psychiatr Scand 1993, 87:395–399.PubMedGoogle Scholar
  12. 12.
    Chui HC, Lyness SA, Sobel E, et al.: Extrapyramidal signs and psychiatric symptoms predict faster cognitive decline in Alzheimer’s disease. Arch Neurol 1994, 51:676–681.PubMedGoogle Scholar
  13. 13.
    McShane R, Keene J, Gedling K, et al.: Do neuroleptic drugs hasten cognitive decline in dementia: prospective study with necropsy follow-up. Br Med J 1997, 314:266–270.Google Scholar
  14. 14.
    Reisberg G, Borenstein J, Salob S, et al.: Behavioural symptoms in Alzheimer’s disease: phenomenology and treatment. J Clin Psychiatry 1987, 47:9–15.Google Scholar
  15. 15.
    Devanand DP, Miller L, Richards M, et al.: The Columbia University Scale for Psychopathology in Alzheimer’s Disease. Arch Neurol 1992, 49:371–376.PubMedGoogle Scholar
  16. 16.
    Ballard CG, Saad K, Patel A, Gahir M, et al.: The prevalence and phenomenology of psychotic symptoms in dementia sufferers. Int J Geriatr Psychiatry 1995, 10:477–485.CrossRefGoogle Scholar
  17. 17.
    Allen NHP, Gordon S, Hope T, et al.: Manchester and Oxford Universities Scale for the Psychological Assessment of Dementia (MOUSEPAD). Br J Psychiatry 1996, 169:293–307.PubMedGoogle Scholar
  18. 18.
    Hope T, Fairburn CG: The Present Behavioural Examination: the development of an interview to measure current behavioural abnormalities. Psychol Med 1992, 22:223–230.PubMedGoogle Scholar
  19. 19.
    Cummings JL, Mega M, Gray K, et al.: The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994, 44:2308–2314.PubMedGoogle Scholar
  20. 20.
    Skoog I: The prevalence of psychotic, depressive, and anxiety syndromes in demented and non-demented 85 year olds. Int J Geriatr Psychiatry 1993, 8:247–253.CrossRefGoogle Scholar
  21. 21.
    Cohen CI, Hyland K, Magai C: Interracial and intraracial differences in neuropsychiatric symptoms, sociodemography, and treatment amongst nursing home patients with dementia. Gerontologist 1998, 38:353–361. The authors report a rigorous study of a cohort of more than 200 nursing home residents with dementia, identifying psychosis in more then 20%.PubMedGoogle Scholar
  22. 22.
    Burns A, Jacoby R, Levy R: Psychiatric phenomena in Alzheimer’s. Br J Psychiatry 1990, 157:72–96.PubMedGoogle Scholar
  23. 23.
    Ballard C, O’Brien J, Coope B, et al.: A prospective study of psychotic symptoms in dementia sufferers: psychosis in dementia. Int Psychogeriatrics 1997, 9:57–64.CrossRefGoogle Scholar
  24. 24.
    Ballard CG, O’Brien J, Lowery K, et al.: A prospective study of dementia with Lewy bodies. Age Ageing 1998, 27:631–636.PubMedCrossRefGoogle Scholar
  25. 25.
    Ballinger BR, Reid AH, Heather BB: Cluster analysis of symptoms in elderly demented patients. Br J Psychiatry 1982, 140:257–262.PubMedGoogle Scholar
  26. 26.
    Flynn GG, Cummings JL, Gorbein J: Delusions in dementia syndromes: investigation of behavioural and neuropsychological correlates. J Neuropsychiatry Clin Neurosci 1991, 3:364–370.PubMedGoogle Scholar
  27. 27.
    Cooper JK, Mungas D, Verma M, et al.: Psychotic symptoms in Alzheimer’s disease. Int J Geriat Psychiatry 1991, 6:721–726.CrossRefGoogle Scholar
  28. 28.
    Holroyd S, Sheldon-Keller A: A study of visual hallucinations in Alzheimer’s disease. Am J Geriatr Psychiatry 1995, 3:198–205.Google Scholar
  29. 29.
    Ballard C, Bannister C, Graham C, et al.: Associations of psychotic symptoms in dementia sufferers. Br J Psychiatry 1995, 167:537–540.PubMedGoogle Scholar
  30. 30.
    McShane R, Gedling K, Reading M, et al.: Prospective study of relations between cortical Lewy bodies, poor eyesight, and hallucinations in Alzheimer’s disease. J Neurol Neurosurg Psychiatry 1995, 59:185–188.PubMedGoogle Scholar
  31. 31.
    Cummings JL: Organic delusions: phenomenology, anecdotal correlation and review. Br J Psychiatry 1985, 146:184–197.PubMedGoogle Scholar
  32. 32.
    Zubenko GS, Moossy J, Marinez AJ, et al.: Neuropathological and neurochemical correlates of psychosis in primary dementia. Arch Neurol 1991, 48:619–624.PubMedGoogle Scholar
  33. 33.
    Förstl H, Burns A, Levy R, et al.: Neuropathological correlates of psychotic phenomena in confirmed Alzheimer’s disease. Br J Psychiatry 1994, 165:53–59.PubMedGoogle Scholar
  34. 34.
    Perry EK, Marshall E, Thompson P, et al.: Monoaminergic activities in dementia with Lewy bodies: relation to hallucinations and extrapyramidal features. J Neural Transm Park Dis Dement Sect 1993, 6:167–177.PubMedCrossRefGoogle Scholar
  35. 35.
    Binetti G, Bianchetti A, Padovani A, et al.: Delusions in Alzheimer’s disease and multi-infarct dementia. Acta Neurol Scand 1993, 88:5–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Kotrla KJ, Chacko RC, Harper RG, et al.: SPECT findings on psychosis in Alzheimer’s disease. Am J Psychiatry 1995, 152:1470–1475.PubMedGoogle Scholar
  37. 37.
    Patel V, Hope RA: Aggressive behaviour in elderly psychiatric in patients. Acta Psychiatr Scand 1992, 85:131–135.PubMedGoogle Scholar
  38. 38.
    Lachs MS, Becker M, Siegal AP, et al.: Delusions and behavioural disturbances in cognitively impaired elderly persons. J Am Geriatr Soc 1992, 40(Suppl 8):768–73.PubMedGoogle Scholar
  39. 39.
    Eastley R, Wilcock GK: Prevalence and correlations of aggressive behaviour occurring in patients with Alzheimer’s disease. Int J Geriatr Psychiatrists 1998, 12:484–487.CrossRefGoogle Scholar
  40. 40.
    Allen NHP, Burns A: The noncognitive features of dementia. Rev Clin Gerontology 1995, 5:57–75.Google Scholar
  41. 41.
    Cooper JK, Mungas D, Weiler PG: Relation of cognitive status and abnormal behaviours in Alzheimer’s disease. J Am Geriatr Soc 1990, 38:867–870.PubMedGoogle Scholar
  42. 42.
    Bondareff W, Mountjoy CQ, Roth M: Loss of neurons of origin of the adrenergic projection to cerebral cortex (nucleus locus coeruleus) in senile dementia. Neurology 1982, 32:164–168.PubMedGoogle Scholar
  43. 43.
    Eichelman B: Neurochemical and psychopharmacological aspects of aggressive behaviour. In In Psychopharmacology: The Third Generation of Progress. Edited by H.Y. Meltzer. New York: Raven; 1987:697–704.Google Scholar
  44. 44.
    Förstl H, Burns A, Levy R, et al.: Neuropathological correlates of behavioural disturbance in confirmed Alzheimer’s disease. Br J Psychiatry 1993, 163:364–368.PubMedGoogle Scholar
  45. 45.
    Mega MS, Cummings JL, Fiorello T, et al.: The spectrum of behavioural changes in Alzheimer’s disease. Neurology 1996, 46:130–135.PubMedGoogle Scholar
  46. 46.
    Cohen D, Eisdorfer C, Gorelick P, et al.: Psychopathology associated with Alzheimer’s disease and related disorders. J Gerontol 1993, 48:M255–260.PubMedGoogle Scholar
  47. 47.
    Hope T, Tilling K, Gedling K, et al.: The structure of wandering in dementia. Int J Geriatr Psychiatry 1994, 9:149–155.CrossRefGoogle Scholar
  48. 48.
    Schneider LS, Pollock VE, Lyness SA: A meta-analysis of controlled trials of neuroleptic treatment in dementia. J Am Geriatr Soc 1990, 38:553–563.PubMedGoogle Scholar
  49. 49.
    Ballard CG, O’Brien J: Pharmacological treatment of behavioural and psychological signs in Alzheimer’s disease: how good is the evidence for current pharmacological treatments. Br Med J In press.Google Scholar
  50. 50.
    Burns A, Craig S: Neuroleptics in the treatment of Alzheimer’s disease (abstract). Neurobiol Ageing 1998, 19(Suppl 4):450.Google Scholar
  51. 51.
    Katz IR, Jeste DV, Mintzer JE, et al.: Comparison of risperidone and placebo for psychosis and behavioural disturbances associated with dementia: a randomized double blind trial. J Clin Psychiatry 1999, 60:107–115. Although disparate symptoms were grouped together for the main analysis, this paper is important as the largest double-blind placebocontrolled trial of a pharmaceutical treatment for BPSD. Although BPSD scores decreased significantly mor ein the risperidone-treated patients, the difference in the proportion of people with a clinically significant response was 68% on active treatment, compared with 61% on placebo, supporting the conclusions from previous reports, which indicate a significant but modest benefit from neurologic treatment.PubMedCrossRefGoogle Scholar
  52. 52.
    Sweet RA, Pollock BG: Neuroleptics in the elderly: guidelines for monitoring. Harvard Rev Psychiatry 1995, 2:327–335.Google Scholar
  53. 53.
    Tariot PN, Erb R, Leibovici A, et al.: Carbamazepine treatment of agitation in nursing home patients with dementia: a preliminary study. J Am Geriatr Soc 1994, 42:1160–1166.PubMedGoogle Scholar
  54. 54.
    Sultzer D, Gray KF, Guny I, et al.: A double blind comparison of trazadone and haloperidol for the treatment of agitation in patients with dementia. Am J Geriatr Psychiatry 1997, 7:60–69.Google Scholar
  55. 55.
    Carlston D, Fleming K, Smith G: Management of dementiarelated behavioural disturbances: a non-pharmacologic approach. Mayo Clin Proc 1995, 70:1108–1115.Google Scholar
  56. 56.
    Sirval RC, Vingerhoets RW, Haffmans PMJ, et al.: Effect of a program of diverse activities on disturbed behaviour in three severely demented patients. Int Psychogeriatr 1997, 4:423–430.CrossRefGoogle Scholar
  57. 57.
    Goddaer J, Abraham I: Effects of relaxing music on agitation during meals among nursing home residents with severe cognitive impairment. Arch Psychiatr Nurs 1994, 8:150–158.PubMedCrossRefGoogle Scholar
  58. 58.
    Raskind MA, Sadowsky CH, Sigmund WR, et al.: Effect of tacrine on language, praxis and noncognitive behavioural problems in Alzheimer’s disease. Arch Neurol 1997, 54:836–40.PubMedGoogle Scholar
  59. 59.
    Cummings JL, Masterman DL: Assessment of treatmentassociated changes in behavior and cholinergic therapy of neuropsychiatric symptoms in Alzheimer’s disease. J Clin Psychiatry 1998, 59(Suppl 13):23–30. Based on a secondary analysis from a cohort of patients selected for cognitive deficits, this paper suggests that cholinesterase inhibitors may improve certain BPSD symptoms, particularly psychosis and apathy. There is a clear need for specific trials of cholinesterase inhibitors for the treatment of psychosis in dementia.PubMedGoogle Scholar
  60. 60.
    Greenwald BS, Kramer-Ginsberg E, Marin DB, et al.: Dementia with co-existent major depression. Am J Psychiatry 1989, 146:1472–1478.PubMedGoogle Scholar
  61. 61.
    Fitz AE, Teri L: Depression, cognition and functional ability in patients with Alzheimer’s disease. J Am Geriatr Soc 1994, 42:186–191.PubMedGoogle Scholar
  62. 62.
    Burns A: Affective symptoms in Alzheimer’s disease. Int J Geriatr Psychiatry 1991, 6:371–376.CrossRefGoogle Scholar
  63. 63.
    Burns A, Lewis G, Jacoby R, et al.: Factors affecting survival in Alzheimer’s disease. Psychol Med 1991, 21:363–370.PubMedGoogle Scholar
  64. 64.
    Greene JG, Smith R, Gardiner M, et al.: Measuring behavioural disturbance of elderly demented patients in the community and its effects on relatives: a factor analytic study. Age Ageing 1982, 11:121–126.PubMedCrossRefGoogle Scholar
  65. 65.
    Burke WJ, Houston MJ, Boust ST, et al.: Use of the geriatric depression scale in dementia of the Alzheimer type. J Am Geriatr Soc 1989, 37:856–860.PubMedGoogle Scholar
  66. 66.
    Kafonek S, Ettinger NH, Roco R: Instruments for screening for depression and dementia in a long term care facility. J Am Geriatr Soc 1989, 37:29–34.PubMedGoogle Scholar
  67. 67.
    Lichtenberg PA, Steiner DA, Marcopulos BA, et al.: Comparison of the Hamilton Depression Rating Scale and the Geriatric Depression Rating Scale: detection of depression in dementia patients. Psychol Rep 1992, 70:515–521.PubMedCrossRefGoogle Scholar
  68. 68.
    Sunderland T, Alterman IS, Yount D, et al.: A new scale for the assessment of depressed mood in dementia patients. Am J Psychiatry 1988, 145:955–959.PubMedGoogle Scholar
  69. 69.
    Alexopoulos GS, Abrams RC, Young RC, et al.: Cornell Scale for depression in dementia. Biol Psychiatry 1988, 23:271–184.PubMedCrossRefGoogle Scholar
  70. 70.
    Ballard CG, Bannister C, Solis M, et al.: The prevalence, associations and symptoms of depression amongst dementia sufferers. J Affect Disord 1996, 36:135–144.PubMedCrossRefGoogle Scholar
  71. 71.
    Ballard C, Coope B, Oyebode F, et al.: Depression in dementia sufferers: a comparison of diagnostic criteria. J Am Geriatr Soc 1997, 45:123–124.PubMedGoogle Scholar
  72. 72.
    Spitzer RL, Endicott J, Robins E, et al.: Research diagnostic criteria: rationale and reliability. Arch Gen Psychiatry 1978, 35:773–782.PubMedGoogle Scholar
  73. 73.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, revised 3rd edition. Washington, DC: American Psychiatric Association; 1987.Google Scholar
  74. 74.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington, DC: American Psychiatric Association; 1994.Google Scholar
  75. 75.
    World Health Organization: International Classification of Disease, 10th edition. Geneva: World Health Organization; 1992.Google Scholar
  76. 76.
    Pozzi D, Golimstock A, Migliorelli R, et al.: Quantified Electroencephaographic correlates of depression in Alzheimer’s disease. Biol Psychiatry 1993, 34:386–391.PubMedCrossRefGoogle Scholar
  77. 77.
    Ballard CG, Bannister C, Oyebode F: Review: depression in dementia sufferers. Int J Geriat Psychiatry 1996, 11:507–515.CrossRefGoogle Scholar
  78. 78.
    O’Connor DW, Pollit PA, Roth M, et al.: Co-existing depression and dementia in a community survey of the elderly. Int Psychogeriatrics 1990, 2:45–53.CrossRefGoogle Scholar
  79. 79.
    Cooper B, Schwarz R: Psychiatric case identification in an elderly urban population. Soc Psychiatry 1982, 17:43–52.CrossRefGoogle Scholar
  80. 80.
    Forsell Y, Jorm AF, Winblad B: Outcome of depression in demented and non-demented elderly: observations from a 3 year follow-up in a community based study. Int J Geriatr Psychiatry 1994, 9:5–10.CrossRefGoogle Scholar
  81. 81.
    Forsell Y, Winblad B: Major depression in a population of demented and non-demented old people: prevalence and correlates. J Am Geriatr Soc 1998, 46:27–30.PubMedGoogle Scholar
  82. 82.
    Henderson AS: Concurrence of affective and cognitive symptoms: the epidemiological evidence. Dementia 1990, 1:119–123.Google Scholar
  83. 83.
    Snowden J, Lane F: Outcome of depression in dementia. Int J Geriatr Psychiatry 1994, 9:589–591.CrossRefGoogle Scholar
  84. 84.
    Lopez OL, Boller F, Becker JT, et al.: Alzheimer’s disease and depression: neuropsychological impairment and progression of the illness. Am J Psychiatry 1990, 147:855–860.PubMedGoogle Scholar
  85. 85.
    Knesevich JW, Martin RL, Berg L, et al.: A preliminary report on affective symptoms in the early stages of senile dementia of the Alzheimer type. Am J Psychiatry 1983, 140:233–235.PubMedGoogle Scholar
  86. 86.
    Ballard CG, Patel A, Solis M, et al.: A one-year follow-up study of depression in dementia sufferers. Br J Psychiatry 1996, 168:287–291.PubMedGoogle Scholar
  87. 87.
    Brodaty H, Luscombe G: Depression in persons with dementia. Int Psychogeriat 1996, 8:609–622.CrossRefGoogle Scholar
  88. 88.
    Starkstein SE, Chamerinski E, Sabe L, et al.: A prospective longitudinal study of depression and anosognosia in Alzheimer’s disease. Br J Psychiatry 1997, 171:47–52.PubMedGoogle Scholar
  89. 89.
    Reifler BV, Larson E, Hanley R: Co-existence of cognitive impairment and depression in geriatric outpatients. Am J Psychiatry 1982, 139:623–626.PubMedGoogle Scholar
  90. 90.
    Teri L, Wagner AW: Assessment of depression in patients with Alzheimer’s disease: concordance among informants. Psychol Aging 1991, 6:280–285.PubMedCrossRefGoogle Scholar
  91. 91.
    Reifler BV, Teri L, Raskind M, et al.: Double blind trial of imipramine in Alzheimer’s disease patients with and without depression. Am J Psychiatry 1989, 146:45–49.PubMedGoogle Scholar
  92. 92.
    Mullen R, Howard R, David A, et al.: Insight in Alzheimer’s disease. Int Geriatr Psychiatry 1996, 11:645–652.CrossRefGoogle Scholar
  93. 93.
    Rovner BW, Broadhead J, Spencer M, et al.: Depression and Alzheimer’s disease. Am J Psychiatry 1989, 146:350–353.PubMedGoogle Scholar
  94. 94.
    Pearlson GD, Ross CA, Lohr WD, et al.: Association between family history of affective disorders and the depressive syndrome of Alzheimer’s disease. Am J Psychiatry 1990, 147:452–456.PubMedGoogle Scholar
  95. 95.
    Orrell M, Bebbington P: Life events in senile dementia: affective symptoms. Br J Psychiatry 1995, 166:613–620.PubMedGoogle Scholar
  96. 96.
    Zubenko GS, Moossy J: Major depression in primary dementia: clinical and neuropathologic correlates. Arch Neurol 1988, 45:1182–1186.PubMedGoogle Scholar
  97. 97.
    Zweig RM, Ross CA, Hedreen JC, et al.: The neuropathology of the aminergic nucei in Alzheimer’s disease. Ann Neurol 1988, 24:233–242.PubMedCrossRefGoogle Scholar
  98. 98.
    Förstl H, Burns A, Luthert P, et al.: Clinical and neuropathological correlations of depression in Alzheimer’s disease. Psychol Med 1992, 22:877–884.PubMedCrossRefGoogle Scholar
  99. 99.
    Hoogendijk WJG, Feenstra MGP, Sommer W, et al.: Do clinicopathological correlates in depressed or agitated AD patients provide a rationale for specific pharmacotherapeutic strategies? (Abstract) Neurobiol Aging 1998, 19(suppl 4):949.Google Scholar
  100. 100.
    Roth M, Mountjoy CQ, Amerein R: Moclobemide in elderly patients with cognitive decline and depression: an international double blind placebo controlled trial. Br J Psychiatry 1996, 168:149–157.PubMedGoogle Scholar
  101. 101.
    Fuchs A, Hehnke U, Erhardt C, et al.: Video rating analysis of effect of maprotiline in patients with depression and dementia. Pharmacopsychiatry 1993, 26:37–41.PubMedCrossRefGoogle Scholar
  102. 102.
    Katona CL, Hunter BN, Bray J: A double blind comparison of the efficacy and safety of paroxetine and imipramine in the treatment of depression with dementia. Int J Geriatr Psychiatry 1998, 13:100–108. There are very few double-blind trials focusing in the treatment of depression in dementia, and most of the literature suggests relatively little benefit for tricyclic antidepressants over placebo. This study, which suggests that paroxetine is significantly more efficacious imipramine in hence extremely interesting, with potentially important implications for treatment and mechanisms. Further treatment studies with selective serotonin re-uptake inhibitors, however, are required.PubMedCrossRefGoogle Scholar
  103. 103.
    Nyth AL, Gottfries CG: The clinical efficacy of citalopram in treatment of emotional disturbances in dementia disorders: a nordic multi-centre study. Br J Psychiatry 1990, 157:894–901.PubMedCrossRefGoogle Scholar
  104. 104.
    Teri L, Logsdon RG, Homoto J: Behavioural treatment of depression in dementia patients: a controlled clinical trial. J Gerontol B Psychol Sci Soc Sci 1997, 52:159–166.Google Scholar
  105. 105.
    Flacker JM, Marcantonio ER: Delirium in the elderly: optimal management. Drugs Aging 1998, 13:119–130.PubMedCrossRefGoogle Scholar
  106. 106.
    Jacobson SA: Delirium in the elderly. Psychiatr Clin North Am 1997, 20:91–110.PubMedCrossRefGoogle Scholar
  107. 107.
    Trzepacz PT, Mulsant BH, Dew MA: Is delirium different when it occurs in dementia? A study using the delirium rating scale. J Neuropsychiatry Clin Neurosci 1998, 10:199–204.PubMedGoogle Scholar
  108. 108.
    Litvan I, MacIntyre A, Goetz CG, et al.: Accuracy of the clinical diagnoses of Lewy body disease, Parkinson disease, and dementia with Lewy bodies: a clinicopathologic study. Arch Neurol 1998, 55:969–978. This study evaluates the accuracy with which dementia with Lewy bodies and Parkinson’s disease can be diagnosed retrospectively applying operationalized clinical criteria to cases with confirmed neuropathologic diagnoses. It investigates the value of assessing specific features for both conditions, including fluctuating levels of confusion (FC) and highlights some of the difficulties with the reliable clinical identification of FC.PubMedCrossRefGoogle Scholar
  109. 109.
    McKeith IG, Galasko D, Kosaka K, et al.: Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology 1996, 47:1113–1124.PubMedGoogle Scholar
  110. 110.
    Mega MS, Masterman Dl, Benson DF, et al.: Dementia with Lewy bodies: reliability and validity of clinical and pathologic criteria. Neurology 1996, 47:1403–1409.PubMedGoogle Scholar
  111. 111.
    Walker MP, Ayre GA, Ashton CH, et al.: A psychophysiological investigation of fluctuating consciousness in neurodegenerative dementia. J Hum Psychopharmacology, in press.Google Scholar
  112. 112.
    Perry EK, Walker MP, Grace J, et al.: Acetylcholine in mind: a neurotransmitter correlate of consciousness. Trends Neurosci 1999, 22:273–280. This paper provides a comprehensive review of the evidence regarding the role of acetylcholine in the generation of human consciousness, concluding t hat acetylcholine is an important correlate of this phenomenon. The importance of exploring degenerative dementias as potential models of altered states of consciousness is also discussed.PubMedCrossRefGoogle Scholar
  113. 113.
    Walker M, Ballard CG: Dementia with Lewy bodies. CNS 1998, 47:1113–1124.Google Scholar
  114. 114.
    Lebert F, Pasquier F, Petit H: Sundowning syndrome in demented patients without neuroleptic therapy. Arch Gerontol Geriatr 1996, 22:49–54.PubMedCrossRefGoogle Scholar
  115. 115.
    Bliwise DL (1989) Dementia. In Principles and Practice of Sleep Medicine. Edited by Kryger M, Roth T, WC D. Philadelphia: WB Saunders; 1989:358–364.Google Scholar
  116. 116.
    Mishim K, Okawa M, Hishikawa Y, et al.: Morning bright light therapy for sleep and behaviour disorders in elderly patients with dementia. Acta Psychiatrica Scand 1994, 89:1–7.Google Scholar
  117. 117.
    Hirono N, Mori E, Yasuda M: Factors associated with psychotic symptoms in Alzheimer’s disease. J Neurol Neurosurg Psychiatry 1998, 64:648–652.PubMedGoogle Scholar
  118. 118.
    Gilley DW, Wilson RS, Becket LA, et al.: Psychotic symptoms and physically aggressive behaviour in Alzheimer’s disease. Am Geriatr Soc 1997, 45:1074–1079.Google Scholar
  119. 119.
    Sultzer DL, Levin HS, Mahler ME: A comparison of psychiatric symptoms in vascular dementia and Alzheimer’s disease. Am J Psychiatry 1993, 150:1806–1812.PubMedGoogle Scholar
  120. 120.
    Ballard CG, Chithiramohan RN, Bannister C, et al.: Paranoid features in the elderly with dementia. Int J Geriatr Psychiatry 1991, 6:155–157.CrossRefGoogle Scholar
  121. 121.
    Jost BC, Grossberg GT: The evolution of psychiatric symptoms in Alzheimer’s disease: a natural history study. J Am Geriatr Soc 1996, 44:1078–81.PubMedGoogle Scholar
  122. 122.
    Cummings JL, Miller B, Hill MA, et al.: Neuropsychiatric aspects of multi-infarct dementia and dementia of the Alzheimer type. Arch Neurol 1987, 44:389–393.PubMedGoogle Scholar
  123. 123.
    Mortimer JA, Ebbitt B, Sung-Pyo J: Predictors of cognitive and functional progression in patients with probable Alzheimer’s disease. Neurology 1992, 42:1696.Google Scholar
  124. 124.
    Jeste DV, Wragg RE, Salmon DP, et al.: Cognitive deficits of patients with Alzheimer’s disease with and without delusions. Am J Psychiatry 1992, 149:184–189.PubMedGoogle Scholar
  125. 125.
    Migliorelli R, Petracca G, Teson A, et al.: Neuropsychiatric and neuropsychological correlates of delusions in Alzheimer’s disease. Psychol Med 1995, 25:505–5013.PubMedCrossRefGoogle Scholar
  126. 126.
    Morriss RK, Rovner BW, Folstein MF: Delusions in newly admitted residents of nursing homes. Am J Psychiatry 1990, 147:299–302.PubMedGoogle Scholar
  127. 127.
    Rovner BW, Kajonck S, Filipp L, et al.: The prevalence of mental illness in a community nursing home. Am J Psychiatry 1986, 143:1446–1449.PubMedGoogle Scholar
  128. 128.
    Chandler JD, Chandler JE: The prevalence of neuropsychiatric disorders in a nursing home population. J Geriatr Psychiatry Neurol 1988, 1:71–76.PubMedCrossRefGoogle Scholar
  129. 129.
    Lopez OL, Gonzalez MP, Becker JT: Symptoms of depression and psychosis in Alzheimer’s disease and frontotemporal dementia: exploration of underlying mechanisms. Neuropsychiatry Neuropsychol Behav Neurol 1996, 9:154–161.Google Scholar
  130. 130.
    Deutsch LH, Bylsma FW, Rovner BW: Psychosis and physical aggression in probable Alzheimer’s disease. Am J Psychiatry 1991, 148:1159–1163.PubMedGoogle Scholar
  131. 131.
    Patterson MB, Schnell AH, Martin RJ: Assessment of behavioural and affective symptoms in Alzheimer’s disease. J Geriatr Psychiatry 1990, 3:21–30.CrossRefGoogle Scholar
  132. 132.
    Lopez OL, Becker JT, Brenner RP: Alzheimer’s disease with delusions and hallucinations: neuropsychological and electroencephalographic correlates. Neurology 1991, 41:906–912.PubMedGoogle Scholar
  133. 133.
    Rubin EH, Drevets WC, Burke WJ, et al.: The nature of psychotic symptoms in senile dementia of the Alzheimer type. J Geriatr Psychiatry Neurol 1988, 1:16–20.PubMedCrossRefGoogle Scholar
  134. 134.
    Abse DW, Dahlstrom WG, Hill C: The value of chemotherapy in senile mental disturbance. JAMA 1960, 174:2036–2042.PubMedGoogle Scholar
  135. 135.
    Hamilton LD, Bennett JL: The use of trifluoperazine in geriatric patients with chronic brain syndrome. J Am Geriatr Soc 1962, 10:140–147.PubMedGoogle Scholar
  136. 136.
    Hamilton LD, Bennett JL: Acetophenazine for hyperactive geriatric patients. Geriatrics 1962, 17:596–601.PubMedGoogle Scholar
  137. 137.
    Sugarman AA, Williams BH, Alderstein AM: Halperidol in the psychiatric disorders of old age. Am J Psychiatry 1964, 120:1190–1192.Google Scholar
  138. 138.
    Rada RT, Kellner R: Thiothixene in the treatment of geriatric patients with chronic organic brain syndrome. J Am Geriatr Soc 1976, 3:105–107.Google Scholar
  139. 139.
    Petrie WM, Ban TA, Berney S: Loxapine in psychogeriatrics: a placebo-and standard-controlled clinical investigation. J Clin Psychopharmacol 1982, 2:122–126.PubMedCrossRefGoogle Scholar
  140. 140.
    Barnes R, Veith R, Okimoto J: Efficacy of antipsychotic medications in behaviourally disturbed dementia patients. Am J Psychiatry 1982, 139:1170–1174.PubMedGoogle Scholar
  141. 141.
    Cahn LA, Diesfeldt HFA: The use of neuroleptics in the treatment of dementia in old age. Psychiatr Neurol Neurochir (Amst) 1973, 76:411–420.Google Scholar
  142. 142.
    Finkel SI, Lyons JS, Anderson RL, et al.: A randomised, placebo controlled trial of thiothixene in agitated demented nursing home patients. Int J Geriatr Psychiatry 1995, 10:129–136.CrossRefGoogle Scholar

Copyright information

© Current Science Inc 1999

Authors and Affiliations

  • Clive Ballard
    • 1
  • Matthew Walker
    • 1
  1. 1.MRC Neurochemical Pathology UnitNewcastle General HospitalNewcastle upon TyneUK

Personalised recommendations