هذیانها و توهمات در بیماری آلزایمر: چکیده ای از ده سال مغز

The authors reviewed studies published from 1990 to 2001 that address the epidemiology, phenomenology, course, etiology, assessment, and treatment of delusions and hallucinations in Alzheimer’s disease. The prevalence of delusions in Alzheimer’s disease patients ranged from 16% to 70% (median=36.5%) in the reviewed reports, and the prevalence of hallucinations ranged from 4% to 76% (median=23%). Delusions and hallucinations tended to persist over time, tended to recur often during the course of Alzheimer’s disease, and were associated with sociodemographic and clinical correlates that differed from one study to another and with substantial consequences such as functional impairment and aggression. Psychosocial methods and both typical and atypical antipsychotics are effective in the treatment of delusions and hallucinations in Alzheimer’s disease. Delusions and hallucinations are among the most common noncognitive neuropsychiatric symptoms seen in patients with dementia and have been reported to occur in a large proportion of patients with Alzheimer’s disease. Delusions and hallucinations strongly contribute to early institutionalization,1 reduce patients’ well-being, and increase the burden of the caregiver in managing the patient.2 Furthermore, these disturbances are associated with more rapid progression of the dementia syndrome.3 Recent advances in the treatment of Alzheimer’s disease, and of its associated neuropsychiatric symptoms, include both pharmacologic and nonpharmacologic interventions. Thus, the topic of delusions and hallucinations in Alzheimer’s disease is timely for several reasons. These symptoms are an important public health problem and are associated with additional disability in patients with Alzheimer’s disease. Effective treatments have been developed and are increasingly widely applied. Finally, study of the relationship between delusions or hallucinations and Alzheimer’s disease is likely to lead to improvements in our understanding of brain-behavior relationships.With these issues in mind, we review findings published from 1990 to 2001 regarding delusions and hallucinations in the context of Alzheimer’s disease with the aim of clarifying current knowledge in this area. Although earlier literature in this area did not differentiate the occurrence of delusions or hallucinations by type of dementia, it is now believed that such differentiation is important since the etiopathogenesis of the different types of dementia may be relevant in the etiopathogenesis of these phenomena as well. Thus, this review is focused as much as possible on Alzheimer’s disease.

Research since 1990 has added significant information to our knowledge of the nosology, epidemiology, and treatment of delusions and hallucinations in Alzheimer’s disease. It has also raised the question of whether delusions and hallucinations should be approached separately, as they have different risk factors, consequences, and imaging characteristics. Future study should focus on refinement of our understanding of the nosology, etiopathogenesis, and treatment of delusions and hallucinations in Alzheimer’s disease. This work will be best carried out in large, population-based, longitudinal studies, as well as in clinical samples. The use of imaging, genetic, and autopsy methods will be critical to the study of etiopathogenesis. Finally, research is needed on the combined use of nonpharmacologic and pharmacologic interventions as well as on use of medication from different classes and the use of combinations of medications. Specific information about dosing strategies, duration of treatment, long-term side effects, and long-term outcomes for the different medications used in the treatment of delusions and hallucinations in Alzheimer’s disease is also needed.