Psychosis in Dementia

Abstract

Psychotic symptoms, such as delusions and hallucinations, are rather common at all stages of dementia. The concept of psychosis in dementia (PiD) is elusive, and the symptomatology may overlap with cognitive symptoms, delirium and other neuropsychiatric symptoms such as agitation and depression. Even though associations between biological markers and the occurrence of PiD exist, no clear causal factor has been identified. Also psychosocial and environmental factors may play a role in increasing the risk of PiD. Rather few treatment trials have focused specifically on PiD. As for other types of neuropsychiatric symptoms in dementia, non-pharmacological options should be the first-line treatment strategy. The evidence for the effects of psychotropic drugs in the treatment of PiD is weak. The best available evidence is for the short-term use of antipsychotic drugs. However, these drugs are associated with a number of serious adverse events, so the treatment needs to be monitored carefully. There is reason to believe that PiD defines a more severe phenotype of dementia, in terms of more rapid disease progression and greater dependency. Efforts to prevent or diminish these symptoms may benefit the patients and their caregivers considerably. (PsycInfo Database Record (c) 2023 APA, all rights reserved)