J Korean Neuropsychiatr Assoc.  2018 Aug;57(3):261-265. 10.4306/jknpa.2018.57.3.261.

Hippocampal Atrophy and Psychotic Symptoms in Patients with Alzheimer's Disease

• Jeong HJ
• Lee YM
• Park JM
• Lee BD
• Moon ES
• Kim SY
• Lee KY
• Kim JH
• Chung YI

• KMID: 2429231
• DOI: http://doi.org/10.4306/jknpa.2018.57.3.261

Abstract

OBJECTIVES
This study examined the difference in the volume or thickness of the medial temporal lobe between Alzheimer's disease patients with psychosis (AD+P) and those without psychosis (AD−P).
METHODS
Overall, 31 AD+P patients and 29 AD−P patients were included from the Memory impairment clinics of Pusan National University Hospital in Korea. AD+P was diagnosed according to Jeste and Finkel's proposed diagnostic criteria for psychosis of Alzheimer's disease. AD−P included AD patients with no psychotic symptoms during a 5-year follow-up period. Medial temporal volume or thickness was measured by 3-tesla MRI and freesufer analysis. Analysis of variance was used to examine the difference in the volume or thickness of medial temporal lobe between AP+P and AD−P after controlling for age, gender, education years, Clinical Dementia Rating scale-Sum of Box, and total intracranial volume.
RESULTS
The hippocampal volume in AD+P was smaller than that in AD−P.
CONCLUSION
These findings suggest that AD+P is associated with a reduced hippocampal volume.

Keyword

Alzheimer's disease; Psychotic symptoms; Medial temporal lobe; Hippocampus

MeSH Terms

Alzheimer Disease*
Atrophy*
Busan
Dementia
Education
Follow-Up Studies
Hippocampus
Humans
Korea
Magnetic Resonance Imaging
Memory
Psychotic Disorders
Temporal Lobe

Reference

1. Jeste DV, Finkel SI. Psychosis of Alzheimer's disease and related dementias. Diagnostic criteria for a distinct syndrome. Am J Geriatr Psychiatry. 2000; 8:29–34.

2. Schneider LS, Dagerman KS. Psychosis of Alzheimer's disease: clinical characteristics and history. J Psychiatr Res. 2004; 38:105–111.

3. Wilson RS, Tang Y, Aggarwal NT, Gilley DW, McCann JJ, Bienias JL, et al. Hallucinations, cognitive decline, and death in Alzheimer's disease. Neuroepidemiology. 2006; 26:68–75.

4. Scarmeas N, Brandt J, Albert M, Hadjigeorgiou G, Papadimitriou A, Dubois B, et al. Delusions and hallucinations are associated with worse outcome in Alzheimer disease. Arch Neurol. 2005; 62:1601–1608.

5. Kaufer DI, Cummings JL, Christine D, Bray T, Castellon S, Masterman D, et al. Assessing the impact of neuropsychiatric symptoms in Alzheimer's disease: the Neuropsychiatric Inventory Caregiver Distress Scale. J Am Geriatr Soc. 1998; 46:210–215.

6. Palaniyappan L, Balain V, Liddle PF. The neuroanatomy of psychotic diathesis: a meta-analytic review. J Psychiatr Res. 2012; 46:1249–1256.

7. Cummings J. Psychosis in neurologic disease: neurobiology and pathogenesis. Neuropsychiatry Neuropsychol Behav Neurol. 1992; 5:144–150.

8. Zubenko GS, Moossy J, Martinez AJ, Rao G, Claassen D, Rosen J, et al. Neuropathologic and neurochemical correlates of psychosis in primary dementia. Arch Neurol. 1991; 48:619–624.

9. Förstl H, Burns A, Levy R, Cairns N. Neuropathological correlates of psychotic phenomena in confirmed Alzheimer's disease. Br J Psychiatry. 1994; 165:53–59.

10. Serra L, Perri R, Cercignani M, Spanò B, Fadda L, Marra C, et al. Are the behavioral symptoms of Alzheimer's disease directly associated with neurodegeneration? J Alzheimers Dis. 2010; 21:627–639.

11. Howanitz E, Bajulaiye R, Losonczy M. Magnetic resonance imaging correlates of psychosis in Alzheimer's disease. J Nerv Ment Dis. 1995; 183:548–549.

12. Jack CR Jr, Knopman DS, Jagust WJ, Shaw LM, Aisen PS, Weiner MW, et al. Hypothetical model of dynamic biomarkers of the Alzheimer's pathological cascade. Lancet Neurol. 2010; 9:119–128.

13. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDSADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology. 1984; 34:939–944.

14. Okugawa G, Nobuhara K, Takase K, Saito Y, Yoshimura M, Kinoshita T. Olanzapine increases grey and white matter volumes in the caudate nucleus of patients with schizophrenia. Neuropsychobiology. 2007; 55:43–46.

15. Fischl B, Dale AM. Measuring the thickness of the human cerebral cortex from magnetic resonance images. Proc Natl Acad Sci U S A. 2000; 97:11050–11055.

16. Staff RT, Shanks MF, Macintosh L, Pestell SJ, Gemmell HG, Venneri A. Delusions in Alzheimer's disease: spet evidence of right hemispheric dysfunction. Cortex. 1999; 35:549–560.

17. Lopez OL, Smith G, Becker JT, Meltzer CC, DeKosky ST. The psychotic phenomenon in probable Alzheimer's disease: a positron emission tomography study. J Neuropsychiatry Clin Neurosci. 2001; 13:50–55.

18. Mentis MJ, Weinstein EA, Horwitz B, McIntosh AR, Pietrini P, Alexander GE, et al. Abnormal brain glucose metabolism in the delusional misidentification syndromes: a positron emission tomography study in Alzheimer disease. Biol Psychiatry. 1995; 38:438–449.

19. Malloy PF, Richardson ED. The frontal lobes and content-specific delusions. J Neuropsychiatry Clin Neurosci. 1994; 6:455–466.

20. Blackwood NJ, Howard RJ, Bentall RP, Murray RM. Cognitive neuropsychiatric models of persecutory delusions. Am J Psychiatry. 2001; 158:527–539.

21. Emanuel JE, Lopez OL, Houck PR, Becker JT, Weamer EA, Demichele-Sweet MA, et al. Trajectory of cognitive decline as a predictor of psychosis in early Alzheimer disease in the cardiovascular health study. Am J Geriatr Psychiatry. 2011; 19:160–168.

22. Weamer EA, Emanuel JE, Varon D, Miyahara S, Wilkosz PA, Lopez OL, et al. The relationship of excess cognitive impairment in MCI and early Alzheimer's disease to the subsequent emergence of psychosis. Int Psychogeriatr. 2009; 21:78–85.

23. Murray PS, Kirkwood CM, Gray MC, Ikonomovic MD, Paljug WR, Abrahamson EE, et al. Beta-Amyloid 42/40 ratio and kalirin expression in Alzheimer disease with psychosis. Neurobiol Aging. 2012; 33:2807–2816.

24. Farber NB, Rubin EH, Newcomer JW, Kinscherf DA, Miller JP, Morris JC, et al. Increased neocortical neurofibrillary tangle density in subjects with Alzheimer disease and psychosis. Arch Gen Psychiatry. 2000; 57:1165–1173.