Psychosis in Alzheimer's Disease

The risk of psychotic symptoms in patients with Alzheimer's disease (AD) has been noted since the first case description of AD in 1907. Recent studies suggest that approximately a third of AD patients manifest psychosis at sometime during the course of their illness. Differentiating psychotic symptoms from the direct effects of cognitive dysfunction in AD can be challenging for clinicians and researchers. Nonetheless, the identification and treatment of such symptoms may be critical, as AD patients with psychosis may have a more rapid cognitive and functional decline, impose greater caregiver burden, and may be at increased risk of early institutionalization. Due to the potential side effects from neuroleptic medications, nonpharmacologic approaches to treatment should be considered, including environmental and behavioral modification and caregiver education. Some pharmacologic interventions may be necessary for symptoms not alleviated by these approaches, with specific elderly data for quetiapine and risperidone. Because there is no evidence for differential efficacy among the various neuroleptic medications, choice of an antipsychotic should be based on the side effect profiles of available medications weighed against the particular characteristics and situation of the individual patient.