Background: Although delusion is one of the common symptoms of Alzheimer's disease (AD), the association between cognitive deficits and delusions remains unclear. Considering the heterogeneity of delusion, the correlation may depend upon the type of the delusion. Methods: 142 consecutive first-visit AD outpatients of the Tajiri Clinic (Osaki, Miyagi, Japan) were enrolled in the study. Psychological data included the Mini-Mental State Examination (MMSE), the Cognitive Abilities Screening Instrument (CASI) and the Frequency-Weighted Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD-FW). Correlations to cognitive deficits for each category of delusional content were evaluated. Results: More severe delusion of ‘residence is not home' was significantly correlated with a lower total MMSE score and poorer orientation as assessed with the CASI. This type of delusion also correlated to activity disturbances and was weakly associated with affective disturbances. Conclusion: Our findings suggest that the ‘residence is not home' delusion is a particular symptom that has a cognitive background, particularly disorientation, and should be discriminated from other delusional phenomena. We should cope with delusions specifying what types of delusions are present since the content of delusions may critically mark the symptomatology of AD. For this purpose, the BEHAVE-AD-FW may be suitable.

Keywords:
Dementia, Psychosis, Behavior, Heterogeneity, Alzheimer’s disease
1.
Fischer CE, Ismail Z, Schweizer TA: Delusions increase functional impairment in Alzheimer's disease. Dement Geriatr Cogn Disord 2012;33:393-399.
2.
Matsumoto N, Ikeda M, Fukuhara R, Shinagawa S, Ishikawa T, Mori T, Toyota Y, Matsumoto T, Adachi H, Hirono N, Tanabe H: Caregiver burden associated with behavioral and psychological symptoms of dementia in elderly people in the local community. Dement Geriatr Cogn Disord 2007;23:219-224.
3.
Steele C, Rovner B, Chase GA, Folstein M: Psychiatric symptoms and nursing home placement of patients with Alzheimer's disease. Am J Psychiatry 1990;147:1049-1051.
4.
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J: The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.
5.
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.
6.
Monteiro IM, Boksay I, Auer SR, Torossian C, Ferris SH, Reisberg B: Addition of a frequency-weighted score to the Behavioral Pathology in Alzheimer's Disease Rating Scale: the BEHAVE-AD-FW: methodology and reliability. Eur Psychiatry 2001;16(suppl 1):5s-24s.
7.
Reisberg B, Borenstein J, Salob SP, Ferris SH, Franssen E, Georgotas A: Behavioral symptoms in Alzheimer's disease: phenomenology and treatment. J Clin Psychiatry 1987;48(suppl):9-15.
8.
Ballard C, Hanney ML, Theodoulou M, Douglas S, McShane R, Kossakowski K, Gill R, Juszczak E, Yu LM, Jacoby R: The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurol 2009;8:151-157.
9.
Kales HC, Valenstein M, Kim HM, McCarthy JF, Ganoczy D, Cunningham F, Blow FC: Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications. Am J Psychiatry 2007;164:1568-1576; quiz 1623.
10.
Musicco M, Palmer K, Russo A, Caltagirone C, Adorni F, Pettenati C, Bisanti L: Association between prescription of conventional or atypical antipsychotic drugs and mortality in older persons with Alzheimer's disease. Dement Geriatr Cogn Disord 2011;31:218-224.
11.
Fernandez M, Gobartt AL, Balana M: Behavioural symptoms in patients with Alzheimer's disease and their association with cognitive impairment. BMC Neurol 2010;10:87.
12.
Holtzer R, Tang MX, Devanand DP, Albert SM, Wegesin DJ, Marder K, Bell K, Albert M, Brandt J, Stern Y: Psychopathological features in Alzheimer's disease: course and relationship with cognitive status. J Am Geriatr Soc 2003;51:953-960.
13.
Serra L, Perri R, Fadda L, Padovani A, Lorusso S, Pettenati C, Caltagirone C, Carlesimo GA: Relationship between cognitive impairment and behavioural disturbances in Alzheimer's disease patients. Behav Neurol 2010;23:123-130.
14.
Ito T, Meguro K, Akanuma K, Meguro M, Lee E, Kasuya M, Ishii H, Mori E: Behavioral and psychological symptoms assessed with the BEHAVE-AD-FW are differentially associated with cognitive dysfunction in Alzheimer's disease. J Clin Neurosci 2007;14:850-855.
15.
Wadsworth LP, Lorius N, Donovan NJ, Locascio JJ, Rentz DM, Johnson KA, Sperling RA, Marshall GA: Neuropsychiatric symptoms and global functional impairment along the Alzheimer's continuum. Dement Geriatr Cogn Disord 2012;34:96-111.
16.
Flint AJ: Delusions in dementia: a review. J Neuropsychiatry Clin Neurosci 1991;3:121-130.
17.
Paulsen JS, Salmon DP, Thal LJ, Romero R, Weisstein-Jenkins C, Galasko D, Hofstetter CR, Thomas R, Grant I, Jeste DV: Incidence of and risk factors for hallucinations and delusions in patients with probable AD. Neurology 2000;54:1965-1971.
18.
Sultzer DL, Levin HS, Mahler ME, High WM, Cummings JL: Assessment of cognitive, psychiatric, and behavioral disturbances in patients with dementia: the Neurobehavioral Rating Scale. J Am Geriatr Soc 1992;40:549-555.
19.
Shanks MF, Venneri A: Thinking through delusions in Alzheimer's disease. Br J Psychiatry 2004;184:193-194.
20.
Burns A, Jacoby R, Levy R: Psychiatric phenomena in Alzheimer's disease. 1: Disorders of thought content. Br J Psychiatry 1990;157:72-76, 92-94.
21.
Nakatsuka M, Meguro K, Tsuboi H, Nakamura K, Akanuma K, Yamaguchi S: Content of delusional thoughts in Alzheimer's disease and assessment of content-specific brain dysfunctions with BEHAVE-AD-FW and SPECT. Int Psychogeriatr 2013;25:939-948.
22.
American Psychiatric Association: Diagnostic and Statistical Manual for Mental Disorders, Third Edition, Revised. Washington, American Psychiatric Press, 1987.
23.
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL: A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.
24.
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.
25.
Folstein MF, Folstein SE, McHugh PR: ‘Mini-mental state'. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
26.
Teng EL, Hasegawa K, Homma A, Imai Y, Larson E, Graves A, Sugimoto K, Yamaguchi T, Sasaki H, Chiu D, et al: The Cognitive Abilities Screening Instrument (CASI): a practical test for cross-cultural epidemiological studies of dementia. Int Psychogeriatr 1994;6:45-58; discussion 62.
27.
Asada T, Homma A, Kimura M, Uno M: Study on the reliability of the Japanese version of the BEHAVE-AD (in Japanese). Jpn J Geriatr Psychiatry 1999;10:825-834.
28.
Harwood DG, Ownby RL, Barker WW, Duara R: The behavioral pathology in Alzheimer's Disease Scale (BEHAVE-AD): factor structure among community-dwelling Alzheimer's disease patients. Int J Geriatr Psychiatry 1998;13:793-800.
29.
Perez-Madriñan G, Cook SE, Saxton JA, Miyahara S, Lopez OL, Kaufer DI, Aizenstein HJ, DeKosky ST, Sweet RA: Alzheimer disease with psychosis: excess cognitive impairment is restricted to the misidentification subtype. Am J Geriatr Psychiatry 2004;12:449-456.
30.
Taulbee LR, Folsom JC: Reality orientation for geriatric patients. Hosp Community Psychiatry 1966;17:133-135.
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2014
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