Many factors contribute to the variability in reported associations. ![]() 19, 20 All previous studies have failed to find an association between delusions or hallucinations and mortality. 6, 7, 12, 14, 15 However, many reports failed to detect significant associations for either cognition 6, 14, 16 - 19 or function-institutionalization. Some studies have reported an association between delusions or hallucinations and faster rates of cognitive decline 3 - 13 or increased risk for functional decline and institutionalization. Many reports have examined the association between delusions, hallucinations, and various disease outcomes with conflicting results. 3 The presence of such features in AD is not only a source of caregiver distress and financial burden (because of the need for treatment with medications and often hospitalization) but also potentially associated with important disease outcomes. Presence of hallucinations is also associated with institutionalization and mortality.ĭelusions and hallucinations are generally observed in about 1 in 4 to 1 in 3 patients with Alzheimer disease (AD), 1, 2 with reported frequencies of delusions as high as 94% 2 and hallucinations as high as 69.5%. Their presence was associated with increased risk for cognitive decline (RR, 1.62 95% CI, 1.06-2.47), functional decline (RR, 2.25 95% CI, 1.54-2.27), institutionalization (RR, 1.60 95% CI, 1.13-2.28), and death (RR, 1.49 95% CI, 1.03-2.14).Ĭonclusions Delusions and hallucinations are very common in AD and predict cognitive and functional decline. Hallucinations were present in 7% of patients at initial visit and in 33% at any visit. Their presence was associated with increased risk for cognitive (risk ratio, 1.50 95% confidence interval, 1.07-2.08) and functional decline (RR, 1.41 95% CI, 1.02-1.94). Delusions were noted for 34% of patients at baseline and 70% at any evaluation. Results During the full course of follow-up, 38% of patients reached the cognitive, 41% the functional, 54% the institutionalization, and 49% the mortality end point. Main Outcome Measures Cognitive (Columbia MMSE score of ≤20/57 ), functional (Blessed Dementia Rating Scale score of ≥10), institutionalization equivalent index, and death. The models controlled for cohort effect, recruitment center, informant status, sex, age, education, a comorbidity index, baseline cognitive and baseline functional performance, behavioral symptoms, and use of neuroleptics and cholinesterase inhibitors. Using the Columbia University Scale for Psychopathology in AD (administered every 6 months, for a total of 3266 visit-assessments, average of 7.2 per patient), the presence of delusions and hallucinations was extracted and examined as time-dependent predictors in Cox models. ![]() ![]() Objective To examine whether the presence of delusions or hallucinations has predictive value for important outcomes in AD.ĭesign, Setting, and Participants A total of 456 patients with AD at early stages (mean Folstein Mini-Mental State Examination score of 21 of 30 at entry) were recruited and followed up semiannually for up to 14 years (mean, 4.5 years) in 5 university-based AD centers in the United States and Europe. According to all previous literature, they are not associated with mortality.
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