Neuropsychiatric symptoms

Question 1

Give three examples of neuropsychiatric symptoms

Answer 1

Examples of neuropsychiatric symptoms include hallucinations, delusions, and depression

Question 2

What are neuropsychiatric symptoms also referred to as?

Answer 2

Non-cognitive disturbances and include behavioural & psychological symptoms.

Question 3

What does the Neuropsychiatric Inventory (NPI) evaluate?

Answer 3

The Neuropsychiatric Inventory (NPI) evaluates 12 neuropsychiatric disturbances

Question 4

Name three of the neuropsychiatric disturbances evaluated by the NPI.

Answer 4

Three neuropsychiatric disturbances evaluated by the NPI include delusions, hallucinations, and agitation/aggression.

Question 5

Why is understanding the aetiology of neuropsychiatric symptoms important?

Answer 5

Reducing patient and carer distress and improving quality of life.

Question 6

What can neuropsychiatric symptoms indicate in Alzheimer’s disease (AD)?

Answer 6

Neuropsychiatric symptoms in AD can indicate a poorer projection for the disease

Question 7

Are behavioural abnormalities common in mild AD

Answer 7

Yes

Question 8

What is a key neuropsychiatric symptom in Lewy body dementia (DLB)?

Answer 8

Hallucinations are a predominant and characteristic symptom of Lewy body dementia

Question 9

How do hallucinations in DLB typically manifest?

Answer 9

Hallucinations in DLB usually involve people or animals.

Question 10

How do hallucinations in Alzheimer’s disease (AD) change through the disease stages?

Answer 10

Hallucinations in AD are rare in the early stages but relatively frequent in later stages

Question 11

What is one brain correlate linked to hallucinations in AD?

Answer 11

Decreased grey matter in the occipital cortex

Question 12

What is the DSM-IV definition of a delusion?

Answer 12

A delusion is “A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary”.

Question 13

How frequent are delusions in Alzheimer’s disease (AD)?

Answer 13

Delusions are very frequent in AD, occurring in 20% - 70% of patients

Question 14

What percentage of AD patients with psychotic symptoms also experience delusions?

Answer 14

94% of AD patients who manifest psychotic symptoms also have delusions

Question 15

Name one type of misidentification delusion

Answer 15

One type of misidentification delusion is Capgras syndrome.

Question 16

What brain areas are associated with increased delusion scores in AD?

Answer 16

Decreased grey matter in the frontal lobe and the right parietal lobe.

Question 17

When is agitation more frequent in Alzheimer’s disease?

Answer 17

Agitation is more frequent in the later stage of Alzheimer’s disease.

Question 18

What brain area is associated with increased agitation scores in AD?

Answer 18

The left insular cortex

Question 19

When is apathy often seen in Alzheimer’s disease?

Answer 19

Apathy is often seen in early presentations of AD.

Question 20

Name one brain area associated with apathy scores in AD.

Answer 20

The left dorsal anterior cingulate cortex.

Question 21

What is one potential reason for depression in the initial stage of Alzheimer’s disease?

Answer 21

In the initial stage of AD, depression can be associated with disease awareness

Question 22

How common are visual hallucinations in AD and FTD?

Answer 22

They are rare in AD (~15-20%) and rare in FTD

Question 23

Which brain regions are linked to delusions and affective symptoms?

Answer 23

The Temporal lobes and limbic system (amygdala, hippocampus)

Question 24

Which brain regions are particularly implicated in visual hallucinations, especially in LBD?

Answer 24

The visual cortex and posterior parietal regions.

Question 25

Which neurochemical is implicated in psychosis, particularly in LBD?

Answer 25

Dopamine

Question 26

What was a key finding from the Ballard et al. (1999) study on DLB?

Answer 26

That cholinesterase inhibitors reduce hallucinations in DLB.

Question 27

What are two proposed explanations for depression in AD?

Answer 27

May relate to limbic system atrophy or be a reactive response to awareness of cognitive decline.

Question 28

Is there debate about whether NPS are always secondary to cognitive decline?

Answer 28

Yes, for example, psychosis in later AD may be secondary, but hallucinations in DLB can be early and diagnostic.

Question 29

What is a major challenge with pharmacological treatments (like antipsychotics) for NPS?

Answer 29

They often have limited benefit and high risk (e.g., mortality).

Question 30

What is the relationship between limbic system atrophy and depression?

Answer 30

Components of the limbic system, such as the amygdala and hippocampus, are involved in emotion regulation.

Question 31

What is a critical analysis point of understanding NPS?

Answer 31

That focusing only on symptom presence may miss the importance of symptom severity and persistence.

Question 32

How are amyloid plaques and neurofibulary tangles associated with delusions?

Answer 32

They disrupt frontal and temporal regions involved in reality testing belief formation.