ABSTRACT

Individuals with neurocognitive disorders (NCD) frequently experience psychotic symptoms, such as delusions. Delusions can contribute to other behavior problems, create dangers for patients and caregivers, and contribute to inpatient hospitalization of individuals with NCD. The current study aimed to identify cognitive symptoms associated with the presence of delusions and to differentiate delusion types based on cognitive profiles among hospitalized older adults with NCD. A review of electronic medical records of hospitalized older adults from an inpatient geriatric psychiatry setting yielded 185 patients with a diagnosis of mild or major NCD who had a neuropsychological evaluation during their admission and whose documentation described a clear delusion. We identified a comparison group of 185 patients without delusions well matched for age, education, and sex, and similar in global cognitive status. Exclusion criteria included delirium and history of a psychotic disorder. We first compared the groups’ performances on a dementia battery. Then, cognitive performances of subgroups with specific delusion types (harm, theft, jealousy, and misidentification) were each compared to the remainder of the delusion-positive group. Exploratory analyses revealed that the delusion-positive group had a greater rate of discontinuation on Trails B and performed worse than the delusion-negative group on Trails A, Behavioral Dyscontrol Scale, Semantic Fluency, and Hopkins Verbal Learning Test-Revised (HVLT-R) initial registration. Theft delusions were associated with worse performance on HVLT-R recognition, misidentification delusions were associated with worse performance on Trails B, and harm delusions were associated with worse performance on a verbal generativity test. The presence of delusions in hospitalized older adults with NCD was associated with worse performance on several cognitive tasks with many being suggestive of associated with frontal-subcortical network integrity. Delusions of theft may be a consequence of reduced integrity of medial temporal lobe memory system.

摘要

患有神经认知障碍（NCD）的人经常会出现精神病性症状，例如妄想。妄想会导致其他行为问题，给患者和护理人员带来危险，并导致非传染性疾病患者的住院治疗。当前的研究旨在识别与妄想症存在相关的认知症状，并根据住院的NCD老年人的认知状况来区分妄想类型。回顾了住院老年精神病科住院老年人的电子病历，结果发现有185例诊断为轻度或重度NCD的患者在入院时进行了神经心理评估，并且其文献描述了明显的妄想。我们确定了185个没有错觉且年龄相匹配的患者的比较组，受教育程度和性别，在全球认知状况方面相似。排除标准包括del妄和精神病史。我们首先用痴呆症电池比较了小组的表现。然后，将具有特定妄想类型（伤害，盗窃，嫉妒和误认）的亚组的认知表现与妄想阳性组的其余人进行比较。探索性分析显示，在行为B上，妄想阳性组的停药率更高，并且在行为A上的妄想阴性组，行为失调量表，语义流利度和霍普金斯语言学习测验修订版（HVLT-R）上表现较差初始注册。盗窃妄想与HVLT-R识别的较差表现有关，误判妄想与线索B的较差表现有关，言语生成力测试中，伤害妄想与较差的表现有关。住院的患有NCD的成年人中的妄想与某些认知任务的表现较差有关，其中许多暗示与额皮质下网络的完整性有关。盗窃妄想可能是内侧颞叶记忆系统完整性降低的结果。