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Content of delusional thoughts in Alzheimer's disease and assessment of content-specific brain dysfunctions with BEHAVE-AD-FW and SPECT

Published online by Cambridge University Press:  22 February 2013

Masahiro Nakatsuka ,
Kenichi Meguro ,
Hiroshi Tsuboi ,
Kei Nakamura ,
Kyoko Akanuma  and
Satoshi Yamaguchi
Masahiro Nakatsuka
Affiliation:
Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
Kenichi Meguro*
Affiliation:
Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan The Osaki-Tajiri SKIP Center, Osaki, Miyagi, Japan
Hiroshi Tsuboi
Affiliation:
Department of Radiology, Osaki Citizen's Hospital, Osaki, Miyagi, Japan
Kei Nakamura
Affiliation:
Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
Kyoko Akanuma
Affiliation:
Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan The Osaki-Tajiri SKIP Center, Osaki, Miyagi, Japan
Satoshi Yamaguchi
Affiliation:
The Osaki-Tajiri SKIP Center, Osaki, Miyagi, Japan
*
Correspondence should be addressed to: Kenichi Meguro, MD, PhD, Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, 980-8575 Sendai, Japan. Phone: +81-22-717-7359; Fax: +81-22-717-7339. Email: k-meg@umin.ac.jp.
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Abstract

Background: A consensus on the brain dysfunction(s) underlying the delusions of Alzheimer's Dementia (AD) remains to be achieved. The aim of the present study was to test the hypothesis that content-based categorization of delusional ideas manifests as dysfunction of category-specific brain regions.

Methods: Fifty-nine consecutive first-visit AD outpatients underwent Single Photon Emission Computed Tomography (SPECT), Mini-Mental State Examination, and Behavioral Pathology in Alzheimer's Disease Frequency-Weighted Severity scale (BEHAVE-AD-FW) to assess cerebral blood flow (CBF), cognitive function, and delusion, respectively. SPECT images were analyzed by SPM5.

Results: CBF decreased at the temporal poles and right inferior temporal gyrus in “delusion of theft,” at the temporal poles in “suspiciousness/paranoia,” at the right parahippocampal gyrus and insula in “abandonment,” and at the right amygdala in “Residence is not home.”

Conclusions: Our findings offer a perspective on the discrete categories of the pathological thoughts of AD patients that have previously been lumped together as “delusions.” Dysfunction of the temporal poles may be associated with a socioemotional deterioration that may include pathological suspiciousness. Delusion of theft may be a manifestation of socioemotional deterioration and poor insight. Emotional factors may be essential for delusions of abandonment and “not home.”

Keywords

dementiapsychosisbehaviorheterogeneity
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 6 , June 2013 , pp. 939 - 948
Copyright
Copyright © International Psychogeriatric Association 2013

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