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Phenotypic cognitive impairment in late-onset delusional disorder

Published online by Cambridge University Press:  13 February 2014

Ben S. Harris ,
Eleftheria J. Kotsopoulos  and
Sami Yamin
Ben S. Harris*
Affiliation:
Aged Persons Mental Health Service, Monash Health, Cheltenham, Melbourne, Australia St Vincent's Health, Fitzroy, Melbourne, Australia
Eleftheria J. Kotsopoulos
Affiliation:
Aged Persons Mental Health Service, Monash Health, Cheltenham, Melbourne, Australia
Sami Yamin
Affiliation:
Aged Persons Mental Health Service, Monash Health, Cheltenham, Melbourne, Australia
*
Correspondence should be addressed to: Dr. Ben S. Harris, Aged Persons Mental Health Service, Monash Health, Kingston Centre, Warrigal Rd, Cheltenham, Melbourne, VIC 3192, Australia. Phone: +613-9265-1750; Fax: +613-9265-1751. Email: ben.harris@monashhealth.org.
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Abstract

Background:

Previous use of heterogeneous diagnostic criteria and insensitive cognitive measures has impeded clarification of the extent and type of cognitive impairment specific to late-onset delusional disorder. We examined whether clinical presentations of late-onset delusional disorder are associated with prodromal or established dementia, and whether it might be a discrete clinical syndrome characterized by its own profile of cognitive impairment.

Method:

Nineteen patients with late-onset delusional disorder from a hospital psychiatric service and 20 patients with dementia of the Alzheimer's type (AD) from an outpatient memory clinic were recruited in a consecutive case series. All patients underwent comprehensive neuropsychological assessment that included general intellectual function, executive function, new learning and delayed memory, language, processing speed, and visuo-perceptual skills.

Results:

Late-onset delusional disorder patients showed moderate impairment to conceptual reasoning, visual object recognition, processing speed, and confrontation naming. Severe impairment appeared in visuo-perceptual planning and organization, and divided attention. Compared with the Alzheimer's disease (AD) group, the late-onset delusional disorder group demonstrated significantly poorer visuo-perceptual skills but a significantly better capacity to consolidate information into delayed memory.

Conclusions:

A high rate of marked cognitive impairment occurs in late-onset delusional disorder. There was evidence of a conceptual reasoning deficit, plus the presence of a visuo-perceptual impairment affecting object recognition. This impairment profile can explain the genesis and maintenance of the observed delusions. Understanding late-onset delusional disorder as other than a purely psychiatric phenomenon or a precursor to AD will lead to better assessment and management approaches.

Keywords

delusionsschizophrenianeuropsychiatryAlzheimer's diseaseneuropsychology
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 6 , June 2014 , pp. 965 - 975
Copyright
Copyright © International Psychogeriatric Association 2014 

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