1. O:/wpfiles/slides/2000/Jeste/ADPsyFDA Psychosis of Alzheimer Disease: A Distinct Syndrome? Dilip V. Jeste, M.D. University of California, San Diego; VA San Diego Healthcare System

2. O:/wpfiles/slides/2000/Jeste/ADPsyFDA Is Psychosis of Alzheimer Disease an Important & Distinct Syndrome? Public health importance Differences between AD pt.s with psychosis and - AD pt.s without psychosis - Non-AD pt.s with psychosis Diagnostic entity – Diagnostic criteria, Neurobiological basis, Measurement tools

3. O:/wpfiles/slides/2000/Jeste/ADPsyFDA Cumulative Incidence of Psychosis of AD (N = 329) (Paulsen et al., 2000)

4. O:/wpfiles/slides/2000/Jeste/ADPsyFDA Psychosis of AD: Public Health Importance 1) High incidence and prevalence 2) Chronic or recurrent 3) Commonly produces functional disruption and requires ongoing treatment

5. O:/wpfiles/slides/2000/Jeste/ADPsyFDA Adverse Associations/Consequences of Psychosis of AD (Differences from AD without Psychosis) 1) More agitation, aggression 2) More rapid cognitive decline 3) Greater caregiver distress 4) Earlier institutionalization 5) Different treatment considerations 6) Higher cost of care

6. O:/wpfiles/slides/2000/Jeste/ADPsyFDA Psychosis of AD: Evidence for Frontotemporal Pathology 1) Neurobehavioral (Deutsch; Paulsen) 2) Neuropsychological (Flynn; Jeste) 3) Brain imaging (Sultzer; Forstl; Cummings) 4) EEG (Lopez; Rao) 5)Post-mortem (Zubenko; Mukaetova-Ladinska)

7. O:/wpfiles/slides/2000/Jeste/ADPsyFDA Neurotransmitters Putatively Involved in Psychosis of AD Dopamine Norepinephrine Serotonin Acetyl choline

8. O:/wpfiles/slides/2000/Jeste/ADPsyFDA Psychosis of AD vs. Schizophrenia in Elderly Psychosis of AD Schizophrenia (1) Prevalence30% to 50%<1% (2) Bizarre or complex delusions RareFrequent (3) Common hallucinationsVisualAuditory

9. O:/wpfiles/slides/2000/Jeste/ADPsyFDA Psychosis of AD vs. Schizophrenia in Elderly Psychosis of AD Schizophrenia (4) First-rank symptoms RareFrequent (5) Active suicidality RareFrequent (6) Past hx of psychosis RareVery Common

10. O:/wpfiles/slides/2000/Jeste/ADPsyFDA Psychosis of AD vs. Schizophrenia in Elderly Psychosis of AD Schizophrenia (7) Eventual remission of psychosis FrequentRare (8) Need for years of antipsychotic use UncommonVery common (9) Avg. optimal antipsychotic dose ~20% of dose in young adults ~50% of dose in young adults

11. O:/wpfiles/slides/2000/Jeste/ADPsyFDA Psychosis of AD: Diagnostic Criteria A.Characteristics sx’s: Delusions or Aud./Vis. Hallucinations B.Primary dx: AD C.Chronology of onset of sx’s of dementia vs. psychosis D.Duration: >1 month Severity: Functional disruption E.Exclusion of: Schizophrenia, etc.; Delirium;Other causes of psychosis (Jeste and Finkel, 2000)

12. O:/wpfiles/slides/2000/Jeste/ADPsyFDA Psychosis of AD: Associated Features 1)Agitation 2)Negative symptoms 3)Depression

13. O:/wpfiles/slides/2000/Jeste/ADPsyFDA Assessment of Psychosis of AD Specific items from a) BEHAVE-AD (Reisberg) b) Neuro-Psychiatric Inventory or NPI (Cummings)