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The Psychotic Phenomenon in Probable Alzheimer's Disease

A Positron Emission Tomography Study

Received September 15, 1999; revised February 7, 2000; accepted March 31, 2000. From the Alzheimer's Disease Research Center and Departments of Neurology, Psychiatry, and Radiology (PET Facility), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Address correspondence to Dr. Lopez, Neuropsychology Research Program, 3501 Forbes Avenue, Suite 830, Pittsburgh, PA 15213.

Positron emission tomography was used to examine the mechanisms of the psychotic phenomenon in Alzheimer's disease (AD). Data from 2 patients with delusions and 2 with hallucinations were compared with those of 5 AD patients without psychosis. The patients with paranoid delusions had diminished relative regional cerebral blood flow (rel-CBF) in the left dorsolateral prefrontal and left medial temporal cortices. The patients with visual hallucinations showed diminished rel-CBF in the right parietal, left medial temporal, and left dorsolateral prefrontal cortices. These findings support the hypothesis that a frontal-temporal abnormality is associated with paranoid delusions in AD. By contrast, visual hallucinations are associated with parietal as well as frontal and temporal lobe dysfunction. In these patients, a left prefrontal–temporal cortex dysfunction appears to be a common denominator for the development of the psychotic phenomenon in AD.

Key Words: Alzheimer's Disease • Psychosis • Delusions • PET Studies

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