Neural basis of delusions in dementia

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  • Hashimoto Mamoru
    Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University

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  • 認知症患者の妄想の発現に関わる要因について
  • ニンチショウ カンジャ ノ モウソウ ノ ハツゲン ニ カカワル ヨウイン ニ ツイテ

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Delusional thoughts are common symptoms in patients with dementia. Delusions reduce the individual well‐being of the dementia sufferer and increase the burden of caregiver, therefore, early detection and adequate intervention on delusions is clinically important. According to previous reports and our data, many factors seem to be involved in the development of delusions in dementia. They include dementia type, severity of dementia, type of delusions such as misidentification delusions or persecutory delusions, cortical lesions such as frontal lobe or limbic system involvement, psychosocial factors such as loss experience, and so on. In terms of dementia type, 61% of patients with DLB had some delusions, whilst the prevalence of delusion in FTLD was extremely low. The different prevalence of delusions among different type of dementia suggests that some neurobiological factors may be associated with development of delusions in dementia. In addition, factor analysis revealed that delusions were classified under the same category as hallucinations in DLB. These results suggest that the disturbance of neuron systems such as dopamine or acetylcholine might be involved in delusions. On the other hand, FTLD may have resistance to delusions because of mild disturbances of dopamine neurons and severe frontal symptoms such as loss of empathy. It is important to take those factors into consideration in the management of delusions in patients with dementia.

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