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Abstract Details

Psychosis in Neurodegenerative Disease
Aging and Dementia
S15 - Aging and Dementia 1 (3:30 PM-3:42 PM)
001

Psychosis in NDG is a major source of stress, anxiety, and depression both for patients and their caregivers and is associated with earlier institutionalization and a higher cost of care. Symptoms are often treated pharmacologically, presuming a neurochemical origin, but few large-scale studies have determined whether particular patterns of regional degeneration are more likely to engender psychotic symptoms. Furthering our understanding of the root causes of this important clinical feature could lead to more tailored prognostic and therapeutic approaches.

 

To better understand the structural neuroanatomic substrate of psychotic symptoms in neurodegenerative disease (NDG) patients.

A cohort of 313 patients with autopsy-proven NDG (140 tauopathies, 70 TDP, 103 AD/DLB pathology) underwent comprehensive chart review for hallucinations and delusions during their disease course. Voxel-based morphometry was performed to compare atrophy patterns between patients with versus without psychotic symptoms.  A custom-fit family-wise error threshold was established via 1000 permutations of the error distribution at p<0.05, establishing a corrected significance threshold of T > 4.39. 

Numerous regions in the bilateral frontal lobes and right temporal lobe predicted psychosis at pFWE<0.05, including peaks at the right nucleus accumbens (T=4.54), right anterior insula (T= 4.60), and right thalamus (T=4.41).

These preliminary results further support past studies finding psychosis related to frontal lobe dysfunction and lend more support to the interesting observation that right hemisphere dysfunction is often correlated with psychosis. They are also notable for confirming the contribution of the right thalamus to psychosis, which has been implicated in schizophrenia and in FTD patients who are C9orf72 carriers. The right anterior insula has been seen to play a role in emotions and processing of external stimuli, and similarly the nucleus accumbens is involved with emotion, salience and reward, suggesting emotions may play a key role in reality testing.

Authors/Disclosures
Andrew Breithaupt (UCSF)
PRESENTER
Dr. Breithaupt has nothing to disclose.
Georges Naasan (Mount Sinai) Dr. Naasan has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Genentech .
No disclosure on file
Estrella Morenas Rodriguez (Hospital De La Santa Creu I Sant Pau) No disclosure on file
No disclosure on file
Anna Karydas (UCSF) No disclosure on file
Salvatore Spina (UCSF Memory and Aging Center) Dr. Spina has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Acsel Health. Dr. Spina has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Precision Xtract. Dr. Spina has received research support from Tau Consortium. Dr. Spina has received research support from Chan Zuckerberg Initiative, LLC. Dr. Spina has received research support from Bluefield Project to Cure FTD.
Lea Grinberg Lea Grinberg has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Curasen Inc. The institution of Lea Grinberg has received research support from NIH. The institution of Lea Grinberg has received research support from Eli Lilly. The institution of Lea Grinberg has received research support from BrightFouus. The institution of Lea Grinberg has received research support from Rainwater Charity Foundation.
William Seeley Dr. Seeley has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GLG Council. Dr. Seeley has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint Global Consulting. Dr. Seeley has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Corcept Therapeutics. Dr. Seeley has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BridgeBio. Dr. Seeley has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Private attorney. The institution of Dr. Seeley has received research support from NIH. The institution of Dr. Seeley has received research support from Rainwater Charitable Foundation. The institution of Dr. Seeley has received research support from Bluefield Project to Cure FTD. The institution of Dr. Seeley has received research support from Chan-Zuckerberg Initiative.
Bruce Miller (University of California, San Francisco) Dr. Miller has nothing to disclose.
Katherine Rankin (University of California San Francisco) The institution of Dr. Rankin has received research support from Marcus Foundation.