What is the prevalence of dementia-related psychosis?

From the Guidelines

Dementia-related psychosis affects approximately 50-80% of people with Alzheimer's disease, as behavioral and psychological symptoms of dementia are among the most troublesome aspects of the disease. The prevalence of dementia-related psychosis can vary depending on the type of dementia, but the study by 1 highlights that behavioral and psychological symptoms such as aggression, depression, or disinhibited behavior are increasingly recognized as efforts by residents to communicate their unmet physical or emotional needs. Some key points to consider include:

• Behavioral and psychological symptoms of dementia are common, affecting 50–80 percent of people with Alzheimer’s, as noted in the study by 1.
• The initial management of these symptoms should be nonpharmacological and delivered by trained staff, with drugs considered only for people with psychosis and those with severe behavioral and psychological symptoms such as aggression.
• The use of drugs for behavioral and psychological symptoms is associated with serious adverse effects, and thus alternative strategies should be considered before drug treatments are initiated, as mentioned in the study by 1. The impact of dementia-related psychosis on quality of life, caregiver burden, and institutionalization rates is significant, and understanding its prevalence is crucial for developing effective management strategies.

From the FDA Drug Label

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. In placebo-controlled clinical trials of elderly patients with dementia-related psychosis, the incidence of death in olanzapine-treated patients was significantly greater than placebo-treated patients (3.5% vs 1.5%, respectively).

The prevalence of dementia-related psychosis is not directly stated in the provided drug labels. However, it is mentioned that elderly patients with dementia-related psychosis are at an increased risk of death when treated with antipsychotic drugs 2 3.

• Key points:
  • Increased mortality risk in elderly patients with dementia-related psychosis treated with antipsychotic drugs
  • No direct information on the prevalence of dementia-related psychosis
• Main idea: The FDA drug labels do not provide a direct answer to the question regarding the prevalence of dementia-related psychosis.

From the Research

Prevalence of Dementia-Related Psychosis

• The prevalence of dementia-related psychosis varies across studies, with estimates ranging from 10% to 73% in patients with Alzheimer's disease 4.
• A study found that 34-63% of individuals with dementia have psychotic symptoms 5.
• In a population-based sample of 85-year-old individuals with dementia, the prevalence of psychotic symptoms was 36% among Alzheimer's disease cases and 54% among vascular dementia cases 6.
• The annualized incidence of psychosis in outpatients with Alzheimer's disease is approximately 20%, and higher in nursing home patients 4.

Clinical Characteristics and History

• Psychosis frequently occurs subsequent to the onset of dementia 4.
• Female gender, greater cognitive impairment, and physical aggression are associated with psychotic signs and symptoms 4.
• Right frontal hypometabolism and greater frontal neuropsychological deficits occur in Alzheimer's disease patients with psychosis 4.
• Among nursing home patients with dementia and psychosis, nearly two-thirds have persistent symptoms over at least 12 weeks 4.

Treatment and Management

• Antipsychotic medication treatment may improve psychotic symptoms modestly 4.
• Donepezil, memantine, and aripiprazole are probably the appropriate options to consider when a pharmacological treatment is indicated 7.
• Psychosocial treatments, such as meaningful communication and simplifying the living environment, can help reduce the adverse impact of psychosis 5.
• Emerging therapies, such as xanomeline-trospium, present promising avenues for treatment 5.