Cited by 189Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsSchizophrenia research and treatment

Psychosis in Alzheimer disease—mechanisms, genetics and therapeutic opportunities

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Ismail, Zahinoor, Creese, Byron, Aarsland, Dag, Kales, Helen C., Lyketsos, Constantine G., Sweet, Robert A., Ballard, Clive·2022·Nature Reviews Neurology

Abstract

Psychosis is a common and distressing symptom in people with Alzheimer disease, and few safe and effective treatments are available. However, new approaches to symptom assessment and treatment are beginning to drive the field forward. New nosological perspectives have been provided by incorporating the emergence of psychotic symptoms in older adults - even in advance of dementia - into epidemiological and neurobiological frameworks as well as into diagnostic and research criteria such as the International Psychogeriatric Association criteria for psychosis in neurocognitive disorders, the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART) research criteria for psychosis in neurodegenerative disease, and the ISTAART criteria for mild behavioural impairment. Here, we highlight the latest findings in genomics, neuroimaging and neurobiology that are informing approaches to drug discovery and repurposing. Current pharmacological and non-pharmacological treatment options are discussed, with a focus on safety and precision medicine. We also explore trial data for pimavanserin, a novel agent that shows promise for the treatment of psychosis in people with dementia, and discuss existing agents that might be useful but need further exploration such as escitalopram, lithium, cholinesterase inhibitors and vitamin D. Although the assessment and management of psychosis in people with dementia remain challenging, new opportunities are providing direction and hope to the field.

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  1. [171]Nathan S, Gill S & Ismail Z in Alzheimer’s Association International Conference (ALZ, 2020).

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Authors
Ismail, Z., Creese, B., Aarsland, D., Kales, H. C., Lyketsos, C. G., Sweet, R. A., & Ballard, C.
Affiliations
  • University of Calgary (CA)
  • University of Exeter (GB)
  • King's College London (GB)
  • University of California Davis Medical Center (US)
  • Johns Hopkins University (US)
  • University of Pittsburgh (US)
Corresponding author
Ballard, Clive
Venue
Nature Reviews Neurology
Published
2022-01-04
Volume
18
Issue
3
Pages
131-144
ISSN
  • 1759-4758 (ISSN-L)
  • 1759-4766
OpenAlex
W4205106947
Cited by
189
References
179
Citations by year
2026: 24 · 2025: 47 · 2024: 61 · 2023: 32 · 2022: 25
FWCI
7.10
Type
journal article
Language
en
Open access
Locations
  • Nature Reviews Neurology (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Brunel University Research Archive (BURA) (Brunel University London) (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion, other-oa)
Funders
  • Bristol-Myers Squibb
  • Eli Lilly and Company
  • Pfizer
  • AstraZeneca
  • GlaxoSmithKline
  • Biogen
  • Fondation Brain Canada
  • Sunovion
  • National Football League Players Association
  • Eisai
  • Astellas Pharma
  • Servier
  • H. Lundbeck A/S
  • Genentech
  • National Institute on Aging (P30AG066468, P30AG066507)
  • National Institute of Mental Health (R01MH116046)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
dementia, drug repurposing, pimavanserin, escitalopram, lithium, cholinesterase inhibitors, vitamin D, non-pharmacological treatment, precision medicine, neuroimaging, neurobiology of psychosis
MeSH terms
Aged, Alzheimer Disease, Humans, Psychotic Disorders, Neurodegenerative Diseases, Neurocognitive Disorders, Neuroimaging

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