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To the Editor:
We read with interest the recent article by Paulsen et al. on risk factors for hallucination and delusion in patients with probable AD.1 The authors conclude that accelerated cognitive decline, deficit in frontal functions, and parkinsonian gait may be predictive markers for the development of psychotic symptoms in AD. The results would support the hypothesis of the hypofrontality model of psychosis secondary to a reduction in serotonin, norepinephrine, and acetylcholine metabolism. The authors also acknowledge that psychotic symptoms may result from dysfunction of dopaminergic mechanisms, which is consistent with the high prevalence of psychosis in patients with Lewy body disease (LBD). Although the possibility exists that patients with LBD may have been overrepresented in the subgroup that developed psychosis, the authors claim that misdiagnosis does not explain the high incidence of hallucinations and delusions in the study.
We would like to comment on Paulsen et al.’s interpretation with data on a possible role of vascular events in psychosis in AD. This observation was noted in 41 community-dwelling patients with AD. The …
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