Secondary Schizophrenia (80 page)

hallucinations.

More recently, Jones and colleagues
[26]
reported
Cerebrovascular disease has also been associated
the results of the first diffuse tensor imaging study
with late-onset schizophrenia and delusional disor-investigating the integrity of white-matter tracts in
der, particularly in the form of subcortical infarcts
a sample of 12 patients with late-onset schizophre-or white-matter hyperintensities. However, the results
nia and 12 controls. There was no difference between
from MRI studies have been inconsistent and the only
the groups regarding fractional anisotropy or mean
investigation using diffuse tensor imaging techniques
diffusivity, which argues against the presence of spe-did not find any difference between patients with
cific structural abnormalities within the white-matter
late-onset schizophrenia and age-gender-education
tracts of patients.

matched controls
[26].

Existing data does not support the hypothesis that
Currently available evidence suggests that cere-schizophrenia and delusional disorder with onset in
brovascular disease per se plays a limited role in the
later life are strongly associated with cerebrovascular
development of schizophrenia-like symptoms in later
disease.

life.

201

Organic Syndromes of Schizophrenia – Section 3

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203

Section 3

Organic syndromes of schizophrenia: other neurological disorders

15Neurodegenerativedisorders(Alzheimer’s

Disease, frontotemporal dementia) and

schizophrenia-like psychosis

Nicola T. Lautenschlager and Alexander F. Kurz
Facts box

and suspiciousness, and fear of theft. Kraepelin also
r

discussed the pathogenesis of delusions in dementia.

Delusions, misidentifications, and

In the eighth edition of his textbook, in which he
hallucinations are common neuropsychiatric

introduced the term “Alzheimer’s Disease (AD),” he
symptoms in Alzheimer’s Disease.

postulated that reduced mental equipment (geistiges
r
Psychotic symptoms in Alzheimer’s Disease

Rüstzeug) and poor judgment resulted in credulity and
can significantly affect the well-being of

prepared the ground for delusional interpretations
[2].

patients and caregivers.

Hallucinations were described as being auditory or
r
Psychotic symptoms in Alzheimer’s Disease

visual, but never bizarre.

differ from psychotic symptoms in

In relation to presenile dementia, neither Arnold
schizophrenia.

Pick’s original descriptions of the lobar atrophies
[3,

r
Clinical criteria for diagnosis of psychosis in
4, 5]
nor subsequent reviews
[6]
mentioned delusions
Alzheimer’s Disease have been proposed.

or hallucinations. In his famous case report from 1907

r

on Auguste D (“ ¨

Uber eine eigenartige Erkrankung der

Several biological markers as risk factors for
Hirnrinde”), Alois Alzheimer mentioned that jealousy
psychosis in Alzheimer’s Disease have been

was the initial symptom in the 51-year-old patient, fol-suggested.

r

lowed by progressive memory loss that was accompa-There is ongoing discussion whether
nied by paranoid ideas, manifest in her behavior of
Alzheimer’s Disease with psychotic

hiding objects and the fear that she would be sexu-symptoms is a specific subtype of Alzheimer’s
ally abused or even killed by the doctor
[7].
She also
Disease or whether genetic factors determine

appeared to experience auditory hallucinations.

a person’s underlying vulnerability to

Little was added to Kraepelin’s description of psy-psychotic symptoms, independent of the
chotic symptoms in senile dementia in subsequent
primary mental illness.

r

years. Walther Spielmeyer characterized, in 1912,
Psychotic symptoms in frontotemporal