title: Psychosis of Alzheimer disease: prevalence, incidence, persistence, risk factors, and mortality.
abstract: OBJECTIVE
  To establish the prevalence, incidence, persistence, risk factors, and mortality risk increase of psychosis of Alzheimer disease (PoAD) in a clinical sample.
  
  
  METHODS
  Cross-sectional, observational study of 491 patients with probable AD who, at baseline visit, were evaluated with the Cambridge Examination for Mental Disorders of the Elderly, the Neuropsychiatric Inventory-10, the Rapid Disability Rating Scale-2, and the Zarit Burden Interview. All participants were reevaluated at 6, 12, 18, and 24 months. PoAD diagnoses were made using specific criteria.
  
  
  RESULTS
  PoAD prevalence was 7.3%, and the cumulative incidence at 6, 12, 18, and 24 months was 5.8%, 10.6%, 13.5%, and 15.1%, respectively. After 1 year, psychotic symptoms persisted in 68.7% of the patients with initial PoAD. At baseline, patients with PoAD scored lower in the Cambridge Cognitive Examination and Mini-Mental State Examination and higher in the Rapid Disability Rating Scale-2 and Zarit Burden Interview tests. Both low scores in the Cambridge Cognitive Examination subscale of learning memory (hazard ratio [HR] = 0.874; 95% CI: 0.788-0.969; Wald χ2 = 6.515; df = 1) and perception (HR = 0.743; 95% CI: 0.610-0.904; Wald χ2 = 8.778; df = 1), and high scores in expressive language (HR = 1.179; 95% CI: 1.024-1.358; Wald χ2 = 5.261; df = 1) and calculation skills (HR = 1.763; 95% CI: 1.067-2.913; Wald χ2 = 4.905; df = 1) were found to be associated with PoAD. PoAD leads to a faster functional impairment, and it increases mortality risk (HR = 2.191; 95% CI: 1.136-4.228; Wald χ2 = 5.471; df = 1) after controlling for age, gender, cognitive and functional disability, general health status, and antipsychotic treatment.
  
  
  CONCLUSIONS
  PoAD seems to define a phenotype of AD of greater severity, with worsened functional progression and increased mortality risk.
authors.affiliation: Research Unit, Institut d'Assistència Sanitària, Salt, Spain; Dementia Unit, Hospital de Santa Caterina, Salt, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Vilalta-Franch
authors.forename: Secundino
authors.initials: S
authors.lastname: López-Pousa
authors.forename: Laia
authors.initials: L
authors.lastname: Calvó-Perxas
authors.forename: Josep
authors.initials: J
authors.lastname: Garre-Olmo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology*; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006304:Health Status; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015995:Prevalence; D011618:Psychotic Disorders / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology; D012307:Risk Factors
keywords: Alzheimer disease; cohort studies; delusions; hallucinations; mortality; psychotic disorders; risk factor