title: Cognitive phenotype of psychotic symptoms in Alzheimer's disease: evidence for impaired visuoperceptual function in the misidentification subtype.
abstract: BACKGROUND
  Establishing the cognitive phenotype of psychotic symptoms in Alzheimer's disease (AD) could localise discrete pathology and target symptomatic treatment. This study aimed to establish whether psychotic symptoms would be associated with poorer performance on neuropsychological tests known to correlate with striatal dopaminergic function and to investigate whether these differences would be attributed to the paranoid (persecutory delusions) or misidentification (misidentification phenomena +/- hallucinations) subtype.
  
  
  METHODS
  Seventy patients with probable AD (34 psychotic and 36 nonpsychotic) were recruited to the study. Analysis of covariance was used to compare motor speed and the rapid visual processing test of sustained visual attention, after adjusting for potential confounding factors. Multivariate analyses were used to compare performance across other cognitive domains. Significant findings were explored by separating patients on the basis of subtype.
  
  
  RESULTS
  Rapid visual processing performance accuracy was reduced in patients with psychotic symptoms (F1,58  = 5.94, p = 0.02) and differed significantly across subtypes (F2,51  = 3.94, p = 0.03), largely because of poorer performance in the misidentification compared with nonpsychotic group. Multivariate analyses (corrected for multiple comparisons) showed poorer performance on the incomplete letters task in psychotic patients (F1,63  = 8.77, p = 0.004) and across subtypes (F2,55  = 10.90, p < 0.001), similarly attributed to the misidentification subtype.
  
  
  CONCLUSIONS
  These findings provide further support of the involvement of dopaminergic networks in the psychosis endophenotype in AD and, in addition, implicate the ventral (temporo-occipital) pathway in the misidentification subtype. Future studies should investigate the early trajectory of neuropathological change in vivo across psychosis subtypes.
authors: Department of Old Age Psychiatry, Institute of Psychiatry, King's College London, SE5 8AF, UK.
authors: Suzanne J
authors: SJ
authors: Reeves
authors: Department of Old Age Psychiatry, Institute of Psychiatry, King's College London, SE5 8AF, UK.
authors: Chloe
authors: C
authors: Clark-Papasavas
authors: Department of Old Age Psychiatry, Institute of Psychiatry, King's College London, SE5 8AF, UK.
authors: Rebecca L
authors: RL
authors: Gould
authors: Department of Old Age Psychiatry, Institute of Psychiatry, King's College London, SE5 8AF, UK.
authors: Dominic
authors: D
authors: Ffytche
authors: Department of Old Age Psychiatry, Institute of Psychiatry, King's College London, SE5 8AF, UK.
authors: Robert J
authors: RJ
authors: Howard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000503:physiopathology / Q000523:psychology*; D003071:Cognition / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D009048:Motor Skills / Q000502:physiology; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D010641:Phenotype; D011618:Psychotic Disorders / Q000175:diagnosis*; D011930:Reaction Time
keywords: Alzheimer's disease; RVP; misidentification; psychosis; subtypes; ventral visual pathway