Clinical features of delusional jealousy in elderly patients with dementia.
OBJECTIVE
Delusional jealousy is a psychotic syndrome characterized by a belief in the infidelity of one's spouse that reaches delusional intensity. Although delusional jealousy has been described in relation to organic psychosis, little is known concerning the actual role of delusional jealousy in dementia. The aim of the present study was to investigate the clinical features of delusional jealousy and possible mechanisms whereby delusional jealousy arises in patients with dementia.


METHODS
We studied 208 consecutive outpatients with dementia (diagnosis based on DSM-III-R criteria; mean [SD] age of 77.0 [8.0] years; study period: September 2011-August 2012). Delusional jealousy was defined as a false belief derived from a pathological jealousy that makes the patient believe that his or her spouse is unfaithful. The prevalence of delusional jealousy was compared between Alzheimer's disease, dementia with Lewy bodies, and vascular dementia. Patients with and without delusional jealousy were compared in terms of general characteristics. In addition, each patient with delusional jealousy and their primary caregivers were interviewed about the clinical features of the syndrome.


RESULTS
Of the 208 patients with dementia, 18 (8.7%) showed delusional jealousy. The prevalence of delusional jealousy in patients who had dementia with Lewy bodies (26.3%) was significantly higher than that in patients with Alzheimer's disease (5.5%) (P < .01). There were no significant differences between patients with and without delusional jealousy in regard to gender (P = 1.00), age (P = .81), educational attainment (P = .29), presence of other persons living with the couple (P = .22), and Mini-Mental State Examination score (P = .47). On the other hand, delusional jealousy was preceded by the onset of serious physical diseases in nearly half of the patients. Delusional jealousy resolved within 12 months after treatment in 15 of 18 patients (83%).


CONCLUSIONS
Although delusional jealousy is a considerable problem in dementia, the prognosis of delusional jealousy in demented patients appears to be relatively benign. In dementia, delusional jealousy may develop more easily in patients who have dementia with Lewy bodies and those with coexisting serious physical disorders.
Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Honjo1-1-1, Chuo-ku, Kumamoto, 860-8556, Japan m-hashi@kumamoto-u.ac.jp.
Mamoru
M
Hashimoto
Shinichi
S
Sakamoto
Manabu
M
Ikeda
D000368:Aged; D000544:Alzheimer Disease / Q000453:epidemiology* / Q000523:psychology; D016022:Case-Control Studies; D015897:Comorbidity; D003702:Delusions / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D015140:Dementia, Vascular / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007578:Jealousy; D020961:Lewy Body Disease / Q000453:epidemiology* / Q000523:psychology; D008297:Male; D015995:Prevalence