title: Incident Psychosis in Subjects With Mild Cognitive Impairment or Alzheimer's Disease.
abstract: OBJECTIVE
  To estimate the incidence of psychotic symptoms in Alzheimer's disease.
  
  
  METHODS
  The study consists of 776 elderly subjects presenting to the Alzheimer Disease Research Center at the University of Pittsburgh (Pittsburgh, Pennsylvania) between May 9, 2000, and August 19, 2014. All participants were diagnosed with mild cognitive impairment (National Institute on Aging-Alzheimer's Association workgroup criteria) or possible or probable Alzheimer's disease (National Institute of Neurologic and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association criteria) and were without psychosis at entry. Psychotic symptoms were evaluated using the Consortium to Establish a Registry for Alzheimer's Disease Behavioral Rating Scale every 6 months. One-, 3- and 5-year cumulative incidences of psychosis were calculated.
  
  
  RESULTS
  The 1-year psychosis incidence was 10% (95% CI, 8%-12%), and this annual rate remained remarkably consistent at 3 and 5 years. Psychosis incidence was related to cognitive status at all time points. However, the incidence rate reached a plateau during the disease course. Cumulative psychosis incidence at 5 years was 61% (95% CI, 52%-69%) in individuals with moderate to severe Alzheimer's disease, not statistically significantly different from the cumulative incidence at 3 years in this group, which was 48% (95% CI, 40%-55%) or from the 5-year incidence in individuals who entered the study with mild Alzheimer's disease, which was 48% (95% CI, 41%-56%).
  
  
  CONCLUSIONS
  Psychosis in Alzheimer's disease has been associated with a number of adverse clinical outcomes. We provide estimates of the risk of psychosis onset within clinically defined subgroups of individuals, a tool clinicians can use in treatment planning. Anticipating which subjects are at high risk for psychosis and the poor outcomes associated with it can help with family education and support decisions to implement nonpharmacologic strategies that may reduce or prevent symptoms.
authors.affiliation: Department of Neurology, University of Pittsburgh School of Medicine, Pennsylvania, USA.
authors.forename: Elise A
authors.initials: EA
authors.lastname: Weamer
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA.
authors.forename: Mary Ann A
authors.initials: MA
authors.lastname: DeMichele-Sweet
authors.affiliation: Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania, USA.
authors.forename: Yona K
authors.initials: YK
authors.lastname: Cloonan
authors.affiliation: Department of Neurology, University of Pittsburgh School of Medicine, Pennsylvania, USA.|Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA.
authors.forename: Oscar L
authors.initials: OL
authors.lastname: Lopez
authors.affiliation: Biomedical Science Tower, Rm W-1645, 3811 O'Hara St, Pittsburgh, PA 15213-2593. sweetra@upmc.edu.|Department of Neurology, University of Pittsburgh School of Medicine, Pennsylvania, USA.|Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA.|VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pennsylvania, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Sweet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000453:epidemiology*; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology*