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Cognitive Decline and Dementia Risk in Older Adults With Psychotic Symptoms: A Prospective Cohort Study

Lookup NU author(s): Sebastian Kohler, Professor Ian McKeith, Professor Carol Brayne


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Objectives: To study the temporal association between psychotic symptoms with cognitive decline and incident dementia. Design: Population-based prospective cohort study. Setting: General population in England and Wales. Participants: A subsample of 2,025 participants of the Medical Research Council Cognitive Function and Ageing Study, representing a study sample of 11,916 nondemented adults age 65 years or older. Measurements: Baseline presence of psychotic symptoms was assessed with the Geriatric Mental State. Cognitive decline (Cambridge Cognitive Examination) and incident dementia (Automated Geriatric Examination for Computer Assisted Taxonomy diagnosis) were evaluated at 2, 6, and 10 years from baseline. Results: A total of 330 participants reported baseline symptoms of paranoid delusions, misidentification, or hallucinations, estimated to represent 13.4% of the older general population without dementia. Psychotic symptoms were cross-sectionally associated with worse cognitive functioning, and individuals with psychotic symptoms displayed more rapid cognitive decline from baseline to a 6-year follow-up, especially in nonmemory functions, than people without such symptoms. They further carried an increased overall risk of later dementia (odds ratio = 2.76, 95% confidence interval = 1.75-4.36). The risk increment was observed independently of baseline cognition, depression, anxiety, and vascular risk factors, increased with increasing numbers of psychotic symptoms, and was highest in people age 65-74 years. Conclusions: Older adults with psychotic symptoms are vulnerable to develop dementia and might be a promising target for indicated prevention strategies. Their neuropsychological functioning should be evaluated on a regular basis. (Am J Geriatr Psychiatry 2013; 21:119-128)

Publication metadata

Author(s): Kohler S, Allardyce J, Verhey FRJ, McKeith IG, Matthews F, Brayne C, Savva GM, Med Res Council Cognitive Function

Publication type: Article

Publication status: Published

Journal: American Journal of Geriatric Psychiatry

Year: 2013

Volume: 21

Issue: 2

Pages: 119-128

Print publication date: 19/09/2012

ISSN (print): 1064-7481

ISSN (electronic): 1545-7214

Publisher: Lippincott Williams & Wilkins


DOI: 10.1016/j.jagp.2012.10.010


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Funder referenceFunder name
Department of Health
KOOTSTRA talent fellowship from Maastricht University
UK NIHR Biomedical Research Centre for Ageing and Age-Related Disease
30972507NEU Interreg IVb project "Health and demographic changes"