Cognitive and Functional Differences Between Delusions and Hallucinations in Alzheimer’s Disease (P2.234)
Bibliographic record
Abstract
Objective:To characterize the clinical profiles of Alzheimer’s disease(AD) patients with psychotic symptoms, delineated into those with delusions, hallucinations, or both. Background:It is estimated that 41[percnt] of AD patients develop psychosis over the course of the illness, 1/3 presenting with delusions and 1/6 with hallucinations. Psychosis in AD is associated with increased cognitive and functional decline, and a more rapid disease progression. Design/Methods:728 subjects from the NACC database with pathologically confirmed AD diagnosis were analyzed. The NPI-Q was used to identify subjects with psychosis and the type of psychosis. Psychotic subjects(AD+P) and each of its subgroups(delusions: AD+D; hallucinations: AD+H; delusions and hallucinations: AD+DH) were compared to never-psychotic subjects(AD-P) using univariate tests, α=0.05. Results:There were no significant differences between AD-P(n=457) and AD+P(n=271) subjects with respect to age of death, years of education, ethnicity, sex, or functional(FAQ) and cognitive status(MMSE, CDR) at the last visit before death. AD+P had a significantly longer disease duration calculated from age of clinical onset to age of death. Breakdown by psychotic symptoms showed that subjects with hallucinations(AD+H(n=52); AD+DH(n=79)) had increased cognitive and functional impairment while delusional subjects(AD+D,n=140) were less cognitively impaired than AD-P. The increased duration of disease was restricted to delusional subjects(AD+D and AD+DH). Conclusion:The contrast between AD patients who experienced delusions versus hallucinations has not been previously reported. Subjects with hallucinations had lower cognitive and functional status compared to non-psychotic subjects, while subjects with delusions had better cognitive status. A possible explanation is that expression of delusions requires some level of cognitive ability, and that delusions diminish with cognition. Data also show that psychotic subjects in general, and those with delusions in particular, had a slower disease progression, contrary to some literature. The distressing nature of psychotic symptoms may prompt these patients to seek medical attention earlier, creating artificially longer disease duration.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".