New-Onset Delusions Heralding an Underlying Neurodegenerative Condition: A Case Report and Review of the Literature.

OBJECTIVE: To present a striking case of new-onset psychosis in a middle-aged woman subsequently diagnosed with behavioral variant frontotemporal dementia (bvFTD). To review the data regarding key red-flag features that may suggest a diagnosis of a neurodegenerative process, and specifically bvFTD, rather than a primary psychotic disorder. To examine the role of genetics, especially mutations of the microtubule-associated protein tau (MAPT) gene, in familial cases of frontotemporal dementia (FTD). DATA SOURCES: The pertinent literature was searched online (PubMed, Google Scholar) using the following search terms: frontotemporal dementia (FTD), Pick's disease, behavioral variant FTD (bvFTD), psychosis, delusions, MAPT, and genetics. No date or language limit was applied. STUDY SELECTION: The case report was generated through detailed assessment of clinical notes, imaging studies, and laboratory results. The brain autopsy was carried out and summarized by our neuropathology team. Previously published literature was selected for inclusion in the review section based on relevance to the topic. RESULTS: A neurodegenerative etiology for psychosis (and specifically bvFTD) should be suspected in patients with progressive deficits in executive function, language, or memory. Other key warning features include the presence of a strong family history of a late-life psychotic disorder (or institutional placement or suicide), loss of empathy, impaired recognition of facial expression, or the development of emotional blunting and apathy, abnormal movements, or seizures. CONCLUSIONS: Neurodegenerative disease should be on the differential diagnosis for any patient presenting with new-onset psychosis and behavioral changes in mid to late adulthood. Should red-flag features be present, early referral to a clinic specializing in dementia is recommended for further evaluation. This case highlights that MAPT mutations can be associated with psychosis in FTD and should be considered in the genetic workup. Ongoing research into the cellular and neural circuit mechanisms of psychosis in neurodegenerative disease may shed light on pathologic processes underlying psychosis in primary psychiatric disorders.

Electroconvulsive Therapy for Major Depression in the Oldest Old: Effects of Medical Comorbidity on Post-Treatment Survival.

This is a longitudinal study of 65 patients who were 80 years old or older at the time they were hospitalized for depression. Thirty-seven were treated with ECT and 28 with medication. Survival after 1, 2, and 3 years in the ECT group was 73.0%, 54.1%, and 51.4%, respectively. Survival after 1, 2, and 3 years in the non-ECT group was 96.4%, 90.5%, and 75.0%, respectively. The relatively high mortality rate in the ECT group in this study suggests that patients over 80 who undergo ECT have more severe physical illness than those who can be treated successfully with medication. Medical comorbidity is a major determinant of long-term outcome of depression in the oldest old.

Cognitive Change After Elective Surgery in Nondemented Older Adults.

The authors report the results of repeated cognitive function tests administered over 10 months to 82 patients between the ages of 55 and 82 who underwent elective surgery. The Mini-Mental State Exam (MMSE) score, 10 months after surgery, was modeled by a multivariate linear regression that included the baseline demographics, baseline cognitive functions, and immediate postoperative MMSE scores. Immediate postoperative MMSE scores were highly significant to 10-month postoperative MMSE scores not explained by baseline variables. The results suggest that immediate postoperative cognitive change may predict later postoperative cognitive decline.

Professional association membership by nursing facility administrators and quality of care.

This article compares 4,220 nursing homes whose administrators belonged to a long-term-care professional association to 12,322 nursing homes whose administrators did not belong to a long-term-care professional association. The research results show that professional membership is associated with higher quality of care on several measures and with a higher private-pay proportion. The study suggests that these facilities do not do better because they have more resources or because they care for less-challenging residents-they do better because they have a professional association as a resource.