Journal of the International Neuropsychological Society

Neurobehaviors and psychotic symptoms in Alzheimer's disease

JANE S.  PAULSEN a1a2a3c1, REBECCA E.  READY a1a3, JULIE C.  STOUT a4, DAVID P.  SALMON a6, LEON J.  THAL a6a7, IGOR  GRANT a5a7 and DILIP V.  JESTE a5a6a7
a1 Department of Psychiatry, University of Iowa, Iowa City
a2 Department of Neurology, University of Iowa, Iowa City
a3 Department of Psychology, University of Iowa, Iowa City
a4 Department of Psychology, University of Indiana
a5 Department of Psychiatry, University of California at San Diego School of Medicine
a6 Department of Neurosciences, University of California at San Diego School of Medicine
a7 San Diego Department of Veterans Affairs Medical Center


Psychotic symptoms are common in Alzheimer's disease (AD) and clinicoanatomical and neuropsychological evidence indicate an association between these symptoms and frontal lobe dysfunction. Neurobehaviors associated with frontal dysfunction were assessed in Alzheimer's disease (AD) patients with (n = 20) and without psychotic symptoms (n = 21) matched for mean age, education, gender, and dementia severity. The Frontal Lobe Personality Scale (FLOPs) was completed by patient caregivers to measure behaviors typically associated with frontal dysfunction. Findings indicated that AD patients with psychotic symptoms exhibited significantly greater neurobehavioral dysfunction (FLOPs M = 130.69, SD = 24.70) than AD patients without psychotic symptoms (FLOPs M = 111.10, SD = 25.83). Subscale analyses indicated that psychotic AD patients were more disinhibited (M = 28.28, SD = 7.54) than patients without psychotic symptoms (M = 20.92, SD = 4.9). Findings are consistent with and contribute to previous neuropsychological and clinicoanatomical research suggesting increased frontal dysfunction in AD with psychotic symptoms and lend additional empirical support to subtyping AD based on the presence of psychotic symptoms. Furthermore, findings provide preliminary evidence indicating which specific type of neurobehavioral abnormalities are related to the presence of distressing psychotic symptoms. (JINS, 2000, 6, 815–820.)

(Received September 14 1999)
(Revised January 5 2000)
(Accepted February 16 2000)

Key Words: Dementia; Psychosis; Alzheimer's disease; Neurobehavioral syndromes.

c1 Reprint requests to: Jane S. Paulsen, Ph.D., The University of Iowa College of Medicine, 1-289 MEB, Iowa City, IA 52242-1000. E-mail: