Issues concerning the frequency of psychotic symptoms in Alzheimer's disease and their relation to the degree and decline of cognitive and functional impairment remain controversial. We therefore investigated 78 outpatients with a clinical diagnosis of Alzheimer's disease according to ICD-10 draft research criteria longitudinally with annual evaluations to study the frequency of psychotic symptoms and their relation to severity and progression of cognitive and functional impairment. Psychotic symptoms were assessed by the BEHAVE-AD, a scale specifically designed to measure these symptoms in patients with Alzheimer's disease. Delusional symptoms were present in 50% of the mildly impaired Alzheimer patients and decreased in frequency within the ongoing disease process. The most frequent delusional symptom was the false conviction that people had stolen things. Hallucinations occurred less frequently but increased within the disease course. In contrast to hallucinations, delusional symptoms were associated with severity of cognitive and functional impairment. Furthermore, delusional symptoms were related to a more rapid progression of cognitive and functional decline. The presence of hallucinations was not associated with the progression rate of the disease. This study demonstrates that psychotic symptoms are quite frequent concomitants in Alzheimer's disease. Their presence early in the disease course may help to identify patients who experience a rampant symptom progression, have a greater risk for institutionalization and should be consequently treated psychopharmacologically and by counselling of the family's management of these non-cognitive disturbances.
KEY woms-Alzheimer's disease; delusions; hallucinations; symptom severity; symptom progression Delusional symptoms and hallucinations are quite common features in the clinical syndrome of dementia . The presence of delusions and hallucinations in Alzheimer's disease strongly contributes to early institutionalization within the disease course . Psychotic symptoms reduce the individual well-being of the dementia sufferer and increase the burden of the caregiver in the management of the patient in daily living. Furthermore, psychotic disturbances are principally remediable by psychopharmacological and psychotherapeutic interven-