Cognitive neuroscience of delusions in aging

Anna EM Holt¹, Martin L Albert²

¹Brain and Cognitive Sciences Department, Massachusetts Institute of Technology, Boston, MA, USA;  ²Department of Neurology, Boston University School of Medicine, Harold Goodglass Aphasia Research Center, VA Boston Healthcare System, Boston, MA, USA

Abstract: Assessments and clinical understanding of late-onset delusions in the elderly are inconsistent and often incomplete. In this review, we consider the prevalence, neurobehavioral features, and neuroanatomic correlations of delusions in elderly persons – those with documented cognitive decline and those with no evidence of cognitive decline. Both groups exhibit a common phenotype: delusions are either of persecution or of misidentification. Lateonset delusions show a nearly complete absence of the grandiose, mystical, or erotomanic content typical of early onset psychoses. Absent also from both elderly populations are formal thought disorders, thought insertions, and delusions of external control. Neuroimaging and behavioral studies suggest a frontotemporal localization of delusions in the elderly, with right hemispheric lateralization in delusional misidentification and left lateralization in delusions of persecution. We propose that delusions in the elderly reflect a common neuroanatomic and functional phenotype, and we discuss applications of our proposal to diagnosis and treatment.

Keywords: delusions, aging, dementia, cognitive neuroscience