Psychosis in Alzheimer’s Disease (AD) is prevalent and indicates poor prognosis. However, the neuropathological, cognitive and brain atrophy patterns underlying these symptoms have not been fully elucidated. In this study, we evaluated 178 patients with AD neuropathological change (ADNC) and ante-mortem volumetric brain magnetic resonance imaging (MRI). Presence of psychosis was determined using the Neuropsychiatric Inventory Questionnaire. Clinical Dementia Rating Sum-of-boxes (CDR-SB) was longitudinally compared between groups with a follow-up of 3000 days using mixed-effects multiple linear regression. Neuropsychological tests closest to the time of MRI and brain regional volumes were cross-sectionally compared. Psychosis was associated with lower age of death, higher longitudinal CDR-SB scores, multi-domain cognitive deficits, higher neuritic plaque severity, Braak stage, Lewy Body pathology (LB) and right temporal lobe regional atrophy. Division according to the presence of LB showed differential patterns of AD-typical pathology, cognitive deficits and regional atrophy. In conclusion, psychosis in ADNC with and without LB has clinical value and associates with subgroup patterns of neuropathology, cognition and regional atrophy.

中文翻译：

---

阿尔茨海默病的精神病与大脑 MRI 体积、认知和神经病理学的特定变化有关

阿尔茨海默病 (AD) 中的精神病很常见，预示着预后不良。然而，这些症状背后的神经病理学、认知和脑萎缩模式尚未完全阐明。在这项研究中，我们评估了 178 名患有 AD 神经病理改变 (ADNC) 的患者和生前体积脑磁共振成像 (MRI)。使用神经精神病学调查问卷确定是否存在精神病。使用混合效应多元线性回归对随访 3000 天的各组之间的临床痴呆评分总和 (CDR-SB) 进行纵向比较。对最接近 MRI 时间的神经心理学测试和大脑区域体积进行了横断面比较。精神病与较低的死亡年龄、较高的纵向 CDR-SB 评分、多域认知缺陷、较高的神经炎斑块严重程度、布拉克分期、路易体病理 (LB) 和右颞叶区域萎缩有关。根据 LB 的存在进行划分，显示出 AD 典型病理、认知缺陷和区域萎缩的不同模式。总之，伴或不伴 LB 的 ADNC 中的精神病均具有临床价值，并与神经病理学、认知和区域萎缩的亚组模式相关。