Psychosis in Neurocognitive Disorder among Ethnoculturally Diverse Older Persons

Background and ObjectivesThere is longstanding evidence that the presence of psychosis in neurocognitive disorders (NCDs) is associated with faster cognitive and functional decline. The goal of this study was to examine how clinician-diagnosed psychosis differs among ethnoracial groups with NCDs (including early onset) and to explore whether these differences exist even for those without advanced dementia.MethodThis is an IRB-approved retrospective analysis. Data are from the National Alzheimer's Coordinating Center Uniform Dataset from 42 Alzheimer's Disease Research Centers. Participants aged 40-95 years as of June 2023 with mild cognitive impairment (MCI) or dementia on baseline evaluation were included. Psychosis was defined as clinician-diagnosed visual or auditory hallucinations or delusions manifesting at the time of baseline evaluation. Ethnoracial groups were self-reported. Associations between ethnoracial groups and psychosis in NCDs were estimated using adjusted multivariable logistic regression with dichotomous measures of outcomes. Covariates included age, sex, years of education, severity of cognitive impairment (Clinical Dementia Rating scale), and presence or absence of any self-reported preexisting psychiatric illness. An analysis by age younger than 65 years was also conducted. Exploratory multivariable logistic regression analyses were performed for participants with milder stages of dementia (Clinical Dementia Rating 0.5 or 1) and for the subset of participants diagnosed with MCI.ResultsA total of 22,854 participants were included. The mean age was 73 + 9.7 years, and 50% were women. A total of 8,352 (37%) had MCI and 14,502 (63%) had dementia. In adjusted analysis, American Indian/Alaska Native (AI/AN) (OR 2.70, 1.75-4.17, p < 0.0001), Black-Latino (OR 2.33, 1.25-4.35, p = 0.0076), Other-Latino (OR 1.82, 1.42-2.33, p < 0.0001), Black, non-Latino (NL) (OR 1.66,1.47-1.87, p < 0.0001), and White-Latino (OR 1.42, 1.21-1.67, p < 0.0001) participants had greater odds of any psychotic symptom than White-NL participants. For age groups 40 to younger than 65 years, only Black-NL participants (OR 1.56, 1.13-2.14, p = 0.0064) were more likely to be diagnosed with any psychotic symptoms. For milder stages of dementia, Black-Latino (OR 3.44, 1.58-7.48, p = 0.0018), AI/AN (OR 2.73, 1.66-4.48, p < 0.0001), Other-Latino (OR 2.38, 1.72-3.30, p < 0.0001), Black-NL (OR 2.08,1.77-2.45, p < 0.0001), and White-Latino (OR 1.55, 1.23-1.95, p = 0.0002) participants had greater odds of psychosis in NCDs when compared with White-NL participants. For MCI alone, there were no significant differences.DiscussionBlack-NL, Latino, and AI/AN individuals were more likely to be diagnosed with psychosis in NCDs when compared with White-NL participants. More research is needed to explore sociocultural, psychosocial, and neuropathologic factors involved.