Dementia
Edited by Alistair Burns and Raymond Levy
Chapman & Hall Medical
London 1994
ISBN 0 412 54740 6

under non-Alzheimer Dementia:
non-vascular (dementia syndromes in psychiatric disorders)
709 Cognitive Changes in Late Paraphrenia [CAVE: Index/TOC p 713]
 late paraphrenia according to Kraepelin (less neg. s.),a
710 'Kay and Roth defined late paraphrenia as "a suitable descriptive term, without prejudice as to aetiology, for all cases with a paranoid symptom complex in which the condition was judged from the content of the delusional and hallucinatory symptoms not to be due to a primary affective disorder (Kay and Roth, 1961).Roth and Morrisey (1952) had already shown that late paraphrenics had a strikingly better survival than patients with organic psychoses and although a degree of overlap between functional and organic psychoses in the elderly was not doubted, a "ubiquitous aetiological role" for cerebral disease in the genesis of psychoses in the elderly was discounted (Kay and Roth, 1961)'
 'One of the problems with the diagnostic concept of paraphrenia is that it has failed to gain international recognition. [...]
 Some authors believe that late paraphrenia is the direct counterpart of schizophrenia with an atypical late onset and should be considered equivalent with the /Diag. and Stat. M./ (DSM-III R) diagnosis of late-onset schizophrenia; at the other extreme all cases are attributed to (sometimes clinically undetectable) organic cerebral changes. There is, of course, an intermediate nosological position which is probably closest to truth: patients with symptoms of late paraphrenia are suffering from a spectrum of disorders ranging from true late-onset schizophrenia, through atypical affective psychoses, "symptomatic schizophrenias" in patients with subtle and highly localized organic changes, to patients with global organic impairment who, early in the course of what may be later diagnosed as dementia, experience psychotic symptoms.
  The failure of late paraphrenia as a diagnostic concept to gain acceptance in North America and the introduction of the /Int Clas of D 10/ (ICD 10) classification (which is expected to replace the diagnosis for the majority of cases with one of paranoid schizophrenia) means that it might be officially doomed to extinction just as Kraepelins paraphrenia disappeared." [NOTE]
711 late-onset psychoses: mostly organic (schizophrenia: Kraeplin 5.6 % 1913, Kolle 16 % 1960, Bleuler 15 % 1943, Fish 21 % 1960) after 40 [NOTE], "survival rates compared favorably to affective admissions and healthy control"
712 imaging: WMI (white matter lesions) and other non-spec. changes in paraphrenics
713 dementia, delusions (org. dis.: simple/complex persecut., grandeur, spec. neur. disorders); Alzheimer's: persec., simple del. theft/suspicion, closely resembles paraphrenia (Burns et al 1990); cognitive deficits, little investigation
714 paraphrenia not an early dementing state (Stockholm: only 12 % in 10 y (Kay and Roth , 1961, 2 % (Post, 1966))
715 conclusion: "considerable overlap in terms of the cog. def. and struct. brain abnorm. found in patients with "functional" psychoses of late onset and those with dementia syndromes. The degree and rate of progression of these measured deficits are however much greater in the dementias."
 Heterogeneity -> no common path of decline