Year: 2020
Type: article
Abstract: Dementia-related psychosis (DRP) is prevalent across dementias and typically manifests as delusions and/or hallucinations. The mechanisms underlying psychosis in dementia are unknown; however, neurobiological and pharmacological evidence has implicated multiple signaling pathways and brain regions. Despite differences in dementia pathology, the neurobiology underlying psychosis appears to involve dysregulation of a cortical and limbic pathway involving serotonergic, gamma-aminobutyric acid ergic, glutamatergic, and dopaminergic signaling. Thus, an imbalance in cortical and mesolimbic excitatory tone may drive symptoms of psychosis. Delusions and hallucinations may result from (1) hyperactivation of pyramidal neurons within the visual cortex, causing visual hallucinations and (2) hyperactivation of the mesolimbic pathway, causing both delusions and hallucinations. Modulation of the 5-HT2A receptor may mitigate hyperactivity at both psychosis-associated pathways. Pimavanserin, an atypical antipsychotic, is a selective serotonin inverse agonist/antagonist at 5-HT2A receptors. Pimavanserin may prove beneficial in treating the hallucinations and delusions of DRP without worsening cognitive or motor function.
Source: CNS Spectrums
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,160
Funders: Eli Lilly and Company, Pfizer, Biogen, Teva Pharmaceutical Industries, Celgene, Sunovion, ACADIA Pharmaceuticals, Sage Therapeutics, Arbor Pharmaceuticals, Eisai, Vifor Pharma, Servier, H. Lundbeck A/S, Grifols, Genentech, EMD Serono, Allergan, National Institute on Aging, National Institute of General Medical Sciences, National Institute of Neurological Disorders and Stroke
Awards: G1398291101, G1520633318, G1598070753, G1931537204, G2311734066, G305086134, Global Alzheimer's Platform Trial-Ready Cohort for Preclinical/Prodromal Alzheimer's Disease, Nevada Exploratory Alzheimer's Disease Research Center (NVEADRC), G4289261452, G4528454814, G492415912, G5744975378, G7455214855, Arizona Alzheimer's Disease Research Center
OpenAlex ID: W3074035787