Identifying Psychosis in Patients with Dementia

Identifying Psychosis in Patients with Dementia: Not a Hallucination or Delusion, the Challenge Really Exists 

Joan FornsJ Bradley Layton, and Mary E Ritchey


Psychosis is a common complication of many types of dementia. It is defined by the presence of hallucinations and delusions and other types of symptoms in patients with dementia. The prevalence is higher in Parkinson’s and Alzheimer’s disease compared to other types of dementia. 

Antipsychotics are a second-line treatment for this condition, but an increased mortality has been observed. The FDA, therefore, issued a black box warning for this indication. Assessing the risk of mortality associated with antipsychotics can be challenging in automated healthcare databases where diagnostic algorithms are used.

Our objective was to describe diagnostic use to capture patients in studies published within the last 10 years. The main conclusions of our literature search are that:

  • The majority of studies analyzing mortality in patients with dementia identified psychosis through medication codes, and most did not account for other life-threating conditions like delirium. 
  • Only 7 studies used diagnostic algorithms to identify these patients. Similar codes were used to identify symptoms of psychosis, but the algorithms were heterogeneous, and all included nonspecific codes.
  • As a result of these findings, a validated coding algorithm updated to ICD-10 codes to identify psychosis associated with dementia is recommended. 

Read the research here.