Toward Localizing Psychosis in Pathologically Confirmed Neurodegenerative Disease
medRxiv February 7, 2025 Andrew G. Breithaupt, Georges Naasan, Suzanne M. Shdo et al. preprint
Psychosis is a common and burdensome symptom in neurodegenerative diseases. Analyzing 283 autopsy-confirmed cases, delusions were linked to atrophy in the right temporal lobe and bilateral frontal lobes, especially when persecutory or paranoid, implicating circuits for reward, emotion, self-awareness, and executive function. Misidentification delusions correlated with right ventral temporal-occipital atrophy, disrupting visual stream processing. No consistent atrophy patterns emerged with hallucinations. Damage to these brain regions predisposes individuals to delusions across different syndromes and pathologies, suggesting shared mechanisms between neurologic and psychiatric disorders.