Delusional disorders in the elderly

Delusions and paranoid ideation are common in the elderly, and they pose a diagnostic and clinical challenge. This article reviews recent findings in the classification of these symptoms, biologic underpinnings, treatment, and prognosis. Based on a review of the relevant literature, delusional disorder in the elderly should be regarded as part of a continuum of late-life psychoses. Although lateonset psychosis may have a neurodevelopmental origin, there is an increasing body of evidence that delusional disorders could be a heralding sign for a neurodegenerative process leading to cognitive decline and dementia. Atypical antipsychotic agents continue to be the first-line treatment for late-onset psychosis despite the lack of robust randomized clinical trials in this population. Increased risk of mortality and cerebrovascular accidents associated with these agents stresses the importance of the need for appropriate patient selection and carefully weighing the benefits and risks when initiating these agents.