[Delirious states in elderly persons. Clinical characteristics].

EXTENSIVE HETEROGENEITY: The nosology of delusional disorders in the elderly is still debatable. The nosology varies greatly from that of the younger adults. It is heterogeneous because of the age at onset of the symptomatology, etiology and behavioural consequences (agitation, aggressiveness) of the delusion. TWO DISTINCT CONTEXTS: We can distinguish between the long term, old, psychoses and the delusions having occurred later in life (after the age of 60). The outcome of the former is still unknown; but often progresses towards the reduction in symptomatology. In the latter, various etiologies are observed with, primarily, delusions associated with dementia, followed by thymus delusions, schizophrenic or non-schizophrenic psychoses, delusions related to cerebral-vascular disorders or sensorial dysafferentation. It is important to underline the fact that any de novo delusion occurring after the age of 65 must evoke an underlying deterioration. ENHANCING FACTORS: In addition to a genetic predisposition suspected in certain cases, vulnerability factors are usually found in the context of age: somatic comorbidity, loneliness, sensory deficiencies, cognitive impairment, polymedication, and addict attitude. FROM A DIAGNOSTIC POINT OF VIEW: The differential diagnosis is essentially made with mental confusion. The evaluation calls upon scales, either specific to the psychosis and similar to those used in adults (SANSS, PANSS, PDI), or global and intended for psychological dementia and behavioural disorders (NPI).