Pre-psychosis in later life as a risk factor for progressive cognitive decline: Findings from the IPA psychosis in neurodegenerative disease working group.

Pre-clinical Alzheimer's disease (AD) has traditionally been characterized by subtle cognitive deficits alongside biomarker changes. However, emerging evidence suggests a spectrum of neuropsychiatric changes, including apathy, affective disturbances, agitation, impulse control deficits, and psychosis, may precede cognitive decline. Late-onset psychotic disorders, such as Very Late-Onset Schizophrenia-Like Psychosis (VLOSLP), differ from pre-psychosis, the latter presenting with subtle symptoms and retained insight.