The Overlap of Neurocognitive Impairment and Psychosis: A Cross-Sectional Study on Dementia Patients with Schizophrenic Features in Bangladesh

Background: Dementia is frequently accompanied by neuropsychiatric symptoms, including psychosis, which can significantly complicate diagnosis and care. In low-resource settings like Bangladesh, this overlap remains understudied. Objective: This study explores the relationship between cognitive impairment and psychotic symptoms in dementia patients, with emphasis on schizophrenic features. Methods: A descriptive cross-sectional study was conducted from January to December 2024 at the Department of Psychiatry, President Abdul Hamid Medical College, Kishoreganj, Bangladesh. Results: The majority of patients had Alzheimer’s disease (47.4%) and severe cognitive impairment (MMSE <18 in 49.5%). Psychotic symptoms were prevalent: hallucinations (54.7%), delusions (50.5%), and suspiciousness (40.0%). BPSD symptoms included agitation/aggression (47.4%) and apathy (42.1%). A significant inverse correlation was found between MMSE and BPRS scores (r = -0.62, p < 0.001), indicating that greater cognitive decline was associated with more severe psychotic features. Chi-square analysis revealed significant associations between dementia severity and hallucinations (p = 0.002), delusions (p = 0.003), and suspiciousness (p = 0.007). No significant differences in psychotic symptom severity were found across dementia subtypes (p = 0.08). Conclusion: Psychotic symptoms are common and strongly associated with the severity of cognitive impairment in dementia patients.