A 12-Year Population-Based Study of Psychosis in Parkinson Disease

Forsaa, Elin Bjelland; Larsen, Jan Petter; Wentzel‐Larsen, Tore; Goetz, Christopher G.; Stebbins, Glenn T.; Aarsland, Dag; Alves, Guido

doi:10.1001/archneurol.2010.166

Cited by 356 publications

(228 citation statements)

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“…Although hallucinations did not occur in the placebo group, they commonly occur in PD, and additional factors such as age, cognitive impairment, other co‐morbidities, or concomitant medications also may influence the risk of this event in this population 13, 14…”

Section: Discussionmentioning

confidence: 83%

Amantadine extended release for levodopa‐induced dyskinesia in Parkinson's disease (EASED Study)

et al. 2015

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ADS‐5102 is a long‐acting, extended‐release capsule formulation of amantadine HCl administered once daily at bedtime. This study investigated the safety, efficacy, and tolerability of ADS‐5102 in Parkinson's disease (PD) patients with levodopa‐induced dyskinesia. This was a randomized, double‐blind, placebo‐controlled, parallel‐group study of 83 PD patients with troublesome dyskinesia assigned to placebo or one of three doses of ADS‐5102 (260 mg, 340 mg, 420 mg) administered daily at bedtime for 8 weeks. The primary efficacy analysis compared change from baseline to week 8 in Unified Dyskinesia Rating Scale (UDysRS) total score for 340 mg ADS‐5102 versus placebo. Secondary outcome measures included change in UDysRS for 260 mg, 420 mg, Fatigue Severity Scale (FSS), Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS‐UPDRS), patient diary, Clinician's Global Impression of Change, and Parkinson's Disease Questionnaire (PDQ‐39). ADS‐5102 340 mg significantly reduced dyskinesia versus placebo (27% reduction in UDysRS, P = 0.005). In addition, ADS‐5102 significantly increased ON time without troublesome dyskinesia, as assessed by PD patient diaries, at 260 mg (P = 0.004), 340 mg (P = 0.008) and 420 mg (P = 0.018). Adverse events (AEs) were reported for 82%, 80%, 95%, and 90% of patients in the placebo, 260‐mg, 340‐mg, and 420‐mg groups, respectively. Constipation, hallucinations, dizziness, and dry mouth were the most frequent AEs. Study withdrawal rates were 9%, 15%, 14%, and 40% for the placebo, 260‐mg, 340‐mg, and 420‐mg groups, respectively. All study withdrawals in the active treatment groups were attributable to AEs. ADS‐5102 was generally well tolerated and resulted in significant and dose‐dependent improvements in dyskinesia in PD patients. © 2015 Adamas Pharmaceuticals, Inc. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

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Section: Discussionmentioning

confidence: 83%

Amantadine extended release for levodopa‐induced dyskinesia in Parkinson's disease (EASED Study)

et al. 2015

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“…Hallucinations are the most common manifestation, and they affect up to 40 percent of patients, particularly those with dementia (29,30). As we saw, the prevalence and severity of hallucinations in PD is higher in elderly patients, progressing over time.…”

Section: Discussionmentioning

confidence: 58%

Neuropsychiatric symptoms and associated caregiver stress in geriatric patients with Parkinson’s disease

2015

neurol neurosci

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Objectives: In Parkinson´s disease, researchers are becoming increasingly aware of the need to include the assessment of behavioural and psychological symptoms as important outcome measures in clinical trials. Besides, clinicians are starting to recognise the need to identify and manage these symptoms in addition to the motor ones. Our objective is to explore the presence of neuropsychiatric symptoms in geriatric patients with Parkinson and the associated distress in their caregivers.Methods: 100 patients with PD ageing 75 years old or more (50 PD without dementia and 50 PD Dementia (PDD) were assessed using the 10-item Neuropsychiatric Inventory-questionnaire (NPI-Q), and the NPI Caregiver Distress Scale (NPI-D). Results:The mean total NPI score was 12.9. At least one neuropsychiatric symptom was present in more than 80% of participants. Within PDD patients about 89% suffered at least one NPI symptom, 70% suffered at least 2 symptoms and one of those symptoms had an intensity scoring 4 of higher in more than 50%. Numbers in PD patients without dementia were significantly lower, though more than 50% of patients had at least 2 symptoms. The most frequent symptom was depression, followed by apathy, anxiety, depression and hallucinations. Antiparkinsonian agents can exacerbate psychotic symptoms. Nearly 60% of caregivers reported suffering a moderate to severe level of stress due to these symptoms. Symptoms causing more stress were agitation/aggression followed by hallucinations and irritability/lability. Conclusions:Neuropsychiatric symptoms are frequent in geriatric patients with PD -specially in patients with PDD-and lead to moderate to severe caregiver distress.

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“…Contrary to these studies, a 12-year study found that higher LED was associated with increased future risk of psychosis. 13 The overall evidence coupled with clinical experience has led dopaminergic therapies to be considered modifiers of psychosis in PD.…”

Section: Medicationsmentioning

confidence: 99%

“…A number of studies found an association between visual hallucinations and RBD, 16,21,36,37 and in one study RBD was a predictor of future psychosis. 13 Additionally, compared to those without hallucinations, PD subjects with hallucinations are more likely to have daytime somnolence, 7 severe sleep fragmentation, 37,38 and vivid dreams. 37,39 Recognition of sleepwake dysregulation in PD with hallucinations led to the hypothesis that hallucinations were caused by intrusion of dream imagery into wakefulness.…”

Section: Sleep Disorders and Autonomic Dysfunctionmentioning

confidence: 99%

“…7,11,12,15 Studies have also found that greater disease severity, as measured by the Activities of Daily Living subscale of the Unified Parkinson Disease Rating Scale (UPDRS Part II), is an independent risk factor for hallucinations in PD. 8,10,12,13 Papapetropoulos et al found that the total UPDRS score was an independent predictor of visual hallucinations in PD.…”

Section: Age Duration Of Disease and Disease Severitymentioning

confidence: 99%

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Risk Factors for Psychosis in Parkinson’s Disease

Barrett

2017

US Endocrinology

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Psychosis is a characteristic neuropsychiatric symptom of Parkinson's disease (PD) that is common and associated with worse outcomes. The purpose of this article is to review identified risk factors for visual hallucinations in PD, the most common manifestation of psychosis. With the possible exception of dopamine agonists, antiparkinsonian medications are only considered modifiers of psychosis in PD. Dementia in PD has consistently been shown to be associated with psychosis, and executive dysfunction and impairment in visual processing appear to play a role in its pathogenesis. The association of psychosis with disorders of sleep-wake dysregulation and autonomic dysfunction supports the involvement of brainstem dysfunction in PD psychosis. Despite many studies evaluating genetic risk factors for hallucinations, GBA mutations are the only variants consistently reported to be associated with an increased risk of hallucinations in PD. Lastly, psychosis in PD is associated with a more severe disease burden, both related and unrelated to PD pathology. Any explanatory model of psychosis in PD must incorporate pharmacological, neuroanatomic, pathological, and genetic factors before there can be a complete understanding of this common and disabling neuropsychiatric symptom. KeywordsParkinson's disease, psychosis, hallucinations, risk factor, dementia, rapid eye movement (REM) sleep behavior disorder Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. had minor hallucinations prior to PD motor symptom onset.3 In addition to being common, psychosis is also associated with worse outcomes: increased institutionalization, 4 decreased quality of life, 5 and increased mortality. Considering its prevalence and association with worse outcomes, many studies have sought to identify risk factors for psychosis, specifically visual hallucinations. These efforts have contributed to an improved understanding of this disabling neuropsychiatric symptom. Some risk factors, i.e. cognitive impairment and rapid eye movement (REM) sleep behavior disorder (RBD), may be integral to the mechanism by which psychotic symptoms emerge and have contributed to development of explanatory models of psychotic symptoms in PD. Other risk factors likely represent correlations arising from concomitant pathology in areas not involved in psychosis but occurring at a similar disease stage. Lastly, multiple studies have helped to clarify the relationship between antiparkinsonian medications, especially dopaminergic medications, and psychosis in PD.The purpose of this article is to review risk factors fo...

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A 12-Year Population-Based Study of Psychosis in Parkinson Disease

Abstract: To investigate the prevalence, incidence, risk factors, and concomitants of Parkinson disease (PD)associated psychosis (PDP) in a population-based prevalent cohort.

Cited by 356 publications

References 40 publications

Amantadine extended release for levodopa‐induced dyskinesia in Parkinson's disease (EASED Study)

Amantadine extended release for levodopa‐induced dyskinesia in Parkinson's disease (EASED Study)

Neuropsychiatric symptoms and associated caregiver stress in geriatric patients with Parkinson’s disease

Risk Factors for Psychosis in Parkinson’s Disease

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