The Prevalence and Determinants of Neuropsychiatric Symptoms in Late‐Stage Parkinsonism

Abstract

BackgroundBackground: Late-stage parkinsonism and Parkinson's disease (PD) are insufficiently studied population. Although neuropsychiatric symptoms (eg, psychosis, depression, anxiety, behavioral problems) are frequently present, their prevalence and clinical predictors remain unknown. Objective Objective: To determine the prevalence and predictors of neuropsychiatric symptoms in late-stage PD. Methods Methods: We conducted a multinational study of patients with PD with ≥7 years disease duration and either a Hoehn and Yahr stage ≥4 or a Schwab and England score ≤ 50% in the on stage. Neuropsychiatric symptoms were assessed through interviews with carers using the Neuropsychiatric Inventory, with a frequency × severity score ≥ 4, indicating clinically relevant symptoms. The determinants analyzed were demographic characteristics, medication, and motor and nonmotor symptoms. Univariate and multivariate logistic analyses were performed on predictors of clinically relevant neuropsychiatric symptoms. Results Results: A total of 625 patients were recruited in whom the Neuropsychiatric Inventory could be completed. In 92.2% (576/625) of the patients, at least 1 neuropsychiatric symptom was present, and 75.5% (472/625) had ≥1 clinically relevant symptom. The most common clinically relevant symptoms were apathy (n = 242; 38.9%), depression (n = 213; 34.5%), and anxiety (n = 148; 23.8%). The multivariate analysis revealed unique sets of predictors for each symptom, particularly the presence of other neuropsychiatric features, cognitive impairment, daytime sleepiness. Conclusion Conclusion:Neuropsychiatric symptoms are common in late-stage PD. The strongest predictors are the presence of other neuropsychiatric symptoms. Clinicians involved in the care for patients with late-stage PD should be aware of these symptoms in this specific disease group and proactively explore other psychiatric comorbidities once a neuropsychiatric symptom is recognized.

High frequency of psychosis in late-stage Parkinsońs disease

“…The frequency we found was similar to the ones reported in few previous studies that reported on hallucinations/psychosis among LSPD patients. Indeed 41% (vs. 43.7% in our sample) of hallucinations have been reported in a large cohort of 623 LSPD patients in agreement with the NPI [7] or 56% (52.3% in our sample) of psychosis in a smallest cohort of 50 patients, in agreement with the MDS-UPDRS item 1.2 [7] . At the same time, comparison among those tests and the CDI have been not performed previously, particularly among LSPD patients.…”

“…For all these reasons, it is difficult to estimate the true prevalence of PDP. It is well established that PDP is more frequent with advancing disease [5] and a high frequency of psychosis and neuropsychiatric symptoms have recently been reported in a multicenter cohort of late-stage (LS) parkinsonism using the Neuropsychiatric Inventory (NPI) [7] . LSPD patients still represent “an orphan” population, whose clinical criteria have been recently proposed [8] , [9] but still poorly described due to the difficult for those patients to be included into clinical studies.…”

One Year Trajectory of Caregiver Burden in Parkinson’s Disease and Analysis of Gender-Specific Aspects

“…Generally, caregiver burden in PD is assessed by generic questionnaires. These tests do not explicitly evaluate all specific aspects of caregiver burden in PD, although the course of PD is different from other geriatric diseases, e.g., due to various motor and non-motor symptoms and long disease duration with progressive impairments in the activities of daily living [6,7]. The recently developed and validated Parkinson's disease caregiver burden questionnaire (PDCB) offers a special opportunity to study disease-specific aspects of caregiver burden in PD [8].…”

Neuropsychiatric Symptoms in Parkinson’s Disease Patients Are Associated with Reduced Health-Related Quality of Life and Increased Caregiver Burden

“…However, this study showed that neuropsychiatric symptoms in total are very frequent. Hommel et al also reported that a high prevalence of neuropsychiatric symptoms (particularly apathy, depression, and anxiety) is the strongest predictor for more neuropsychiatric symptoms in late-stage PD [ 52 ]. Hence, screening for other psychiatric comorbidities, such as with the SEND-PD, is already crucial in the early stage of the disease [ 52 ].…”