Psychosis in Parkinson’s Disease: A Clinical Marker for Increased Management

October 13, 2017

Researchers suggest that psychosis among Parkinson’s Disease patients is associated with worse outcomes, including dementia and increased mortality. A study investigates PD patients without dementia to identify those at risk for these outcomes.

The study, which appeared recently in Parkinsonism Related Disorders, included 101 patients with PD without dementia, seen at the University of Virginia (Charlottesville).

Participants underwent a baseline standard neurological exam and common PD symptom assessment (MDS-UPDRS); PD psychosis assessed using NINDS-NIMH criteria; and standardized scales or questionnaires to assess psychotic symptoms, visual hallucinations, visual illusions, REM sleep behavior disorder, autonomic symptoms, and cognitive function.

According to the study, per PubMed, of the 33 (32.7%) PD subjects who met diagnostic criteria for psychosis in PD, visual illusions were most common (72.7%), followed by visual hallucinations (39.4%). Adjusted for presence of REM sleep behavior disorder (RBD) (p = 0.097), use of dopamine agonists (OR = 3.7, p = 0.012) and greater autonomic symptom burden (OR = 1.1 (per 1-unit change in score on SCOPA-AUT), p = 0.012) were associated with greater risk of psychosis.

Use of dopamine agonists (OR = 5.0, p = 0.007), higher MDS-UPDRS Part II score (OR = 1.1, p = 0.010), and presence of RBD (OR = 4.8, p = 0.012) were independent predictors of visual hallucinations and visual illusions. MDS-UPDRS item 1.2 score ≥1 had highly correlated with the SAPS score (r = 0.65, p < 0.0001), but was 42% sensitive and 96% specific for identifying psychosis.

“Our study supports prior recommendations to lower, stop, or replace dopamine agonists in favor of other dopaminergic medications in PD patients without dementia who have bothersome visual psychotic symptoms. Even with stopping dopamine agonists, however, it is not known whether psychotic symptoms would resolve in these patients,” explains the study’s first author, Matthew Barrett, MD, from the University of Virginia (Charlottesville), and colleagues, in a media release from Neurology Times.

The single center study performed at a tertiary care center concludes that psychosis is common and is linked to worse PD-symptom burdens in patients with PD without dementia.

In addition, the risk of psychosis in PD is increased with the use of dopamine agonists, which supports the recommendation to lower, stop, or replace dopamine agonists in patients with PD without dementia who have visual psychotic symptoms.

And lastly, independent predictors of visual hallucinations/illusions include dopamine agonists, increased motor symptoms, and REM sleep behavior disorder.

[Source(s): Neurology Times, PubMed]

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