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. 2020 May 21;7(5):531-542.
doi: 10.1002/mdc3.12968. eCollection 2020 Jul.

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

Adrianus L A J Hommel  1   2 , Marjan J Meinders  3 , Stefan Lorenzl  4   5 , Richard Dodel  6 , Miguel Coelho  7   8   9 , Joaquim J Ferreira  7 , Brice Laurens  10   11 , Umberto Spampinato  10   11 , Wassilios Meissner  10   11   12   13 , Kristina Rosqvist  14 , Jonathan Timpka  14 , Per Odin  14 , Michael Wittenberg  15 , Bas R Bloem PhD  1 , Raymond T Koopmans  16   17 , Anette Schrag  18 ; Care of Late‐Stage Parkinsonism Consortium
Affiliations

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

Adrianus L A J Hommel et al. Mov Disord Clin Pract. .

Abstract

Background: 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: To determine the prevalence and predictors of neuropsychiatric symptoms in late-stage PD.

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: 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: 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.

Keywords: depression; late‐stage parkinsonism; neuropsychiatric symptoms; prevalence; psychosis.

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Conflict of interest statement

The Care of late‐stage Parkinsonism‐study (CLaSP) is being funded by the European Commission (Joint Programme–Neurodegenerative Disease Research “European Research Projects for the Evaluation of Health Care Policies, Strategies and Interventions for Neurodegenerative Diseases”) through national funding bodies in all 6 countries (Economic and Social Research Council ES/L009250/1; BMBF, Marburg, Germany 01ED1403A, Munich, Germany 01ED1403B; Bordeaux, France, ANR‐13‐JPHC‐0001‐07; Lisbon, Portugal, HC/ 0002/2012; Lund, Sweden, HC‐559‐002; Nijmegen, Holland, 733051003). A.L.A.J.H. was supported by the Groenhuysen organization and Stichting Beroepsopleiding Huisartsen. A.S. was supported by the National Institute for Health Research University College London/University College London Hospital Biomedical Research Centre.

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