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

Hommel, Adrianus L.A.J. ; Meinders, Marjan J. ; Lorenzl, Stefan ; Dodel, Richard ; Coelho, Miguel ; Ferreira, Joaquim J. ; Laurens, Brice ; Spampinato, Umberto ; Meissner, Wassilios and Rosqvist, Kristina LU , et al. (2020) In Movement Disorders Clinical Practice 7(5). p.531-542
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... (More)

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.

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author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
depression, late-stage parkinsonism, neuropsychiatric symptoms, prevalence, psychosis
in
Movement Disorders Clinical Practice
volume
7
issue
5
pages
12 pages
publisher
John Wiley & Sons Inc.
external identifiers
  • scopus:85085050369
  • pmid:32626798
ISSN
2330-1619
DOI
10.1002/mdc3.12968
language
English
LU publication?
yes
id
bd02a012-3fb1-40d8-a1f3-abf9d36eb6fc
date added to LUP
2020-06-23 08:01:31
date last changed
2024-04-17 11:24:13
@article{bd02a012-3fb1-40d8-a1f3-abf9d36eb6fc,
  abstract     = {{<p>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.</p>}},
  author       = {{Hommel, Adrianus L.A.J. and Meinders, Marjan J. and Lorenzl, Stefan and Dodel, Richard and Coelho, Miguel and Ferreira, Joaquim J. and Laurens, Brice and Spampinato, Umberto and Meissner, Wassilios and Rosqvist, Kristina and Timpka, Jonathan and Odin, Per and Wittenberg, Michael and Bloem PhD, Bas R. and Koopmans, Raymond T. and Schrag, Anette}},
  issn         = {{2330-1619}},
  keywords     = {{depression; late-stage parkinsonism; neuropsychiatric symptoms; prevalence; psychosis}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{531--542}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Movement Disorders Clinical Practice}},
  title        = {{The Prevalence and Determinants of Neuropsychiatric Symptoms in Late-Stage Parkinsonism}},
  url          = {{http://dx.doi.org/10.1002/mdc3.12968}},
  doi          = {{10.1002/mdc3.12968}},
  volume       = {{7}},
  year         = {{2020}},
}