Parkinson Disease Psychosis Tied to Higher Risk for All-Cause Mortality

A hearing impaired elderly senior adult man wearing a hearing aid is sitting staring through the hazy, speckled, unwashed window and grungy mesh screen of a living room window at home. He has early stage dementia and will sit motionless for minutes at a time gazing engrossed at the outside world.
Presenting at the 2022 AAN Annual Meeting, Mayo Clinic researchers investigated and compared the survival rates and symptoms of Parkinson disease and Parkinson disease psychosis.

Mortality from any causes is significantly higher in patients with Parkinson disease (PD) psychosis (PDP) compared with patients with PD only, according to study findings presented at the 2022 American Academy of Neurology (AAN) Annual Meeting, held from April 2 to April 7 in Seattle, Washington, and virtually from April 24-26, 2022.

Patients with PD are susceptible to experiencing psychosis, which in turn, may affect their quality of life. There is limited data regarding the effects of psychosis in PD on survival rates in a population-based cohort, the researchers noted. The objective of the current study was to assess survival rates and symptoms across PD and PDD using data from of a population-based cohort.

In the study, Mayo Clinic researchers investigated and compared the survival rates and symptoms of PD vs PDP between the years 2006 and 2015. The researchers used the Rochester Epidemiology Project to identify a cohort of patients with PD from Olmsted County, Minnesota, during the study period. The study employed a movement disorder specialist who reviewed the clinical records of these patients to confirm the PD diagnosis. The National Institute of Neurological Disorders and Stroke/National Institute of Mental Health unified criteria were used to diagnose PDP.

Out of 225 cases of PD in the cohort, the researchers identified 69 cases of PDP (31%). Patients with PDP had a significantly higher rate of mortality from any causes compared with patients with only PD (hazard ratio [HR], 4.79; P =.005), but no differences were found between male and female patients. Despite these findings, the researchers reported that a 5-year increase in age at the onset of PD was associated with a significantly higher risk of mortality (HR, 2.39; P <.001).

Patients with PDP had higher rates of cognitive impairment (40.6% vs 25.6%; P =.024) as well as greater rates of orthostatic hypotension (26.1% vs 14.7%; P =.042) vs patients with PD. There were no significant differences between those with PDP and PD only in regard to the rates of falls (P =0.63), chronic dizziness (P =0.54), or somnolence (P =.13).

Approximately 45% (n=31) of the patients with PDP received a prescription for an antipsychotic drug, showing that a majority of these patients (55%) remained untreated. The researchers found no significant differences between patients with PDP who were treated with an antipsychotic vs patients with PDP who were not treated with an antipsychotic in terms of falls (P =.40), dizziness (P =.70), somnolence (P =.59), cognitive impairment (P =.17), or orthostatic hypotension (P =.44).

The researchers concluded “Psychosis is associated with a higher risk of all-causes mortality in PD; age of onset of PD influences the mortality risk.”

Reference

Stang C, Camerucci E, Mullan A, et al. Survival differences among patients with Parkinson’s disease and Parkinson’s disease psychosis: A population-based study (2006-2015). Presented at: the 2022 AAN Annual Meeting; April 2-7, 2022; Seattle, Washington; April 24-26, 2022; Virtual Meeting. Abstract P4.007.

This article originally appeared on Neurology Advisor