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Baseline Markers of Future Psychosis in Early PD

Neurology; 2018 May; Barrett, Blair, et al

Rapid eye movement sleep behavior disorder (RBD), excessive daytime sleepiness (EDS), and greater autonomic symptom burden are associated with greater risk of future psychotic symptoms in Parkinson disease (PD), according to a recent study. Furthermore, reduced cholinergic nucleus 4 (Ch4) density at baseline is associated with future psychotic symptoms and a greater burden of RBD, EDS, and autonomic symptoms. This cohort study evaluated 423 patients with newly diagnosed PD collected as part of the Parkinson's Progression Markers Initiative. Psychotic symptoms were assessed with the Movement Disorders Society–Unified Parkinson Disease Rating Scale item 1.2, which assesses hallucinations and psychosis over the past week. Researchers found:

  • Multivariate logistic regression adjusted for age and sex found that greater autonomic symptoms, RBD, and EDS at baseline were associated with increased risk of reporting psychotic symptoms on ≥2 occasions.
  • Having 2 or 3 of these baseline symptoms was associated with lower Ch4 density.
  • In a logistic regression model adjusted for age and sex, higher Ch4 gray matter density was associated with lower risk of reporting psychotic symptoms on ≥2 occasions.

Citation:

Barrett MJ, Blair JC, Sperling SA, Smolkin ME, Druzgal TJ. Baseline symptoms and basal forebrain volume predict future psychosis in early Parkinson disease. Neurology. 2018;90(18): e1618-e1626. doi:10.1212/WNL.0000000000005421.