Literature Review

Baseline Symptoms May Predict Psychosis in Parkinson’s Disease


 

After performing multivariate logistic regression and adjusting the results for age and sex, Dr. Barrett and colleagues found that greater autonomic symptoms (odds ratio [OR], 1.07 for a one-unit change in SCOPA-AUT), the presence of RBD (OR, 1.9), and EDS (OR, 2.5) at baseline were associated with increased risk of reporting psychotic symptoms on two or more occasions, compared to no or one psychotic event.

A logistic regression model adjusted for age and sex indicated that greater autonomic symptoms (OR, 1.08 for a one-unit change in SCOPA-AUT) and EDS (OR, 1.8) at baseline were associated with increased risk of psychotic symptoms on one or more occasions. A Cox regression model adjusted for EDS (hazard ratio [HR], 1.5) indicated that greater autonomic symptoms (HR, 1.03 for a one-unit change in SCOPA-AUT) and presence of RBD (HR, 1.47) were associated with increased risk of having a first psychotic event.

At the last assessment, patients with Parkinson’s disease and two or more psychotic events were more likely to have the postural instability and gait difficulty motor phenotype and lower scores on the Montreal Cognitive Assessment, Letter Number Sequencing test, and Symbol Digit Modalities Test.

The investigators had data about cholinergic nuclei densities at baseline for 228 participants with Parkinson’s disease and 101 controls. Ch4 density in Parkinson’s disease was associated with lower risk of reporting psychotic symptoms on two or more occasions (OR, 0.96 for an increase in density of one unit). Mean Ch4 densities were 1.7% greater for the control group, compared with the Parkinson’s disease group. Participants with Parkinson’s disease and two or more psychotic events had lower baseline Ch4 density, compared with healthy controls, but participants with Parkinson’s disease with no or one psychotic event did not.

In linear regression models adjusted for age and sex, autonomic symptoms were associated with baseline Ch4 density, but EDS and RBD were not. Having comorbid EDS and RBD was associated with lower Ch4 density.

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