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Abstract
Objective: To evaluate the course and predictors of neuropsychiatric symptoms (NPS) and cognition in patients with de novo Parkinson disease (PD).
Methods: Cross-sectional study of the cohort of de novo, untreated (at enrollment) patients with PD and healthy controls (HCs) from the Parkinson's Progression Markers Initiative. Participants have serial assessments of global cognition and symptoms of depression, anxiety, psychosis, impulse control disorders (ICDs), sleep and wakefulness, apathy, and fatigue. Available data up to 24 months of follow-up were included.
Results: The available sample size was as follows: baseline (PD = 423, HCs = 196), 12 months (PD = 261, HCs = 145), and 24 months (PD = 96, HCs = 83). Patients with PD experienced more depression, fatigue, apathy, and anxiety than HCs at all time points, and apathy (p = 0.001) and psychosis (p = 0.003) increased over time in patients with PD. Approximately two-thirds of patients with PD who screened positive for depression at any given visit were not taking an antidepressant. The Montreal Cognitive Assessment score decreased significantly over time in patients with PD (p < 0.001), but the change was comparable to that in HCs. At the 24-month visit, 44% of patients had been on dopamine replacement therapy (DRT) for at least 1 year, and this group reported more incident ICDs (p = 0.009) and excessive daytime sleepiness (p = 0.03).
Conclusion: Multiple NPS are more common in de novo, untreated patients with PD compared with the general population, but they also remain relatively stable in early disease, while global cognition slightly deteriorates. In contrast, initiation of DRT is associated with increasing frequency of several other NPS.
GLOSSARY
- DRT=
- dopamine replacement therapy;
- EDS=
- excessive daytime sleepiness;
- ESS=
- Epworth Sleepiness Scale;
- GDS=
- Geriatric Depression Scale;
- GEE=
- generalized estimating equation;
- HC=
- healthy control;
- ICD=
- impulse control disorder;
- IQR=
- interquartile range;
- MAO-B=
- monoamine oxidase type B;
- MCI=
- mild cognitive impairment;
- MDS-UPDRS=
- Movement Disorders Society Unified Parkinson's Disease Rating Scale;
- MoCA=
- Montreal Cognitive Assessment;
- NPS=
- neuropsychiatric symptoms;
- PD=
- Parkinson disease;
- PIGD=
- postural instability and gait disturbance;
- PPMI=
- Parkinson's Progression Markers Initiative;
- QUIP=
- Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease;
- RBD=
- REM sleep behavior disorder;
- STAI=
- State-Trait Anxiety Inventory;
- UPSIT=
- University of Pennsylvania Smell Identification Test
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received March 23, 2014.
- Accepted in final form June 23, 2014.
- © 2014 American Academy of Neurology
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