AUTHOR=Flanigan Joseph L. , Harrison Madaline B. , Patrie James T. , Shah Binit B. , Sperling Scott A. , Wyman-Chick Kathryn A. , Dalrymple William Alex , Barrett Matthew J. 

TITLE=Clinical and cognitive features associated with psychosis in Parkinson's disease: a longitudinal study

JOURNAL=Frontiers in Aging Neuroscience

VOLUME=16

YEAR=2024

URL=https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2024.1463426

DOI=10.3389/fnagi.2024.1463426

ISSN=1663-4365

ABSTRACT=<sec><title>Background</title><p>Parkinson's disease psychosis (PDPsy) is associated with increased nursing home placement and mortality and is closely linked with cognitive dysfunction.</p></sec><sec><title>Objective</title><p>Assess the clinical and cognitive features associated with PDPsy in patients without dementia.</p></sec><sec><title>Methods</title><p>We prospectively recruited people with Parkinson's disease (PwP) without dementia for a 3-year, longitudinal study at an outpatient movement disorders clinic. Participants completed annual visits involving assessment of motor and non-motor symptoms including neuropsychological testing. PDPsy was defined as the recurring presence of visual illusions, sense of presence, hallucinations, or delusions for at least 1 month. Using generalized estimating equations, we conducted two sets of analyses to separately assess the clinical and the cognitive predictors of PDPsy.</p></sec><sec><title>Results</title><p>We enrolled 105 participants. At baseline, mean age was 67.8 (SD = 8.0), median disease duration was 4.9 years (IQR: 3.4–7.7), and mean MoCA was 24.8 (SD = 2.3). Prevalence of PDPsy increased over 3 years from 31% (<italic>n</italic> = 32) to 39% (<italic>n</italic> = 26). Forty-five participants (43%) experienced PDPsy. Visual illusions were most common (70%, <italic>n</italic> = 84), followed by hallucinations (58.3%, <italic>n</italic> = 70). In multivariate analysis, of the clinical variables, only depressive symptoms [OR 1.09, 95% CI: (1.03, 1.16), <italic>p</italic> = 0.004] increased the odds of PDPsy; of the cognitive variables, only Trail Making Test B-A scores [OR 1.43, 95% CI: (1.06, 1.93), <italic>p</italic> = 0.018] significantly increased the odds of PDPsy.</p></sec><sec><title>Conclusions</title><p>In PwP without dementia, depressive symptoms were associated with increased risk of PDPsy. Executive/attentional dysfunction was also associated with PDPsy and may mark the transition from isolated minor hallucinations to more complex psychotic symptoms.</p></sec>