Department of Neurology, University of Virginia, Charlottesville, VA, USA.
Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
Parkinsonism Relat Disord. 2017 Oct;43:56-60. doi: 10.1016/j.parkreldis.2017.07.011. Epub 2017 Jul 15.
Considering that psychosis in Parkinson disease (PD) is associated with worse outcomes, including dementia, we aimed to study the characteristics, correlates, and assessment of PD psychosis in those without dementia.
101 PD subjects without dementia (Montreal Cognitive Assessment ≥21/30) were recruited to participate in a study of neuropsychiatric symptoms in PD. This study included a baseline standard neurological exam and common PD symptom assessments. Using the Scale for the Assessment of Positive Symptoms (SAPS) and separate assessment of visual illusions and sense of presence, NINDS-NIMH criteria for PD psychosis were applied.
Of the 33 (32.7%) PD subjects who met diagnostic criteria for psychosis in PD, visual illusions were most common (72.7%), followed by visual hallucinations (39.4%). Adjusted for presence of REM sleep behavior disorder (RBD) (p = 0.097), use of dopamine agonists (OR = 3.7, p = 0.012) and greater autonomic symptom burden (OR = 1.1 (per 1-unit change in score on SCOPA-AUT), p = 0.012) were associated with greater risk of psychosis. Use of dopamine agonists (OR = 5.0, p = 0.007), higher MDS-UPDRS Part II score (OR = 1.1, p = 0.010), and presence of RBD (OR = 4.8, p = 0.012) were independent predictors of visual hallucinations and visual illusions. MDS-UPDRS item 1.2 score ≥1 had highly correlated with the SAPS score (r = 0.65, p < 0.0001), but was 42% sensitive and 96% specific for identifying psychosis.
This study confirms the association between dopamine agonists and psychosis in PD patients without dementia. The association of RBD, autonomic symptoms, and MDS-UPDRS Part II scores with psychosis underscore its link to brainstem dysfunction and greater PD motor symptom severity.
鉴于帕金森病（PD）中的精神病与更差的结局相关，包括痴呆，我们旨在研究无痴呆的 PD 精神病患者的特征、相关性和评估。
招募了 101 名无痴呆（蒙特利尔认知评估≥21/30）的 PD 患者参与 PD 神经精神症状的研究。该研究包括基线标准神经检查和常见 PD 症状评估。使用阳性症状评定量表（SAPS）和单独评估幻觉和存在感，应用 NINDS-NIMH 诊断 PD 精神病的标准。
在符合 PD 精神病诊断标准的 33 名（32.7%）PD 患者中，最常见的是幻觉（72.7%），其次是幻视（39.4%）。调整 REM 睡眠行为障碍（RBD）的存在（p=0.097）、多巴胺激动剂的使用（OR=3.7，p=0.012）和更大的自主症状负担（OR=1.1（每 SCOPA-AUT 评分增加 1 分），p=0.012）与精神病风险增加相关。多巴胺激动剂的使用（OR=5.0，p=0.007）、更高的 MDS-UPDRS 第二部分评分（OR=1.1，p=0.010）和 RBD 的存在（OR=4.8，p=0.012）是幻觉和幻觉的独立预测因子。MDS-UPDRS 项目 1.2 评分≥1 与 SAPS 评分高度相关（r=0.65，p<0.0001），但对识别精神病的敏感性为 42%，特异性为 96%。
这项研究证实了无痴呆的 PD 患者中多巴胺激动剂与精神病之间的关联。RBD、自主症状和 MDS-UPDRS 第二部分评分与精神病的关联强调了它与脑干功能障碍和更大的 PD 运动症状严重程度的联系。
