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
Department of Neurology, University of Virginia, Charlottesville, VA, United States.
Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States.
Front Aging Neurosci. 2024 Nov 6;16:1463426. doi: 10.3389/fnagi.2024.1463426. eCollection 2024.
Parkinson's disease psychosis (PDPsy) is associated with increased nursing home placement and mortality and is closely linked with cognitive dysfunction.
Assess the clinical and cognitive features associated with PDPsy in patients without dementia.
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.
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% ( = 32) to 39% ( = 26). Forty-five participants (43%) experienced PDPsy. Visual illusions were most common (70%, = 84), followed by hallucinations (58.3%, = 70). In multivariate analysis, of the clinical variables, only depressive symptoms [OR 1.09, 95% CI: (1.03, 1.16), = 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), = 0.018] significantly increased the odds of PDPsy.
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.
帕金森病性精神病（PDPsy）与入住养老院的几率增加及死亡率相关，且与认知功能障碍密切相关。
评估无痴呆患者中与PDPsy相关的临床和认知特征。
我们在一家门诊运动障碍诊所前瞻性招募了无痴呆的帕金森病患者（PwP），进行为期3年的纵向研究。参与者每年就诊，包括评估运动和非运动症状，其中包括神经心理学测试。PDPsy被定义为视觉错觉、存在感、幻觉或妄想反复出现至少1个月。我们使用广义估计方程进行了两组分析，分别评估PDPsy的临床和认知预测因素。
我们纳入了105名参与者。基线时，平均年龄为67.8岁（标准差 = 8.0），疾病持续时间中位数为4.9年（四分位间距：3.4 - 7.7），平均蒙特利尔认知评估量表（MoCA）得分为24.8分（标准差 = 2.3）。PDPsy的患病率在3年中从31%（n = 32）增加到39%（n = 26）。45名参与者（43%）出现了PDPsy。视觉错觉最为常见（70%，n = 84），其次是幻觉（58.3%，n = 70）。在多变量分析中，在临床变量中，只有抑郁症状[比值比（OR）1.09，95%置信区间：（1.03，1.16），P = 0.004]增加了PDPsy的几率；在认知变量中，只有连线测验B - A得分[OR 1.43，95%置信区间：（1.06，1.93），P = 0.018]显著增加了PDPsy的几率。
在无痴呆的PwP中，抑郁症状与PDPsy风险增加相关。执行/注意力功能障碍也与PDPsy相关，可能标志着从孤立的轻微幻觉向更复杂的精神病性症状的转变。
