Neuropsychiatric Symptoms in Parkinson's Disease with Mild Cognitive Impairment and Dementia

Abstract

Neuropsychiatric symptoms commonly complicate Parkinson's disease (PD), however the presence of such symptoms in mild cognitive impairment (PD-MCI) specifically has not yet been well described. The objective of this study was to examine and compare the prevalence and profile of neuropsychiatric symptoms in patients with PD-MCI (n = 48) to those with PD and no cognitive impairment (PD-NC, n = 54) and to those with dementia in PD (PDD, n = 25). PD-MCI and PDD were defined using specific consensus criteria, and neuropsychiatric symptoms were assessed with the 12-item Neuropsychiatric Inventory (NPI). Self-rated apathy, depression, and anxiety rating scales were also administered. Over 79% of all participants reported at least one neuropsychiatric symptom in the past month. The proportion in each group who had total NPI scores of ≥4 (“clinically significant”) was as follows: PD-NC, 64.8%; PD-MCI, 62%; PDD 76%. Apathy was reported in almost 50% of those with PD-MCI and PDD, and it was an important neuropsychiatric symptom differentiating PD-MCI from PD-NC. Psychosis (hallucinations and delusions) increased from 12.9% in PD-NC group; 16.7% in PD-MCI group; and 48% in PDD group. Identifying neuropsychiatric symptoms in PD-MCI may have implications for ascertaining conversion to dementia in PD.

Cognitive and neuroanatomical correlates of neuropsychiatric symptoms in Parkinson's disease: A systematic review

“…In this study, apathy was also significantly correlated with factors such as advanced stage of disease and dopamine agonist load and all cognitive measures used in that study (e.g. Trail Making Test, Verbal Fluency Task, Wisconsin Card Sorting Test, 5-minute recall of 3 words and MMSE) [16].…”

“…In PD patients with dementia the prevalence of neuropsychiatric symptoms was found to be higher. In the Aarsland et al study, 50 out of 139 patients were demented [14] and in a further study, Leroi et al [16] reported that 96% of PD patients with dementia presented with at least one neuropsychiatric symptom. Another study demonstrated an association between the total Neuropsychiatric Inventory (NPI) score [17] and depression and anxiety (as measured by the Hospital Anxiety and Depression Scale) [18] in non-demented PD patients.…”

“…There are several pieces of evidence which support the hypothesis that cognitive impairments and dementia are a consequence of the development of NPS in general and apathy in particular [14, 41, 43-45, 47-53, 72]. For instance, a recent study [16] explored the frequency of NPS in three groups of patients with PD; patients without cognitive impairment (PD-NC, n = 54), patients with mild cognitive impairment (PD-MCI, n = 48) and patients with dementia (PDD, n = 25). Patients who showed at least one NPS were 39 (72.2%) in the PD-NC group, 38 (79.2%) in the PD-MCI group and 24 (96%) in the PDD group.…”

Parkinson’s disease psychosis

“…A study of the prevalence of psychosis in PD in those without any cognitive impairment, as compared to those with mild cognitive impairment or dementia, demonstrated that psychotic symptoms positively correlated with severity of cognitive impairment; 20 this was also found in the PRIAMO trial. 16 In attempts to develop specific criteria for psychotic symptoms without confounding cognitive impairment, 250 patients with idiopathic PD and mini-mental status examination (MMSE) .23 from community-based clinics were evaluated for psychotic symptoms based on National Institute of Neurological Disorders and Stroke/National Institute of Mental Health criteria.…”

Parkinson’s Disease Psychosis – Prevalence Patterns Across the EU-5

“…17,[44][45][46] These broad reported ranges highlight the difficulty of carrying out cross-study comparisons. Common variations in study design identified from a targeted literature review (unpublished findings) include the criteria for patient selection, the definition of PDP, the symptoms of psychosis that were of interest to study investigators, differences in the methodology used to assess symptoms, and the timeframe over which symptoms were observed.…”