Onset and Remission of Psychosis in Parkinson's Disease: Pharmacologic and Motoric Markers

Jared T. Hinkle, Kate Perepezko, Catherine C. Bakker, Martijn P.G. Broen, Kathleen Chin, Ted M. Dawson, Vanessa Johnson, Zoltan Mari, Cherie L. Marvel, Kelly A. Mills, Alexander Pantelyat, Olga Pletnikova, Liana S. Rosenthal, Melissa D. Shepard, Daniel A. Stevens, Juan C. Troncoso, Jiangxia Wang, Gregory M. Pontone

Research output: Contribution to journalArticle

Abstract

Background: Psychosis is among the most disabling complications of Parkinson's disease (PD). The chronicity of PD psychosis remains understudied, and the relative importance of dopaminergic therapy versus the disease process itself in engendering psychosis remains unclear. The objective of this study was to examine pharmacologic and motoric correlates of PD psychosis onset and remission in a longitudinally monitored PD cohort. Methods: We analyzed data from 165 participants enrolled in a longitudinal PD study through the Morris K. Udall Parkinson's Disease Research Center of Excellence at Johns Hopkins University. Evaluations included formal psychiatric assessment and were conducted at 2-year intervals. Regression with generalized estimated equations was used to produce unadjusted and adjusted estimates for time-varying longitudinal associations between psychosis and putative risk factors. Results: Sixty-two participants (37.6%) were diagnosed with psychosis during at least 1 evaluation. Of 49 participants with psychosis who were followed over multiple evaluations, 13 (26.5%) demonstrated remission despite a significant increase in Hoehn & Yahr stage (P = 0.009); 2 of these individuals later relapsed. Multivariable regression with generalized estimated equations identified dementia diagnosis, akinesia-rigidity, anticholinergic usage, and levodopa-carbidopa dose as significantly associated with psychosis, whereas disease duration was not. A subanalysis of 30 incident psychosis cases suggested that the dopamine agonist dose was lowered after psychosis onset with a compensatory increase in the levodopa-carbidopa dosage. Conclusion: The current findings suggest that, in the context of standard therapy, PD-related psychotic disorder can remit at a frequency of approximately 27%. In addition, akinetic-rigid motor impairment was more strongly associated with psychosis than disease duration, independent of cognitive impairment and medications.

Original languageEnglish (US)
Pages (from-to)31-38
Number of pages8
JournalMovement Disorders Clinical Practice
Volume5
Issue number1
DOIs
StatePublished - Jan 1 2018

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Psychotic Disorders
Parkinson Disease
Dopamine Agonists
Cholinergic Antagonists
Psychiatry
Dementia

Keywords

  • hallucinations
  • motor subtypes
  • Parkinson's disease
  • psychosis
  • remission

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Onset and Remission of Psychosis in Parkinson's Disease : Pharmacologic and Motoric Markers. / Hinkle, Jared T.; Perepezko, Kate; Bakker, Catherine C.; Broen, Martijn P.G.; Chin, Kathleen; Dawson, Ted M.; Johnson, Vanessa; Mari, Zoltan; Marvel, Cherie L.; Mills, Kelly A.; Pantelyat, Alexander; Pletnikova, Olga; Rosenthal, Liana S.; Shepard, Melissa D.; Stevens, Daniel A.; Troncoso, Juan C.; Wang, Jiangxia; Pontone, Gregory M.

In: Movement Disorders Clinical Practice, Vol. 5, No. 1, 01.01.2018, p. 31-38.

Research output: Contribution to journalArticle

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abstract = "Background: Psychosis is among the most disabling complications of Parkinson's disease (PD). The chronicity of PD psychosis remains understudied, and the relative importance of dopaminergic therapy versus the disease process itself in engendering psychosis remains unclear. The objective of this study was to examine pharmacologic and motoric correlates of PD psychosis onset and remission in a longitudinally monitored PD cohort. Methods: We analyzed data from 165 participants enrolled in a longitudinal PD study through the Morris K. Udall Parkinson's Disease Research Center of Excellence at Johns Hopkins University. Evaluations included formal psychiatric assessment and were conducted at 2-year intervals. Regression with generalized estimated equations was used to produce unadjusted and adjusted estimates for time-varying longitudinal associations between psychosis and putative risk factors. Results: Sixty-two participants (37.6{\%}) were diagnosed with psychosis during at least 1 evaluation. Of 49 participants with psychosis who were followed over multiple evaluations, 13 (26.5{\%}) demonstrated remission despite a significant increase in Hoehn & Yahr stage (P = 0.009); 2 of these individuals later relapsed. Multivariable regression with generalized estimated equations identified dementia diagnosis, akinesia-rigidity, anticholinergic usage, and levodopa-carbidopa dose as significantly associated with psychosis, whereas disease duration was not. A subanalysis of 30 incident psychosis cases suggested that the dopamine agonist dose was lowered after psychosis onset with a compensatory increase in the levodopa-carbidopa dosage. Conclusion: The current findings suggest that, in the context of standard therapy, PD-related psychotic disorder can remit at a frequency of approximately 27{\%}. In addition, akinetic-rigid motor impairment was more strongly associated with psychosis than disease duration, independent of cognitive impairment and medications.",
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AU - Hinkle, Jared T.

AU - Perepezko, Kate

AU - Bakker, Catherine C.

AU - Broen, Martijn P.G.

AU - Chin, Kathleen

AU - Dawson, Ted M.

AU - Johnson, Vanessa

AU - Mari, Zoltan

AU - Marvel, Cherie L.

AU - Mills, Kelly A.

AU - Pantelyat, Alexander

AU - Pletnikova, Olga

AU - Rosenthal, Liana S.

AU - Shepard, Melissa D.

AU - Stevens, Daniel A.

AU - Troncoso, Juan C.

AU - Wang, Jiangxia

AU - Pontone, Gregory M.

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N2 - Background: Psychosis is among the most disabling complications of Parkinson's disease (PD). The chronicity of PD psychosis remains understudied, and the relative importance of dopaminergic therapy versus the disease process itself in engendering psychosis remains unclear. The objective of this study was to examine pharmacologic and motoric correlates of PD psychosis onset and remission in a longitudinally monitored PD cohort. Methods: We analyzed data from 165 participants enrolled in a longitudinal PD study through the Morris K. Udall Parkinson's Disease Research Center of Excellence at Johns Hopkins University. Evaluations included formal psychiatric assessment and were conducted at 2-year intervals. Regression with generalized estimated equations was used to produce unadjusted and adjusted estimates for time-varying longitudinal associations between psychosis and putative risk factors. Results: Sixty-two participants (37.6%) were diagnosed with psychosis during at least 1 evaluation. Of 49 participants with psychosis who were followed over multiple evaluations, 13 (26.5%) demonstrated remission despite a significant increase in Hoehn & Yahr stage (P = 0.009); 2 of these individuals later relapsed. Multivariable regression with generalized estimated equations identified dementia diagnosis, akinesia-rigidity, anticholinergic usage, and levodopa-carbidopa dose as significantly associated with psychosis, whereas disease duration was not. A subanalysis of 30 incident psychosis cases suggested that the dopamine agonist dose was lowered after psychosis onset with a compensatory increase in the levodopa-carbidopa dosage. Conclusion: The current findings suggest that, in the context of standard therapy, PD-related psychotic disorder can remit at a frequency of approximately 27%. In addition, akinetic-rigid motor impairment was more strongly associated with psychosis than disease duration, independent of cognitive impairment and medications.

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