Objective: To characterize patients with Parkinson’s disease psychosis (PDP) in the Medicare database, determine comorbidities associated with PDP, and evaluate mortality in PDP compared to PD patients without psychosis.

Background: PDP is characterized by hallucinations or delusions, has a cumulative prevalence of over 50%, and is a leading cause of disability and institutionalization. However, studies have provided conflicting results around prevalence, comorbidities and course for PDP. This analysis evaluates one of the largest populations of PDP patients and determines the factors and outcomes associated with PDP.

Methods: A retrospective study evaluated the full Medicare claims database during a 4-year period from January 1, 2012 to December 31, 2015. PD patients were identified as patients having at least one claim for a diagnosis of PD and another confirmatory claim for PD at some point during the study period. PDP patients were identified as those with at least one psychosis diagnosis claim during the study period and at least 2 PD diagnosis claims, with at least one of those occurring before the first psychosis diagnosis.

Results: Overall, there were 106,893 PD patients identified; 68,821 patients without psychosis (PDP-) and 38,072 patients with psychosis (PDP+). The PDP+ cohort was older (mean age=81.9 vs 78.7 years (p<0.0001). The PDP+ cohort had more medical comorbidities, with a mean Charlson Comorbidity Index score = 4.14 vs 2.46 in the PDP- cohort (p<0.0001). The most common comorbidities, defined as prevalence >10% in the PDP+ cohort and prevalence in the PDP+ cohort >2x the PDP- cohort, include: UTI, dementia, congestive heart failure, depressive symptoms, stroke, and pneumonia. Hospitalizations were greater in the PDP+ cohort vs. the PDP- cohort (43.3% vs. 17.6%, p<0.001). Additionally, A&E visits were statistically greater in the PDP+ cohort vs. the PDP- cohort (63.1% vs. 32.6%, p<0.001). Age-standardized mortality in the PDP+ cohort was significantly higher than in the PDP- cohort (28.2 vs 7.3 deaths per 100 patient-years; p<0.0001).

Conclusions: Analyses from a large-scale national medical claims database highlights that psychosis in PD is associated with increasing age, multiple medical, neurological and psychiatric comorbidities, and higher mortality rates. The results highlight the various burdens associated with PDP and the need for prompt diagnosis and management.

« Back to 2018 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/parkinsons-disease-psychosis-associated-comorbidities-and-mortality-in-the-medicare-population/