Objective: To determine the progression of neuropsychiatric symptoms (NPS) in Parkinson’s disease (PD) and their associations with quality of life (QoL) and motor problems.

Background: Emerging evidence suggests non-motor symptoms including NPS may predate the onset of motor problems. NPS occur in over 60% of PD patients, leading to increased risk of institutionalisation. At present there are few longitudinal studies assessing the burden of NPS on QoL in non-demented PD patients and caregivers.

Method: Patients with newly diagnosed idiopathic PD (n=212) and controls (n=99) were recruited to the Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation-PD (ICICLE-PD) study. Participants completed the Neuropsychiatric Inventory with Caregiver Distress scale (NPI-D) to measure NPS; Parkinson’s Disease Questionnaire (PDQ‐39) to measure QoL; Movement Disorders Society Unified Parkinson’s Disease Rating Scale Part III (MDS-UPDRS III) to measure severity of motor impairments; and Montreal Cognitive Assessment (MoCA) to measure global cognition. Assessments were repeated at 18 and 36-month follow-up. Multivariate linear regression was used to predict NPI-D and QoL, adjusting for confounding variables.

Results: Hallucinations, depression, anxiety and apathy were more common in PD subjects than controls at each time point (p<0.05 for all). Irritability, sleep disturbances and appetite changes were significantly higher in PD subjects than controls at 18 months, with appetite changes still significant at 36 months (p<0.05). Lower MoCA and higher MDS-UPDRS-III scores at 36 months were significant predictors of NPI total score at this time point (β=-0.260, p=0.010; β=0.411, p<0.001 respectively) but not at baseline (p>0.05). Higher NPI-D score was a significant determinant of poorer QoL at both baseline (ΔR2=0.063, p<0.05) and this was consistent at 36 months (ΔR2=0.041, p<0.05).

Conclusion: Prevalence of NPS is higher in PD compared to controls and is associated with greater motor problems and poorer QoL. Clinicians should be aware of their frequency, since earlier identification of patients with NPS at diagnosis will allow provision of specialist support.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/progression-of-neuropsychiatric-symptoms-in-parkinsons-disease/