Objective: To determine the interval between impact on health-related quality of life (HRQL) and initiation of treatment with neuroleptics in patients with Parkinson’s disease (PD) psychosis.

Background: Initially, mild psychotic symptoms in PD are frequently not reported and the history and impact of psychosis can therefore be difficult to determine prior to treatment with antipsychotic medication (AP).

Methods: Using data from the National Parkinson Foundation’s Quality Improvement Initiative (NPF-QII), a longitudinal outcomes study of patients managed in an expert care setting without exclusions, subjects with at least baseline plus two follow-up visits were evaluated. The AP group consisted of 153 subjects who reported no AP use at baseline and first follow-up but who reported AP use at the second follow-up. The control group consisted of 2733 subjects who reported no AP use at all three visits. The groups were compared through the computation of a weighed average matching the frequency of subjects by age and disease duration after adjusting for sex and symptomatic comorbidities. The AP and control group were compared for differences in HRQL measured using the PDQ-39.

Results: The AP group had significantly worse HRQL at baseline and first follow-up (p < 0.01) however at second follow-up, when the AP group had initiated AP medication, there was no significant difference between the AP and control group (p = 0.78). Compared with the control group, the AP group averaged 0.43 standard deviations worse on the PDQ-39 score (approximately 5 points on the PDQ-39 summary index score) prior to treatment with AP medication.

Conclusions: Subjects who receive treatment for PD psychosis have a worse HRQL compared to their peers detectable 2 years prior to being prescribed AP medication. This difference disappears with initiation of antipsychotics, raising the possibility that earlier detection and treatment might benefit patients. This longitudinal outcomes registry, through its large size and systematic data collection, provides the opportunity to evaluate the status of patients prior to an event such as the emergence of psychotic symptoms.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/neuroleptic-medication-is-associated-with-a-worse-health-status-in-the-years-prior-to-treatment-but-have-the-potential-for-normalization/