Objective: to define the evolution of apathy and other neuropsychiatric symptoms in patients with early Parkinson’s disease (PD).

Background: Apathy is a common neuropsychiatric symptom in PD, presenting as isolated or with depression and anxiety. Its management can be challenging, with some studies pointing towards a possible improvement with dopaminergic treatment.

Method: In this study, we assessed a cohort of patients before the introduction of dopaminergic treatment and 3 to 5 years later, once dopaminergic treatment had been already introduced. Patients underwent a neuropsychological assessment at baseline and at follow-up, including the MATTIS dementia rating scale (MDRS), the Frontal assessment battery for cognition, the Starstkstein apathy scale for apathy, the BDI-2 for depression and the STAI for anxiety, as well the Ardouin Scale of Behavior in Parkinson’s Disease (ASBPD). The levodopa equivalent daily dose was collected at each visit. The primary outcome of the study was the change of the Starkstein apathy scale at 3-5 years compared to baseline. The secondary outcomes were the change in depression and anxiety, as well as the development of hyperdopaminergic behaviors at 3-5 years compared to baseline.

Results: 198 patients with de novo PD were included at baseline and 90 patients 3-5 years afterwards. Of these 90, 4 patients were excluded from the analysis because of inclusion was not fulfilled (score at the MDRS<130). Mean age at inclusion was 59.7 years +/-7.2. Mean dose of levodopa daily equivalents at follow-up was 425.5 mg+/-354.1. The primary outcome showed a significant improvement of apathy at follow-up compared to baseline (respectively 10.9+/-5.6, 12.6+/-5.7, p= 0.006). Anxiety significantly improved at 5 years, as measured with the STAI (p<0.001). Depression, measured with the BDI 2, improved only in patients with initial apathy (p=0.003). Hyperdominergic behaviors, measured with the ASBPD, significantly increased at follow-up (<0.001).

Conclusion: Apathy significantly improved in a cohort of patients with de novo PD over years, once the dopaminergic treatment had been started. The introduction of dopaminergic medication allows an improvement over time of apathy, anxiety and depression in early PD, but also the development of hyperdopaminergic behaviours.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/apathy-in-de-novo-parkinsons-disease-improves-after-the-first-years-with-dopaminergic-treatment/