Objective: To find out the prevalence of neuropsychiatric symptoms in patients with Movement Disorders.

To find out the relationship between cognitive impairment and neuropsychiatric symptoms as well as the severity of caregivers distress in various movement disorders.

Background: Behavioral and Psychological Symptoms are frequent coexisting symptoms in patients with Movement Disorders (MD).  These symptoms ought to depend on the type and extent of MD, as the pattern of anatomical involvement in these diseases often differ substantially. Hence, in this study we intended to explore the pattern of symptoms in a number of MDs. We also assessed the difference of symptoms in patients with mild cognitive impairment with that of moderate to severe MD.

Method: We recruited 178 patients with MD s (as per consultant’s diagnosis), from the neurology Out Patient Department of Institute of Neurosciences- Kolkata. Mini Mental State Examination (MMSE) was utilized to estimate the cognitive status of the patients. Objective and uniform identification of neuropsychiatric symptoms were performed using Neuropsychiatric Inventory (NPI).

Results: Mean age of these patients was 64 years (SD 9.28) and 75% were male. The overall neuropsychiatric symptoms were most prominent in Parkinson’s disease dementia (PDD). Depression (68.2%) and hallucination (57.6%) were most prominent presenting neuropsychiatric symptoms in PDD. Among these disorders neuropsychiatric symptoms were also frequent in Progressive Supranuclear Palsy (PSP), where depression (53.8%) was although high but was not as frequent as in PDD. Interestingly, MSA (Multisystem Atrophy) and NPH (Normal Pressure Hydrocephalus) presented with minimum neuropsychiatric features among all dementia category under evaluation. All neuropsychiatric symptoms were comparatively more frequent among patients with moderate to severe cognitive impairment (MMSE score 0-20 out of 30), especially Delusion, aggression and depression were significantly higher among them.

Conclusion: The patients with PDD and PSP should be routinely screened for all neuropsychiatric symptoms using standard tests, as the prevalence of behavioral and psychological symptoms is higher in these groups. The probability of coexistence of poor cognition and depression (also aggression and hallucination) in patients with MD is high. The presence of one symptom should alert the clinicians to look for other features.

References: Cummings, J., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D., & Gornbein, J. (1994). The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology, 44(12), 2308-2308. Feast, A., Orrell, M., Charlesworth, G., Melunsky, N., Poland, F., & Moniz-Cook, E. (2016). Behavioural and psychological symptoms in dementia and the challenges for family carers: systematic review. The British Journal Of Psychiatry, 208(5), 429-434. http://dx.doi.org/10.1192/bjp.bp.114.153684

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MDS Abstracts - https://www.mdsabstracts.org/abstract/behavioral-and-psychological-symptoms-in-patients-with-movement-disorders/