Objective: Describe and compare patients with evidence of dementia-related psychosis diagnosed with Parkinson’s disease with dementia (PDD) versus patients with dementia but no Parkinson’s disease diagnosis (NPD).

Background: Patients with Parkinson’s disease (PD) often develop comorbid dementia (1), and approximately 50% of PD patients develop psychosis (2). Little is known about the characteristics and healthcare use of patients with PD, dementia, and psychosis, or how PD may affect use of healthcare resources.

Method: This claims-data analysis examined commercial and Medicare Advantage enrollees aged ≥40 years with evidence of dementia-related psychosis from 01Jan2009–31Mar2017. The first observed indicator of psychosis (≥2 diagnoses or antipsychotic fill) co-occurring or following evidence of dementia (≥2 diagnoses or pharmacy fill) was the index date. Continuous insurance enrollment was required from 12 months prior to dementia through 12 months post-index. Cohorts were based on presence/absence of PDD, defined from ≥1 claim for PD plus unspecified dementia or dementia due to a medical condition. Patient characteristics, health care utilization, and costs were measured in the year before the index date.

Results: Of 12,047 dementia patients identified, 311 had ≥1 claim with PDD (2.6%). PDD patients averaged slightly younger (79 years [SD=7]) than NPD patients (80 [7]; p=0.049), and a higher percentage were male (58.8% vs. 33.0%; p<0.001). Significantly higher (p<0.05) percentages of PDD patients had ≥1 diagnosis in 13 of the top 21 comorbid conditions, including diseases of the heart, back, skin, urinary, and gastrointestinal systems. Higher percentages of PDD patients had outpatient (88.4% vs. 69.8%) and ER visits (61.1% vs. 48.8%) and inpatient stays (34.4% vs. 27.2%; all p<0.01) than NPD patients. Mean visit counts were higher for office (13.2 [11.8] vs. 10.3 [11.2]) and ER visits (1.5 [2.4] vs. 1.1 [2.3]) and inpatient stays (0.50 [0.87] vs. 0.39 [0.78]; all p<0.05). Mean all-cause healthcare costs for PDD patients were significantly higher for all categories of medical services except for costs due to inpatient stays (total medical=$13,593 vs. $10,397; p<0.001); mean pharmacy costs were similar between cohorts.

Conclusion: PDD patients had higher disease burden, use of medical services, and medical care costs than NPD patients in the year before psychosis occurred.

References: 1. Mantri S, Fullard M, Gray SL. Patterns of dementia treatment and frank prescribing errors in older adults with Parkinson disease. JAMA Neurol 2019;76(1):41–49. 2. Forsaa EB, Larsen JP, Wentzel-Larsen T, et al. A 12-year population-based study of psychosis in Parkinson disease. Arch Neurol 2010;67(8):996–1001.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparison-of-dementia-patients-with-and-without-parkinsons-disease-before-dementia-related-psychosis-occurs-an-administrative-claims-data-analysis/