Objective: To determine the incidence of psychosis in patients with Parkinson’s disease (PD) and to investigate the survival after a psychosis diagnosis among an incident PD cohort from 1991-2010 in Olmsted County, MN.

Background: Psychosis after the onset of PD is a well-known non-motor complication, but few studies have estimated incidence and survival.

Method: We used the Rochester Epidemiology Project to define an incident cohort study of Parkinsonism from 1991-2010 in Olmsted County, MN. A movement disorder specialist reviewed the electronic medical records (EMR) and applied clinical criterion to diagnose PD. Psychosis was diagnosed using NINDS/NIMH unified criteria. Incidence rates of psychosis were calculated per 100-person years within our cohort of PD patients. The risk of mortality was assessed using a Cox proportional hazards model using the onset of PD as time 0. Onset of psychosis was treated as a time-dependent covariate, and the model was adjusted for sex, age at PD onset, and presence of tremors and bradykinesia. Secondary analysis restricted the cohort to PDP patients only. A cox proportional hazards model was then fit using the onset of psychosis as time 0. Treatment with antipsychotic medication was included as a time-dependent covariate, and the model included the same adjustments as in the primary analysis

Results: We identified 669 cases of Parkinsonism; among them 297 patients were clinically diagnosed with PD. Of the 297 PD patients, 114 (38.4%) had evidence of psychosis (60% male); the median age of onset of psychosis was 79.4 years. The incidence of Parkinson Disease Psychosis (PDP) was 4.28 cases per 100 person-years. PDP patients had a 71% increased risk of death compared to PD patients (HR=1.71, CI: 1.36-1.80). There was no sex difference in risk of death after psychosis among PDP patients (HR=1.11, CI: 0.71-1.73). Of the 114 patients diagnosed with psychosis, 59 were treated with antipsychotics. There was not any significant difference in survival between treated PDP patients and untreated PDP patients (HR=1.11; CI: 0.72-1.71).

Conclusion: The presence of PDP increased the risk of death compared to PD patients without psychosis. Men with PDP did not have a statistically significant difference in risk of death compared to women with PDP. Lastly, treatment with anti-psychotics did not impact on survival for PDP patients. Further studies in more recent eras are needed to confirm our findings.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/incidence-and-survival-of-psychosis-in-patients-with-parkinsons-disease-1991-2010/