Objective: To determine the rates of pharmacological treatment for neuropsychiatric symptoms (NPS) in patients with early Parkinson’s disease (PD), and identify predictors of under-treatment.

Background: NPS contribute to adverse outcomes in PD but represent a unique challenge to diagnose and treat. Despite evidence-based pharmacological treatments that may alleviate these symptoms, prior studies examining single NPS report that few patients receive treatment.

Method: Longitudinal study of early PD participants in the Parkinson’s Progression Markers Initiative. We screened for NPS using the Geriatric Depression Scale-15, State-Trait Anxiety Inventory, MDS-Unified Parkinson’s Disease Rating Scale, and Montreal Cognitive Assessment or diagnosis of mild cognitive impairment or dementia. The proportion of PD participants and healthy controls (HC) with treated and untreated NPS was determined at years 0 (de novo PD) and 4 (early PD), and compared to treatment rates one year later. Logistic models were used to examine predictors of NPS treatment status.

Results: A total of 395 de novo PD (mean age 62, 66% male) and 185 HC (mean age 61, 64% male) at year 0, and 307 early PD (mean age 65, 66% male) and 147 HC (mean age 64, 63% male) at year 4 were studied. Fewer NPS-positive de novo PD subjects were receiving treatment for depression (39%) and anxiety (36%), compared with HC (42% and 64%, respectively), and none were receiving treatment for other NPS. Of the PD subjects with untreated NPS at year 0, few started treatment for depression (23%), anxiety (19%), or cognitive impairment (0%) by the following year. More NPS-positive early PD subjects were receiving treatment for depression (58%), anxiety (57%), psychosis (8%), fatigue (1%), and cognitive impairment (8%), although none were receiving treatment for apathy. Of the PD subjects with untreated NPS at year 4, <15% started treatment for anxiety (11%), psychosis (9%), fatigue (1%), or cognitive impairment (6%) by the following year, and none started treatment for depression or apathy. The only predictor of treatment for any NPS was a higher anxiety score (OR 1.14 [1.07,1.21] de novo PD; OR 1.07 [1.01,1.12] early PD).

Conclusion: Evidence-based pharmacotherapies for NPS remain under-utilized in PD, even among a highly engaged group of research participants screened for NPS and cared for by movement disorders specialists. This represents a gap in the quality of care for PD patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/rates-of-pharmacological-treatment-of-neuropsychiatric-symptoms-in-early-parkinsons-disease/