Objective: To explore the factors which may predict the onset of psychosis in Parkinson’s disease (PD).

Background: Non-motor symptoms (NMS) are commonly observed in PD. Psychosis is one of the debilitating NMS of PD, which commonly manifests as Visual Hallucinations (VH) and minor hallucinations (MH). As psychosis is associated with poor functional outcome in patients with PD, it is crucial to identify patients who are prone to develop psychosis early in the course of the disease.

Methods: In this prospective study, 51 consecutive patients with PD having psychosis (PDP) were recruited from the neurology outpatient clinics of the National Institute of Mental Health and Neurosciences (NIMHANS), India. Diagnosis of PDP was done as per the National Institute of Neurological Disorders and Stroke-National Institute of Mental Health (NINDS-NIMH) criteria. Median of the latency of onset of psychotic symptoms from the onset of motor symptoms was calculated and after doing a median split, the cohort of PDP were divided into early onset PDP (EOP, n=25, men=19) and late onset PDP (LOP, n=26, men=22). Both the groups were compared for several demographic and clinical characteristics.

Results: MH was the commonest manifestation of psychosis in our cohort (n=29), followed by formed VH (n=9), auditory hallucination (n=5), delusion (n=5), tactile hallucination (n=4), and olfactory hallucination (n=2). Forty patients had one of the above forms of psychosis whereas 11 had the psychotic symptoms in combinations. Patients with LOP were older compared to those with EOP (63.4±7.0 years vs 56.5±8.1 years, p=0.002).  EOP and LOP were similar in terms of years of education, age at onset of motor symptoms, and MMSE.  Severity and stage of PD was similar in both the groups. LOP group had higher LED/day (819.1±365.8 vs 608.5±356.3, p=0.04) compared to those with EOP.  Patients with EOP had poor scores on frontal assessment battery (13.8±2.0 vs 15.3±1.8, p=0.007), more frequently had RBD (80% vs 46.2%, p=0.02), PIGD phenotype (72% vs 26.9%, p=0.002), and excessive daytime sleepiness (Epworth Sleepiness Scale: 8.04±3.7 vs 3.9±3.1) compared to those with LOP.

Conclusions: Presence of RBD, excessive daytime sleepiness, frontal lobe dysfunction, and PIGD phenotype of PD may be associated with early onset of psychosis in PD.  Higher LEDD may not trigger early occurrence of psychosis in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/predictors-of-onset-of-psychosis-in-parkinsons-disease-who-gets-it-early/