Objective: To assess clusters of neuropsychiatric symptoms in Parkinson’s disease and their relation to motor symptoms and demographic markers in a large PD cohort.

Background: Neuropsychiatric symptoms are highly present in PD patients and might occur in specific clusters of symptoms. Characteristic motor phenotypes, medication regimes or social factors might prompt expression of specific clusters.

Method: Retrospective data analysis of 350 consecutive PD patients who underwent standardized neuropsychiatric work-up. From this cohort, 219 patients had complete assessment including assessment of depression and anxiety (HADS), impulse control disorders (QUIP), mania (MSS), and cognition (MMST), and were interrogated with hierarchal cluster analysis using the Ward-method. Resulting clusters were tested for differences in demographic, education and PD related factors including disease stage, UPDRS III in ON and OFF state, motor subtyping and type and amount of dopaminergic therapy using parametric and non-parametric tests as appropriate using SPSS version 25.

Results: We identified 4 clusters: 1) neuropsychiatricly unaffected (n = 59), 2) cognitively impaired (n = 24), 3) with impulse-control disorder (n = 45), and 4) patients with a mixed profile (“mixed”, n = 91). Neuropsychiatricly unaffected patients showed symptoms in none of the examined domains (p < 0.001); cognitively impaired patients exhibited lowest performance in MMST (24.3 ± 3.3, p < 0.001) and showed anxious (9.0 ± 2.7, p < 0.001 compared to cluster 1 and 4) and depressive symptoms (10.1 ± 2.8, p < 0.001). Patients with impulse-control disorder were characterized by high values in the QUIP (34.1 ± 13.0, p < 0.001) and anxious (9.5 ± 3.1, p < 0.001 compared to cluster 1 and 4) and depressive symptoms (7.3 ± 3.1, p < 0.001). Cognitively impaired patients tended to have more severe disease stage (3.3 ± 0.9 vs. 1) 2.7 ± 1.0 vs. 3) 2.6 ± 0.9 vs. 4) 2.5 ± 0.8, p = 0.54) and had lower education (p = 0,047). We did not find significant differences in other PD related factors between clusters.

Conclusion: PD patients´ neuropsychiatric profiles can be subtyped into different clusters. Anxiety and depression are common comorbid symptoms in patients with cognitive impairment and with impulse-control disorder. More severe disease stage (PD specific) and lower education (PD non-specific) are associated with cognitive impairment in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/neuropsychiatric-clusters-in-patients-with-parkinsons-disease-and-their-clinical-and-demographic-correlates/