Objective: To assess and compare personality profiles and psychiatric symptoms in de-novo clinically-established body-first and brain-first PD.

Background: Body-first and brain-first have recently been proposed as new clinical-neuropathological models of PD. Evidence on neuropsychiatric symptoms and personality traits in the two remain limited.

Method: PD patients with motor symptom onset 1-2 years prior were prospectively evaluated at the Movement Disorders Clinic in Ferrara between February 1, 2023, and February 1, 2024. Demographic and clinical data (MDS-UPDRS, RBDq, NMSS, MOCA, SCOPA-AUT) were collected, along with neuropsychological and personality trait assessments (BDI-II, PAS, Diagnostic Criteria for Apathy (DCA), PDQ-39, Pathological Obsessive Compulsive Personality Scale (POPs), Big Five Inventory (BFI)).  A hybrid hierarchical k-means clustering approach among patients with RBD onset ≥1 year before motor symptoms (RBDq ≥8) and higher SCOPA-AUT and NMSS (cardiovascular/gastrointestinal) identified body-first. They were compared with a group matched for age, sex, disease duration, severity, and LEDD with no evidence of RBD, constipation or OH, representing the brain-first.

Results: Fourty-seven patients were evaluated, 10 classified as body-first and 16 as brain-first [tab1]. Eight were excluded after cluster analysis, and 13 did not meet control group criteria. Body-first showed significantly higher scores for BDI (7.5±6.2 vs 1.7±2.3, p=0.002), PAS (8.5±8.4 vs 2.4±2.4, p=0.008), POPs-Maladaptive Perfectionism (30.6±7.7 vs 27.4±7.1, p=0.040), POPs-Difficulties with Changes (23.3±8.7 vs 18.0±6.5, p=0.022), and BFI-Neuroticism (BFI-N) (22.1±6.8 vs 18.6±5.0, p=0.048), along with lower BFI-Extroversion (19.5±5.2 vs 28.0±6.1, p=0.050) [tab2]. In body-first, BDI and PAS correlated positively (0.955, 0.880) with BFI-N, a pattern not observed in the counterpart [fig1].

Conclusion: A stronger association between neuropsychiatric symptoms and body-first subtype was detected. Body-first patients are more prone to depressive symptoms (though subclinical) and struggle more with adaptation and coping in response to the diagnosis of PD. They also show higher neuroticism, maladaptive perfectionism, and resistance to change, while brain-first PD is associated with greater extroversion. In the body-first group, higher neuroticism correlates with more depressive symptoms and poorer coping.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/personality-traits-and-neuropsychiatric-assessment-in-de-novo-clinically-established-body-first-and-brain-first-parkinsons-disease/