Objective: To examine drug use trends among hospitalized Parkinson’s disease (PD) patients in the U.S. and to assess the association between PD medications and delirium. Additionally we sought to analyze the association with major psychiatric complications, and potential risk factors.

Background: Clinical guidelines for PD treatment have evolved, and the evolution affects prescribing patterns. Dopamine agonist (DA) use has declined due mainly to psychiatric concerns (e.g. ICD’s), however real-world trends and the impact on delirium remain unclear. This study investigates these potentially critical relationships.

Method: A large U.S. hospital-based PINC AI healthcare database was analyzed, including PD patients aged ≥21 years who were hospitalized from Jan 1, 2018, to June 26, 2023. The annual medication usage was analyzed via OLS regression using a Benjamini-Hochberg correction. Delirium occurrence was the primary outcome, with known risk factors of COVID-19, and PD medications used as potential explanatory variables. Binary logistic regression assessed delirium risk, calculating the odds ratios with 95% confidence intervals. LASSO regression was used for variable selection, and model performance was evaluated using ROC and calibration curves. Chi-square analysis assessed delirium risk among anti-PD drugs.

Results: Among 313,075 PD patients, levodopa/carbidopa (L/C) was most prescribed (63.2%), followed by DA (6.7%). DA and catechol-O-methyltransferase inhibitor (COMTI) use declined in patients aged >65 years (p < 0.05, OLS regression with FDR). Delirium incidence over time increased (p < 0.01, OLS regression with FDR), and PD medications were found to be significant risk factors (p < 0.01, binary logistic regression with LASSO). A nomogram predicted delirium probability (AUC 0.69 in both training and validation cohorts). L/C, COMTI, and monoamine oxidase-B inhibitors were associated with delirium, while DA was not.

Conclusion: PD prescribing patterns have evolved, with a large recent decline in DA use. Adjunctive drug use slightly increased, while most patients continued L/C. Despite fewer DA prescriptions, delirium incidence has risen over time in hospitalized PD patients. PD medications were a delirium risk factor, whereas COVID-19 was not. L/C was strongly associated with delirium, though further research is needed to address confounders such as disease severity, age, cognitive status, comorbidities and causality.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/trends-in-u-s-drug-use-among-hospitalized-parkinsons-patients-experiencing-delirium/