Objective: To compare neuropsychiatric disorders (NPsy), other non-motor symptoms (NMS), and associated medication use and costs in individuals with advanced Parkinson’s Disease (aPD) with those newly diagnosed with PD (PD) and without PD (no-PD).

Background: NPsy and NMS impose a significant clinical burden on people with PD (PwP). A comprehensive landscape on the prevalence of NPsy and NMS in PwP is lacking.

Method: Retrospective analysis using the US Commercial and Medicare Advantage insurance claims dataset (01/2016–06/2024). Adults (≥18y) with a PD diagnosis and ≥1 PD medication claim were categorized into 2 PwP groups: aPD (Levodopa Equivalent Daily Dose ≥1000 mg) and PD (incident users of PD treatment). No-PD were individuals without any PD diagnosis. Diagnoses were identified by International Classification of Diseases (ICD-10) codes and associated medications by National Drug Codes. aPD were propensity score matched on age, gender, health insurance plan, comorbidity index, US region, and index year 1:1 to PD and 1:5 to no-PD. T-tests, Fisher’s exact, and Pearson chi-squared tests were utilized.

Results: The study included 9477 aPD–PD and 9477–47385 aPD–no-PD matched pairs, of which the mean age was 74y with most covered by Medicare Advantage (>90%). Compared with PD, aPD had higher coding rates for any psychosis disorder (13.7% vs 12.1%; *P<.05) and NMS (42.8%* vs 34.8%) though CI was similar (25.7% vs 26.2%; P=.426) and apathy low across groups (0.2%* vs 0% [Table 1]). For aPD compared with no-PD, any psychosis disorders were ≥3 times higher (13.7%* vs 4.2%), NMS were ≥2 times higher (42.8%* vs 19.8%), and orthostatic hypotension was 10 times more frequent (9.7%* vs 0.9%). More patients with aPD were on ≥1 medication for NyPsy/NMS than PD or no-PD (52.9%* vs 46.8% vs 27.4% [Table 2]). Most common medications for NPsy/NMS in PwP were 2nd-gen antipsychotics (>11%), cholinesterase inhibitors (>15%), and α-adrenergic blockers (>17%); all significantly higher in aPD, leading to greater mean annual medication costs than PD or no-PD for psychosis disorders ($1006.3* vs $338.8 vs $35.4) and NMS ($770.2* vs $325.7 vs $106.9).

Conclusion: PwP are significantly more likely to receive NPsy and NMS diagnoses than the general population, leading to higher medication use and costs. These often underreported comorbidities must be recognized and effectively managed alongside PD.

Table 1

Table 2

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MDS Abstracts - https://www.mdsabstracts.org/abstract/parkinsons-disease-increased-presence-of-neuropsychiatric-symptoms-and-non-motor-issues-drive-higher-medication-use-and-costs/