Objective: To evaluate the association between psychotic symptom severity and caregiver burden in patients with PD.

Background: Psychotic symptoms are common in Parkinson’s disease (PD) and represent an important source of disability for both patients and caregivers. While the presence of psychosis has been associated with poorer outcomes in PD, the relationship between psychosis severity and caregiver burden remains incompletely understood.

Method: We performed a cross-sectional analysis of patients with PD from a tertiary movement disorders center. Psychotic symptoms were assessed using item 1.2 (hallucinations and psychosis) of the Movement Disorder Society–Unified Parkinson’s Disease Rating Scale Part I (MDS-UPDRS 1), scored from 0 (absent) to 4 (severe). Caregiver burden was measured using the Zarit Burden Interview (ZBI-22). Multivariable linear regression models were constructed to evaluate the association between psychosis severity and caregiver burden, adjusting for age, disease duration, and motor severity measured by the Hoehn and Yahr stage. MDS-UPDRS 1.2 score of 0 was used as the reference category.

Results: A total of 298 patients were included in the final analysis. Mild psychotic symptoms (scores 1–2) were not significantly associated with caregiver burden. However, moderate and severe psychosis showed an independent association with higher ZBI scores. Compared with patients without psychosis, those with a MDS-UPDRS 1.2 score of 3 had an adjusted increase of 12.8 points in ZBI burden scores (β = 12.84, 95% CI 0.56–25.11, p = 0.041), while those with a score of 4 showed an increase of 19.1 points (β = 19.10, 95% CI 4.58–33.63, p = 0.010). Age, disease duration, and motor severity were not independently associated with caregiver burden in the adjusted model. The overall model was statistically significant (p = 0.026).

Conclusion: Moderate-to-severe psychotic symptoms, rather than mild psychosis, are independently associated with increased caregiver burden in PD. These findings suggest a threshold effect, highlighting the importance of early recognition and management of clinically significant psychosis to mitigate caregiver impact.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/severity-of-psychotic-symptoms-is-independently-associated-with-caregiver-burden-in-parkinsons-disease-a-cross-sectional-analysis/