Objective: To describe the cognitive-psychiatric course in the first 5 years of diagnosed Parkinson disease (PD).

Background: Although common, little is known about the differential progression and co-morbidity of non-motor symptoms in PD, or introduction of psychiatric medications.

Method: Using prospectively-collected data in the context of the Parkinson’s Progression Markers Initiative (PPMI) study annual visits, we evaluated prevalence, correlates, and treatment of depression, anxiety, REM sleep behavior disorder [RBD] symptoms, impulse control disorders [ICDs], psychosis, apathy, excessive daytime sleepiness and cognitive impairment.

Results: Of 423 PD participants evaluated at baseline, 316 were available for analyses at year 5. Depression, anxiety and rapid eye movement sleep behavior disorder (RBD) symptoms were common at disease onset (14%, 25% and 26%), changing little at 5 years to 20%, 21% and 38%. Psychosis and apathy were uncommon at baseline (3% for each) but quadrupled over five years (to 13% and 12%), and fatigue tripled (from 11% to 32%). ICD symptoms remained relatively unchanged (21% to 27%). At year 5 all psychiatric symptoms, except ICDs and daytime sleepiness, were at least 4-fold more common in PD compared with healthy controls, and 56% of PD patients screened positive for 3 or more psychiatric-cognitive disorders at the year 5 visit. Rates of mild cognitive impairment (MCI) or dementia per site investigator diagnosis increased from 9% to 20% over time, but only 3.6% had dementia at year 5. Antidepressant and anxiolytic/hypnotic use was common at baseline and increased over time (18% to 27% for the former; 13% to 24% for the latter); antipsychotic and cognitive-enhancing medication use was uncommon throughout (2% and 5% of patients at year 5).

Conclusion: There is high prevalence of nearly all psychiatric symptoms in early PD. Variability in baseline prevalence and temporal evolution might represent differential impact of distribution and spread of disease pathology, treatment effects, and psychological factors. Significant cognitive impairment (i.e., dementia) is not common in early disease. Regarding treatment, antidepressant and anxiolytic/sleep medication use are common in early PD, while antipsychotic and cognitive-enhancing medication use are not.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cognitive-and-psychiatric-course-in-the-initial-lustrum-of-parkinson-disease-the-glass-is-half-full/