Objective: To describe the clinical and demographic characteristics of patients with PDP and their relationship with the use of DAs.

Background: Parkinson’s Disease Psychosis (PDP) affects up to 40% of patients, presenting as hallucinations, illusions, and delusions, with visual hallucinations being the most commonly reported symptom [1] and typically occurring in the late stages of the disease, often more than 10 years after the diagnosis.[2] While a potential association exists between dopaminergic therapy and the development of psychotic symptoms, [3] evidence suggesting dopamine’s role in disorders like schizophrenia,[4] has led to the recommendation of reducing dopaminergic agonists (DAs) as part of the management of PDP.[5] However, evidence remains inconclusive, and the role of DAs in PDP remains unclear.[6]

Method: Cross-sectional study. Consecutive patients with clinical diagnosis of PD were recruited from the outpatient Movement Disorders Clinic at our Hospital from June 2022 to December 2023. Sociodemographic and clinical information was collected from the medical record. The presence of psychosis was defined as a score >1 in the MDS-UPDRS item 1.2; variables were compared between patients with and without psychosis using Mann-Whitney U and X2 tests.

Results: We included 121 patients, whose demographic characteristics and clinical rating scale scores are detailed in Table 1. We found that 59 patients (48.8%) were taking DAs, most of them pramipexole (81.4%), with a median usage of 5.5 years (IQR 3-11). Psychosis was present in 29 (23.9%) patients, and was associated with longer disease duration (p = 0.001), worse cognitive performance assessed by MoCA (p= 0.001), and higher use of DAs (p=0.013). Patients without psychosis were more likely to have never used DAs. (Table 2)

Conclusion: Psychosis in patients with PD was associated with disease duration and use of DAs. Although psychosis may result from disease progression, further studies, using validated scales for PDP, are warranted to clarify the role of DAs in psychotic symptoms.

Table 1 Characteristics of population

Table 2. Patients with PD and psychosis

References: 1. Zahodne LB, Fernandez HH. Pathophysiology and treatment of psychosis in Parkinson’s disease: a review. Drugs Aging. 2008;25(8):665-82. doi: 10.2165/00002512-200825080-00004. PMID: 18665659; PMCID: PMC3045853.
2. Papapetropoulos S. Drug-induced psychosis in Parkinson disease: phenomenology and correlations among psychosis rating instruments. Clin Neuropharmacol 2006;29:59. [PubMed: 16518136]
3. Park, A., & Stacy, M. (2011). Dopamine-induced nonmotor symptoms of Parkinson’s disease. Parkinson’s Disease, 485063. https://doi.org/10.4061/2011/485063
4. Howes, O. D., Montgomery, A. J., Asselin, M.-C., Murray, R. M., Valli, I., Tabraham, P., Bramon-Bosch, E., Valmaggia, L., Johns, L., Broome, M., McGuire, P. K., & Grasby, P. M. (2009). Elevated striatal dopamine function linked to prodromal signs of schizophrenia. Archives of General Psychiatry, 66(1), 13–20. https://doi.org/10.1001/archgenpsychiatry.2008.514
5. Pahwa R, Isaacson SH, Small GW, Torres-Yaghi Y, Pagan F, Sabbagh M. Screening, Diagnosis, and Management of Parkinson’s Disease Psychosis: Recommendations From an Expert Panel. Neurol Ther. 2022 Dec;11(4):1571-1582. doi: 10.1007/s40120-022-00388-y. Epub 2022 Jul 29. Erratum in: Neurol Ther. 2023 Oct;12(5):1803. PMID: 35906500; PMCID: PMC9362468.
6. Chengyu Zhang, Suzanne Reeves, Anthony S. David, Harry Costello& Jonathan Rogers (2023): Neuropsychiatric features of Parkinson’s disease in the era prior to the use of dopaminergic therapies, Cognitive Neuropsychiatry, doi: 10.1080/13546805.2023.2212151

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dopamine-agonist-use-and-psychotic-symptoms-in-patients-with-parkinsons-disease/