Objective: Examine clinical features associated with psychosis among Parkinson’s disease (PD) patients without dementia.

Background: Previously identified risk factors for PD psychosis include duration and severity of PD, autonomic dysfunction, REM sleep behavior disorder, daytime somnolence, and cognitive impairment. Little is known regarding PD psychosis in patients without dementia. Prior research has not clearly established the frequency with which minor hallucinations progress to more complex psychotic symptoms, such as well-formed visual hallucinations, hallucinations in other modalities, and delusions.

Method: Participants met the following inclusion criteria: 1) ≥ 30-years old at onset of first motor symptom, 2) ≤ 85 years of age, 3) diagnosis of idiopathic PD based on the UK Brain Bank criteria, and 4) Montreal Cognitive Assessment (MoCA) >21. The presence of psychosis was defined as the recurring presence of at least one of the following symptoms for at least one month: visual illusions, sense of presence, hallucinations, or delusions. Motor, autonomic, sleep, mood, and cognitive symptoms were evaluated.

Results: A total of 105 participants completed baseline visits (59% men; age = 67.8 ± 8.0 years; disease duration =4.9 years [IQR: 3.4-7.7]; UPDRS-III =24 [IQR 16-36]; MoCA = 24.8 ± 2.3), 92 completed year-one visits, 74 completed year-two visits, and 67 completed year-three visits. The prevalence of psychosis increased during the study from 31% (n=32) at baseline to 39% (n=26) at year three. Over three years, 43% (n=45) experienced psychosis. Of the 120 psychotic events, visual illusions were the most common (70%, n=84), followed by hallucinations (58.3%, n=70). Isolated minor hallucinations accounted for 39.2% (n=47) of psychotic events. In multivariate analysis of clinical features, only depressive symptoms (Beck Depression Inventory-II) significantly increased the odds of psychosis (OR 1.09, 95% CI: [1.03, 1.16], p=.004).  Of the cognitive assessments, only worse performance on Trail-Making Test B-A significantly increased the odds of psychosis (OR 1.43, 95% CI: [1.06, 1.93], p=.018).

Conclusion: In non-demented patients with PD, depressive symptoms and executive dysfunction were associated with increased risk of psychosis. Executive dysfunction may mark the transition from isolated minor hallucinations to more complex psychotic symptoms.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/longitudinal-study-of-clinical-symptoms-associated-with-psychosis-in-parkinsons-disease-without-dementia/