Objective: To describe the prevalence of Parkinson’s Disease (PD) associated psychosis (PDAP) at a Brazilian movement disorders outpatient and to evaluate its associated factors.

Background: Non-motor symptoms in PD, such as psychosis, can be as disabling as the motor symptoms. PDAP development involves disease and treatment-related features, and its prevalence varies widely in the literature due to the influence of social and epidemiological factors. Data about PDAP in Brazilian patients is scarce.

Method: This is a cross-sectional study carried out in a Brazilian movement disorders outpatient between May and December/2022. We include ≥18 years-old patients with PD defined by the UK Brain Bank criteria. Patients with aphasia, traumatic brain injuries, other movement disorders or neuropsychiatric diseases were excluded. We apply the NINDS/NIMH criteria to assess PDAP, MMSE for cognitive impairment and Modified Hoehn&Yahr scale (mH&Y) for disease severity. Quantitative variables with normal and non-normal distribution were presented as mean with standard deviation or median with interquartile range and compared using the t-Student test or Mann-Whitney, respectively. Chi-square or Fisher tests were used for categorical variables.

Results: Eighteen (24%) PD patients had PDAP. There was no significant difference between PDAP and non-PDAP groups regarding age (68.2±8.2 vs 66±11, p=0.505), age of onset (54.3±8.3 vs 56.5±10.2, p=0.65), disease severity according to the mH&Y (p=0.499) or sex (p=0.684). The PDAP group had a longer disease duration (13.8±6.2 vs 9.6±4.9, p=0.003), a higher history of cerebrovascular disease (16.7% vs 0%, p=0.007) and of smoking (61.1% vs 26.3%, p=0.012). The median MMSE score was lower in the PDAP group (23.5 [IR 19.3-27 vs 27.0 [IR 22-29], p=0.041). Regarding treatment, the PDAP group had a higher LEDD (1348mg [IR 600-1575] vs 750mg [IR 600-1063], p<0.001), a higher frequency of levodopa-controlled release drugs (83.3% vs 40.3%, p=0.001) and COMT-inhibitors use (55.5% vs 15.7%, p=0.002). There were no significant differences for other dopaminergic drugs and comorbidities.

Conclusion: PDAP is frequent in our Brazilian PD patients and is associated with a higher LEDD, longer disease duration, history of cerebrovascular disease and smoking and lower MMSE scores. In contrast to most studies, dopamine agonist use was not associated with PDAP in our sample.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/parkinsons-disease-associated-psychosis-in-a-brazilian-sample-worse-cognitive-outcomes-higher-ledd-and-longer-disease-duration/