Objective: To evaluate the influence of neuropsychiatric symptoms in identifying Parkinson’s disease (PD) patients who will progress to dementia (PDD) in the imminent future (~4 years).

Background: Neuropsychiatric symptoms are common in PD and may be associated with conversion to PDD.

Methods: One hundred and twenty-three non-demented PD patients were followed over 3.5-4.5 years; 27 progressed to PDD during the study. All patients received Level II neuropsychological testing: two or more tests were assessed in each of the five cognitive domains; a global cognitive score was derived by averaging the z-scores from the attention, executive function, episodic memory, and visuospatial domains. Neuropsychiatric evaluations included the Neuropsychiatric Inventory (NPI), Geriatric Depression Scale (GDS), the hallucination and depression items from the UPDRS, and the emotional well-being, hallucination and distressing dream items from the PD Questionnaire (PDQ). ROC tests were used to analyse whether measures at study entry were associated with future progression to PDD.

Results: As expected, baseline cognition (ROC for global score, AUC = 0.87, CI = 0.79-0.94), and older age (AUC = 0.73, CI = 0.63-0.84), were useful at discriminating conversion to PDD four years later. Time since diagnosis (AUC = 0.63, CI = 0.51-0.75) and the NPI total score (AUC = 0.62, CI = 0.50-0.75) showed smaller effect sizes.  The NPI sub-scale scores and GDS (AUC all < 0.62) were not significantly associated with PDD conversion. Interestingly, baseline patient-reported hallucinations, using items from the PDQ and UPDRS, were associated with conversion to PDD (AUC = 0.70, CI = 0.60-0.80; AUC = 0.69, CI = 0.57-0.80, respectively), whereas the hallucination sub-scale on the NPI (reported by the significant other) was not significant (AUC = 0.55, CI = 0.48-0.62). The AUC’s of the hallucination items of the PDQ and UPDRS showed a stronger association with PDD progression compared to hallucinations reported by the NPI (p < 0.05).

Conclusions: While cognitive testing is a better predictor, patient-reported hallucinations also suggest an increased probability of conversion to PDD within 4 years. Other neuropsychiatric measures, particularly those reported by a patient’s significant other, may not be as useful in this regard.

« Back to 2017 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/patient-reported-hallucinations-and-the-probability-of-progression-to-dementia-in-parkinsons-disease/