Objective: To estimate the prevalence and correlates of neuropsychiatric symptoms (NPS) in a cohort of consecutive patients with Parkinson’s disease (PD) recruited in the initial motor stage of the disease (Hoehn and Yahr stage 1).

Background: NPS in the early stage of PD are considered as an expression of degenerative process, despite the associations with psychosocial, demographic and clinical factors and dopamine replacement therapy.

Methods: Non-demented PD outpatients with hemiparkinsonism (n=111) and sex and age-matched healthy controls (HC) (n=105) underwent detailed clinical, psychiatric and neuropsychological testing. Psychiatric evaluation consisted of depression, anxiety, apathy, perceptive problems and sleep and wakefulness assessments. Mild cognitive impairment in PD (PD-MCI) was diagnosed according to the MDS Task Force Level 2 criteria (1).

Results: Even in the initial motor stage of PD, patients had significantly higher scores on all psychiatric scales and significantly lower scores on the Addenbrooke’s Cognitive Examination-Revised compared with HC. The combination of apathy, daytime sleepiness and nocturnal sleep problems was predictive for subject’s separation into the PD group. Apathy, depression and anxiety occurred respectively in 33%, 22% and 7% of PD patients compared to 4%, 5% and 1% of HC. REM sleep behavior disorder (RBD) was present in 20.7% of patients with PD, who presented with higher psychiatric burden and more altered dreams compared to patients without RBD. Criteria for MCI associated with PD were fulfilled in 24 % of PD patients in contrast to 7% of MCI in HC group at the -1.5 SD. PD-MCI patients at early disease endorsed depression and anxiety more frequently compared to PD-nonMCI patients. Sleep problems in PD-MCI patients included a higher grade of altered dreams, sleep fragmentation and movements during sleep. The prevalence of RBD did not differ among PD patients with and without MCI. Treated patients (n=71) had more sleep problems, but did not differ in the frequency of MCI from drug naive patients (n=40).

Conclusions: Apathy, anxiety, depression, and sleep disturbances are most frequent NPS in early PD patients. Cognitive deterioration might influence the frequency of NPS. Refrence: 1. Litvan I, Goldman JG, Troster AI, et al: Diagnostic criteria for mild cognitive impairment in Parkinson’s disease: The Movement Disorder Society Task Force guidelines. Mov Disord 2012; 27:349–356.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/psychiatric-manifestations-in-the-initial-motor-stage-of-parkinsons-disease/