Objective: This study aims to evaluate the role of neuropsychiatric symptoms in the diagnosis of Early Parkinson’s Disease.

Background: Neuropsychiatric symptoms (NPS) are important and frequent nonmotor features in Parkinson disease (PD), manifesting from the premotor phase through the advanced stage1. This systematic review seeks to evaluate the prevalence and significance of NPS in early PD and their potential contribution to improving diagnostic accuracy.

Method: A search was performed in the PubMed database, using the keywords “neuropsychiatric symptoms”, “early Parkinson disease” and “diagnosis” and their equivalents. Articles published in English were selected. Case reports, systematic reviews, meta-analysis were excluded. After title and abstract analysis, duplicates were excluded and all articles approaching NPS in early PD were included.

Results: 173 articles were found; 9 met the inclusion criteria, including 1 randomized clinical trial2 and 8 observational studies1,3-9. Sample sizes varied from 28 to 341 participants, totalyzing 1.112 PD patients and 526 healthy controls. Among those evaluated, 1 studie3 showed more than 50% of its patients had NPS present at the time of the diagnoses and 11 presented 25% had depression/dysphoria and apathy/indifference at that time. Even in the initial motor stage of the disease, patients with PD had significantly higher scores on psychiatric scales compared with healthy control subjects4. The most common disorders were depression, apathy and anxiety, although mild behavioral impairment was also significant1,3,5. Furthermore, these studies showed worsening of the UPDRS-III test associated to NPS, demonstrating a correlation between these non-motor features and  increased PD gravity1,3,5,.

Conclusion: NPS are highly prevalent in early PD, mainly depression, apathy and anxiety. Therefore, further studies are needed to investigate if the onset of NPS happens before motor symptoms and could be used as a diagnosis tool.

References: 1. Yoo HS, Lee S, Chung SJ, Ye BS, Sohn YH, Yun M, et al. Clinical and Striatal Dopamine Transporter Predictors of Mild Behavioral Impairment in Drug-Naive Parkinson Disease. Clin Nucl Med. novembro de 2020;45(11):e463–8.

2. Hu P, Cao R, Fang J, Yang Q, Liu T, Yu F, et al. Alterations in event-related potential responses to empathy for pain in Parkinson’s disease on and off medication. Clin Neurophysiol. abril de 2021;132(4):914–21.

3. Aarsland D, Brønnick K, Alves G, Tysnes OB, Pedersen KF, Ehrt U, et al. The spectrum of neuropsychiatric symptoms in patients with early untreated Parkinson’s disease. J Neurol Neurosurg Psychiatry. agosto de 2009;80(8):928–30.

4. Stanković I, Stefanova E, Tomić A, Lukić MJ, Stojković T, Marković V, et al. Psychiatric Symptoms in the Initial Motor Stage of Parkinson’s Disease. J Neuropsychiatry Clin Neurosci. Summer de 2016;28(3):205–10.

5. Oh YS, Kim JH, Yoo SW, Hwang EJ, Lyoo CH, Lee KS, et al. Neuropsychiatric symptoms and striatal monoamine availability in early Parkinson’s disease without dementia. Neurol Sci. fevereiro de 2021;42(2):711–8.

6. Santangelo G, Vitale C, Picillo M, Cuoco S, Moccia M, Pezzella D, et al. Apathy and striatal dopamine transporter levels in de-novo, untreated Parkinson’s disease patients. Parkinsonism Relat Disord. maio de 2015;21(5):489–93.

7. Oruc S, Gülseren G, Kusbecı OY, Özbulut O. An evaluation of neuropsychiatric symptoms in Parkinson’s disease patients. Niger J Clin Pract. julho de 2017;20(7):900–4.

8. Meira B, Lhommée E, Schmitt E, Klinger H, Bichon A, Pélissier P, et al. Early Parkinson’s Disease Phenotypes Tailored by Personality, Behavior, and Motor Symptoms. J Parkinsons Dis. 2022;12(5):1665–76.

9. Duncan GW, Khoo TK, Yarnall AJ, O’Brien JT, Coleman SY, Brooks DJ, et al. Health-related quality of life in early Parkinson’s disease: the impact of nonmotor symptoms. Mov Disord. fevereiro de 2014;29(2):195–202.

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