The Prevalence and Determinants of Neuropsychiatric Symptoms in Late-Stage Parkinsonism.

Autor: Hommel ALAJ; Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders Nijmegen the Netherlands.; Groenhuysen Organisation Roosendaal the Netherlands., Meinders MJ; Radboud University Medical Center Radboud Institute for Health Sciences Nijmegen the Netherlands., Lorenzl S; Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München-Klinikum Großhadern Munich Germany.; Institute of Nursing Science and Practice Salzburg Austria., Dodel R; Department of Geriatric Medicine University Hospital Essen Essen Germany., Coelho M; University of Lisbon, Lisbon School of Medicine (FMUL), Laboratory of Clinical Pharmacology and Therapeutics, Lisbon, Portugal; and University of Lisbon Lisbon School of Medicine (FMUL), Instituto de Medicina Molecular Lisbon Portugal.; University of Lisbon Lisbon School of Medicine (FMUL), Instituto de Medicina Molecular Lisbon Portugal.; Department of Neurosciences Service of Neurology, Hospital Santa Maria Lisbon Portugal., Ferreira JJ; University of Lisbon, Lisbon School of Medicine (FMUL), Laboratory of Clinical Pharmacology and Therapeutics, Lisbon, Portugal; and University of Lisbon Lisbon School of Medicine (FMUL), Instituto de Medicina Molecular Lisbon Portugal., Laurens B; Service de Neurologie CHU de Bordeaux 33000 Bordeaux France.; Univ. de Bordeaux, Institut des Maladies Neurodégénératives Bordeaux France., Spampinato U; Service de Neurologie CHU de Bordeaux 33000 Bordeaux France.; Univ. de Bordeaux, Institut des Maladies Neurodégénératives Bordeaux France., Meissner W; Service de Neurologie CHU de Bordeaux 33000 Bordeaux France.; Univ. de Bordeaux, Institut des Maladies Neurodégénératives Bordeaux France.; Department of Medicine University of Otago Christchurch New Zealand.; New Zealand Brain Research Institute Christchurch New Zealand., Rosqvist K; Department of Neurology, Department of Clinical Sciences Lund University Lund Sweden., Timpka J; Department of Neurology, Department of Clinical Sciences Lund University Lund Sweden., Odin P; Department of Neurology, Department of Clinical Sciences Lund University Lund Sweden., Wittenberg M; Coordinating Centre for Clinical Trials Philipps University Marburg Marburg Germany., Bloem PhD BR; Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders Nijmegen the Netherlands., Koopmans RT; Radboud University Medical Center Department of Primary and Community Care Nijmegen The Netherlands.; Joachim en Anna, Center for Specialized Geriatric Care Nijmegen The Netherlands., Schrag A; University College London, Queen Square Institute of Neurology, University College London London United Kingdom.
Jazyk: angličtina
Zdroj: Movement disorders clinical practice [Mov Disord Clin Pract] 2020 May 21; Vol. 7 (5), pp. 531-542. Date of Electronic Publication: 2020 May 21 (Print Publication: 2020).
DOI: 10.1002/mdc3.12968
Abstrakt: Background: Late-stage parkinsonism and Parkinson's disease (PD) are insufficiently studied population. Although neuropsychiatric symptoms (eg, psychosis, depression, anxiety, behavioral problems) are frequently present, their prevalence and clinical predictors remain unknown.
Objective: To determine the prevalence and predictors of neuropsychiatric symptoms in late-stage PD.
Methods: We conducted a multinational study of patients with PD with ≥7 years disease duration and either a Hoehn and Yahr stage ≥4 or a Schwab and England score ≤ 50% in the on stage. Neuropsychiatric symptoms were assessed through interviews with carers using the Neuropsychiatric Inventory, with a frequency × severity score ≥ 4, indicating clinically relevant symptoms. The determinants analyzed were demographic characteristics, medication, and motor and nonmotor symptoms. Univariate and multivariate logistic analyses were performed on predictors of clinically relevant neuropsychiatric symptoms.
Results: A total of 625 patients were recruited in whom the Neuropsychiatric Inventory could be completed. In 92.2% (576/625) of the patients, at least 1 neuropsychiatric symptom was present, and 75.5% (472/625) had ≥1 clinically relevant symptom. The most common clinically relevant symptoms were apathy (n = 242; 38.9%), depression (n = 213; 34.5%), and anxiety (n = 148; 23.8%). The multivariate analysis revealed unique sets of predictors for each symptom, particularly the presence of other neuropsychiatric features, cognitive impairment, daytime sleepiness.
Conclusion: Neuropsychiatric symptoms are common in late-stage PD. The strongest predictors are the presence of other neuropsychiatric symptoms. Clinicians involved in the care for patients with late-stage PD should be aware of these symptoms in this specific disease group and proactively explore other psychiatric comorbidities once a neuropsychiatric symptom is recognized.
Competing Interests: The Care of late‐stage Parkinsonism‐study (CLaSP) is being funded by the European Commission (Joint Programme–Neurodegenerative Disease Research “European Research Projects for the Evaluation of Health Care Policies, Strategies and Interventions for Neurodegenerative Diseases”) through national funding bodies in all 6 countries (Economic and Social Research Council ES/L009250/1; BMBF, Marburg, Germany 01ED1403A, Munich, Germany 01ED1403B; Bordeaux, France, ANR‐13‐JPHC‐0001‐07; Lisbon, Portugal, HC/ 0002/2012; Lund, Sweden, HC‐559‐002; Nijmegen, Holland, 733051003). A.L.A.J.H. was supported by the Groenhuysen organization and Stichting Beroepsopleiding Huisartsen. A.S. was supported by the National Institute for Health Research University College London/University College London Hospital Biomedical Research Centre.
(© 2020 International Parkinson and Movement Disorder Society.)
Databáze: MEDLINE
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