Psychosis associated to Parkinson's disease in the early stages: relevance of cognitive decline and depression
- Letterio Morgante1,
- Carlo Colosimo2,
- Angelo Antonini3,4,
- Roberto Marconi5,
- Giuseppe Meco2,
- Massimo Pederzoli6,
- Francesco E Pontieri7,
- Giulio Cicarelli8,
- Giovanni Abbruzzese9,
- Salvatore Zappulla10,
- Silvia Ramat11,
- Michela Manfredi12,
- Edo Bottacchi13,
- Michele Abrignani14,
- Alfredo Berardelli15,
- Autilia Cozzolino16,
- Claudio Paradiso3,
- Danilo De Gaspari3,
- Francesca Morgante1,
- Paolo Barone16,
- on behalf of the PRIAMO Study Group*
- 1Dipartimento di Neuroscienze, Scienze Psichiatriche ed Anestesiologiche Università di Messina, Messina, Italy
- 2Dipartimento di Neurologia e Psichiatria, Sapienza Università di Roma, Roma, Italy
- 3Istituti Clinici di Perfezionamento, Parkinson Institute, Milano, Italy
- 4IRCCS San Camillo, Venezia, Italy
- 5Dipartimento di Neuroscienze, Ospedale della Misericordia, Grosseto, Italy
- 6Dipartimento di Neurologia, Ospedale Civile, Vimercate, Milano, Italy
- 7Ospedale Sant'Andrea, II facoltà di Medicina e Chirurgia, Sapienza Università di Roma, Roma, Italy
- 8Neurologia e Stroke, AORN San Giuseppe Moscati, Avellino, Italy
- 9Centro Parkinson-Dipartimento di Neuroscienze, Oftalmologia e Genetica, Università degli Studi di Genova, Genova, Italy
- 10Neurologia, Ospedale Umberto I, Enna, Italy
- 11Clinica Neurologica, Azienda Ospedaliera Universitaria, Firenze, Italy
- 12Fondazione Salvatore Maugeri IRCCS, Castel Goffredo, Mantova, Italy
- 13UO di Neurologia, Ospedale Regionale, Aosta, Italy
- 14UO Neurologia, Ospedale San Biagio di Marsala, Marsala, Trapani, Italy
- 15Dipartimento di Scienze Neurologiche and Neuromed Institute, Sapienza Università di Roma, Roma, Italy
- 16Università Federico II and IDC-Hermitage-Capodimonte, Napoli, Italy
- Correspondence to Professor L Morgante, Dipartimento di Neuroscienze, Scienze Psichiatriche ed Anestesiologiche, Università di Messina, Via Consolare Valeria 1, 98125 Messina, Italy;
Contributors LM and FM contributed to the conception and design of the article, interpretation of the data, drafting the article and revising it critically for important intellectual content, and contributed to final approval of the version to be published. The other authors contributed to revising the article critically for important intellectual content.
- Received 10 March 2011
- Revised 25 June 2011
- Accepted 4 July 2011
- Published Online First 11 August 2011
Objective To evaluate the prevalence of psychosis associated with Parkinson's disease (PSY-PD) in its early stages, its incidence over a 24 month follow-up period and the association with motor and non-motor clinical features.
Methods PRIAMO is a 2 year longitudinal observational study that has enrolled patients with parkinsonism in 55 Italian centres. A cohort of 495 patients with early disease stage PD (baseline Hoehn and Yahr score ≤2, disease's duration (median) 3.4 years) were followed for 2 years. PSY-PD was evaluated by means of a clinician rated questionnaire and defined as the presence of at least one of the following symptoms occurring for at least 1 month: illusions, hallucinations, jealousy ideas and persecutory ideas. Patients with and without PSY-PD were compared on several clinical variables, encompassing motor and non-motor features.
Results The prevalence of PSY-PD at baseline was 3%; the incidences at 12 and 24 months were 5.2% and 7.7%, respectively. Longer disease duration and prescription of dopamine agonists at baseline were associated with the development of PSY-PD over the 24 month period. At this follow-up time, worse disease severity, decline in cognitive performances, presence of depressive symptoms and anxiety were more frequently observed in PSY-PD.
Conclusions Psychotic type symptoms may occur in the early stages of PD although less frequently than in later stages. Beyond dopaminergic treatment, there are disease related factors, such as disease severity and the occurrence of cognitive and depressive symptoms, which may underlie the onset of psychotic type symptoms from the earliest stages.
↵* For PRIAMO Study Group see appendix 1 at the end of the article.
Funding This study was supported by an educational grant issued by Boehringer Ingelheim, Italy.
Competing interests LM has received honoraria for lectures and educational activities from UCB Pharma, Glaxo Smithkline and serves on scientific advisory boards for Boehringer Ingelheim. CC received honoraria from serving on the scientific advisory board of Boehringer Ingelheim Pharmaceuticals, Ipsen Pharmaceuticals, Novartis Pharmaceuticals and UCB/Schwarz, and received royalties from CIC Edizioni Internazionali Publishers. RM received honoraria from serving on the scientific advisory board of Boehringer Ingelheim, serves as an editorial board member of the Journal of Neurodegenerative Disorders and has received honoraria for speaking engagements from Boehringer Ingelheim, Glaxo Smithkline, Lundbeck and UCB Pharmaceuticals. AA has received honoraria for consulting services and symposia from Abbott, Boehringer Ingelheim, GSK, Lundbeck, UCB, Novartis and Merck Serono. GM received institutional support from Ministero dell'Istruzione, dell'Università e della Ricerca (MIUR). MP received honoraria for speaking engagements from Boehringer Ingelheim. FEP received honoraria for speaking engagements from Boehringer Ingelheim, Novartis, GSK and received institutional support from Ministero dell'Istruzione, dell'Università e della Ricerca (MIUR). GA received honoraria from serving on the scientific advisory board of Boehringer Ingelheim and Novartis, serves as a member of scientific committee of the journal Equilibri, received honoraria for speaking engagements from Novartis, Lundbeck, Glaxo Smith Kline, UCB and Boehringer Ingelheim, and received institutional support from Ministero dell'Istruzione, dell'Università e della Ricerca. EB received funding for a trip from Novartis and Lilly and received honoraria for speaking engagements from Lilly, GSK, Boehringer Ingelheim and Sanofi Aventis. AB received honoraria for speaking engagements from Boehringer Ingelheim and received institutional support from MIUR. FM receives research support from Neureca Onlus, Milan. PB received honoraria for serving on the scientific advisory board of Boehringer Ingelheim, Merck Serono, Novartis Italy, UCB Italy and Lundbeck Italy, serves as an editorial board member of Journal of Neurodegenerative Disorders and Parkinson's Europe, received honoraria for speaking engagements from Boehringer Ingelheim, Merck Serono, Novartis Italy, UCB Italy and Lundbeck Italy, and received research support from Boehringer Ingelheim, Merck Serono, Novartis Italy, UCB Italy and Lundbeck Italy.
Ethics approval The ethic committees of each participating site approved the study.
Provenance and peer review Not commissioned; externally peer reviewed.