First Longitudinal Findings: Psychiatric Symptoms More Common in Untreated PD Patients than Controls

The first longitudinal findings from PPMI have been published.  Researchers from the University of Pennsylvania affiliated with PPMI published in the journal Neurology that depression, anxiety and fatigue are more common in newly diagnosed Parkinson?s disease patients compared to the general population.  Excessive daytime sleepiness and impulse control disorders were found to be associated with the start of dopamine replacement therapy. 

These findings aren?t very surprising to the research field and probably not to the patient population, either. We?ve long known that depression, anxiety and fatigue are symptoms of Parkinson?s, but one of the aims of PPMI is validation.  ?It’s really a chance to assess the frequency and characteristics of psychiatric and cognitive symptoms in PD, compare it with healthy controls, and then also look at its evolution over time,? said Daniel Weintraub, MD, the senior author on the paper and chair of the PPMI Cognitive/Behavioral Working Group.

One illuminating finding from Dr. Weintraub?s study is that depression may be undertreated in the Parkinson?s population. Two-thirds of patients who screened positive for depression during the study were not taking an antidepressant.

For more details on this study and others using the PPMI data and specimens, visit Publications.

Course of psychiatric symptoms and global cognition in early Parkinson disease.

de la Riva P, Smith K, Xie SX, Weintraub D.

OBJECTIVE:

To evaluate the course and predictors of neuropsychiatric symptoms (NPS) and cognition in patients with de novo Parkinson disease (PD).

METHODS:

Cross-sectional study of the cohort of de novo, untreated (at enrollment) patients with PD and healthy controls (HCs) from the Parkinson’s Progression Markers Initiative. Participants have serial assessments of global cognition and symptoms of depression, anxiety, psychosis, impulse control disorders (ICDs), sleep and wakefulness, apathy, and fatigue. Available data up to 24 months of follow-up were included.

RESULTS:

The available sample size was as follows: baseline (PD = 423, HCs = 196), 12 months (PD = 261, HCs = 145), and 24 months (PD = 96, HCs = 83). Patients with PD experienced more depression, fatigue, apathy, and anxiety than HCs at all time points, and apathy (p = 0.001) and psychosis (p = 0.003) increased over time in patients with PD. Approximately two-thirds of patients with PD who screened positive for depression at any given visit were not taking an antidepressant. The Montreal Cognitive Assessment score decreased significantly over time in patients with PD (p < 0.001), but the change was comparable to that in HCs. At the 24-month visit, 44% of patients had been on dopamine replacement therapy (DRT) for at least 1 year, and this group reported more incident ICDs (p = 0.009) and excessive daytime sleepiness (p = 0.03).

CONCLUSION:

Multiple NPS are more common in de novo, untreated patients with PD compared with the general population, but they also remain relatively stable in early disease, while global cognition slightly deteriorates. In contrast, initiation of DRT is associated with increasing frequency of several other NPS.

Neurology. 2014 Aug 15. pii: 10.1212/WNL.0000000000000801. [Epub ahead of print]