Neuropsychiatric symptoms and cognitive abilities over the initial quinquennium of Parkinson disease

Ann Clin Transl Neurol. 2020 Apr;7(4):449-461. doi: 10.1002/acn3.51022. Epub 2020 Apr 13.


Objective: To determine the evolution of numerous neuropsychiatric symptoms and cognitive abilities in Parkinson disease from disease onset.

Methods: Prospectively collected, longitudinal (untreated, disease onset to year 5), observational data from Parkinson's Progression Markers Initiative annual visits was used to evaluate prevalence, correlates, and treatment of 10 neuropsychiatric symptoms and cognitive impairment in Parkinson disease participants and matched healthy controls.

Results: Of 423 Parkinson disease participants evaluated at baseline, 315 (74.5%) were assessed at year 5. Eight neuropsychiatric symptoms studied increased in absolute prevalence by 6.2-20.9% at year 5 relative to baseline, and cognitive impairment increased by 2.7-6.2%. In comparison, the frequency of neuropsychiatric symptoms in healthy controls remained stable or declined over time. Antidepressant and anxiolytic/hypnotic use in Parkinson disease were common at baseline and increased over time (18% to 27% for the former; 13% to 24% for the latter); antipsychotic and cognitive-enhancing medication use was uncommon throughout (2% and 5% of patients at year 5); and potentially harmful anticholinergic medication use was common and increased over time. At year 5 the cross-sectional prevalence for having three or more neuropsychiatric disorders/cognitive impairment was 56% for Parkinson disease participants versus 13% for healthy controls, and by then seven of the examined disorders had either occurred or been treated at some time point in the majority of Parkinson disease patients. Principal component analysis suggested an affective disorder subtype only.

Interpretation: Neuropsychiatric features in Parkinson disease are common from the onset, increase over time, are frequently comorbid, and fluctuate in severity.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Behavioral Symptoms / drug therapy
  • Behavioral Symptoms / epidemiology
  • Behavioral Symptoms / etiology
  • Behavioral Symptoms / physiopathology*
  • Cognitive Dysfunction / drug therapy
  • Cognitive Dysfunction / epidemiology
  • Cognitive Dysfunction / etiology
  • Cognitive Dysfunction / physiopathology*
  • Disease Progression*
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Parkinson Disease / complications
  • Parkinson Disease / drug therapy
  • Parkinson Disease / epidemiology
  • Parkinson Disease / physiopathology*
  • Prevalence

Grants and funding

This work was funded by Michael J. Fox Foundation for Parkinson's Research grant .