Neuropsychiatric co-morbidities in non-demented Parkinson's disease.
OBJECTIVE
To evaluate neuropsychiatric co-morbidities (depression, psychosis and anxiety) in non-demented patients with Parkinson's disease (PD).


BACKGROUND
Non-motor symptoms like neuropsychiatric co-morbidities are common in Parkinson's disease and may predate motor symptoms. Currently there is scarcity of data regarding neuropsychiatry manifestations in Indian patients with PD.


METHODS
In this cross-sectional study consecutive 126 non-demented patients with PD (MMSE ≥25) were enrolled. They were assessed using Unified Parkinson's disease rating scale (UPDRS), Hoehn & Yahr (H&Y) stage, Schwab and England (S&E) scale of activity of daily life. Mini-international neuropsychiatric interview (MINI) was used for diagnosis of depression, psychosis and anxiety. Beck's depression inventory (BDI), Brief psychiatric rating scale (BSRS) and Hamilton rating scale for anxiety (HAM-A) scales were used for assessment of severity of depression, psychosis and anxiety respectively.


RESULTS
Mean age and duration of disease was 57.9 ± 10.9 years and 7.3 ± 3.6 years respectively. At least one of the neuropsychiatric co-morbidity was present in 64% patients. Depression, suicidal risk, psychosis and anxiety were present in 43.7%, 31%, 23.8% and 35.7% respectively. Visual hallucinations (20.6%) were most frequent, followed by tactile (13.5%), auditory (7.2%) and olfactory hallucinations (1.6%). Patients with depression had higher motor disability (UPDRS-motor score 33.1 ± 14.0 vs 27.3 ± 13.3; and UPDRS-total 50.7 ± 21.8 vs 41.0 ± 20.3, all p values <0.05). Patients with psychosis were older (63.6 ± 8.0 years vs 56.1 ± 11.1 years, p < 0.05) and had longer duration of illness (8.6 ± 3.4 years vs 6.9 ± 3.5, p < 0.05).


CONCLUSIONS
About two third patients with Parkinson's disease have associated neuropsychiatric co-morbidities. Depression was more frequent in patients with higher disability and psychosis with longer duration of disease and older age. These co-morbidities need to be addressed during management of patients with PD.
Department of Neurology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
Nirendra Kumar
NK
Rai
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Vinay
V
Goyal
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
Nand
N
Kumar
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Garima
G
Shukla
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Achal Kumar
AK
Srivastava
Department of Neurology, Medanta, Gurgaon, Haryana, India.
Sumit
S
Singh
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Madhuri
M
Behari
Anxiety; Parkinson's disease; comorbidity; depression; neuropsychiatry; psychosis