Psychosis in Early Onset Parkinson’s Disease: A Population-based Study in Southeast Minnesota
Mohamed Derhab1, Ali Zare Dehnavi1, Aidan F. Mullan1, Emanuele Camerucci3, Pierpaolo Turcano4, Khaled Ghoniem2, James Bower1, Rodolfo Savica2
1Neurology, Mayo Clinic, 2Mayo Clinic, 3Neurology, Kansas University Medical Center, 4Rush University Medical Center
Objective:
Our study aims to determine the prevalence of psychosis in EOPD, explore its temporal relationship with PD onset, identify risk factors, assess its impact on all-cause mortality, and evaluate how antipsychotics and SSRIs affect mortality in EOPD patients with psychosis.
Background:
Early Onset Parkinson’s Disease (EOPD), defined as Parkinson’s disease (PD) diagnosed before age 50, often presents unique challenges compared to its late-onset counterpart, particularly with regard to non-motor symptoms such as psychosis. Psychosis in EOPD is associated with increased functional impairments and may lead to a higher mortality risk.
Design/Methods:
Our cohort includes 829 patients with EOPD diagnosed between January 1969 to October 2021 in Olmsted County, Minnesota. EOPD was defined as PD onset at or before the age of 50. Psychosis was defined based on the NINDS/NIMH Work Group clinical criteria, and its association with all-cause mortality was assessed using Cox proportional hazards models. Secondary analyses examined the effects of antipsychotic medications and SSRIs on mortality risk among patients who developed psychosis.
Results:
Of 829 patients with EOPD, 158 (19.1%) developed psychosis at a median of 12.1 years after PD onset. Psychosis was significantly associated with a higher risk of death in unadjusted (HR = 4.31, 95% CI: 2.59–7.18, p < 0.001) and adjusted (HR = 3.55, 95% CI: 2.10–6.01, p < 0.001) models. Among psychotic patients, 46.8% were treated with antipsychotic medications, and 46.2% with SSRIs. No significant difference in mortality risk was observed between patients treated with antipsychotics or SSRIs versus those who were not.
Conclusions:
Psychosis is a common complication in EOPD and is associated with a significant increase in all-cause mortality. The use of antipsychotics and SSRIs did not significantly alter the mortality risk in these patients. Further research is needed to understand the mechanisms driving this association and to develop tailored interventions.
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