Compare neuropsychiatric disorders (NPsy), other non-motor symptoms (NMS), and associated medication use and costs in advanced Parkinson’s Disease (aPD) with individuals newly diagnosed with PD (PD) and without PD (no-PD).

Retrospective analysis of US Commercial and Medicare Advantage claims (01/2016–06/2024). Adults (≥18y) with PD diagnosis and ≥1 PD medication claim were categorized as aPD (Levodopa Equivalent Daily Dose ≥1000 mg) or PD (incident users of PD treatment). Diagnoses were identified by ICD-10 codes and associated medications by National Drug Codes. aPD were propensity score matched on age, gender, health insurance plan, comorbidity index, US region, and index year 1:1 to PD and 1:5 to no-PD. T-tests, Fisher’s exact, and Pearson chi-squared tests were utilized.

The study included 9477 aPD–PD and 9477–47385 aPD–no-PD matched pairs; mean age 74y, most with Medicare Advantage (>90%). Compared with PD, aPD had higher coding rates for any psychosis disorder (13.7% vs 12.1%; *P<.05) and NMS (42.8%* vs 34.8%). CI was similar (25.7% vs 26.2%; P=.426) and apathy low across groups (0.2%* vs 0%). For aPD versus no-PD, psychosis disorders were ≥3x higher (13.7%* vs 4.2%), NMS were ≥2x higher (42.8%* vs 19.8%), orthostatic hypotension was 10x more frequent (9.7%* vs 0.9%). More aPD patients were on ≥1 medication for NyPsy/NMS than PD or no-PD (52.9%* vs 46.8% vs 27.4%). Most common medications for NPsy/NMS were 2nd-gen antipsychotics (>11%), cholinesterase inhibitors (>15%), α-adrenergic blockers (>17%);all significantly higher in aPD, leading to greater mean annual medication costs than PD or no-PD for psychosis disorders ($1006.3* vs $338.8 vs $35.4) and NMS ($770.2* vs $325.7 vs $106.9).

PwP are significantly more likely to receive NPsy and NMS diagnoses than the general population, leading to higher medication use and costs.