Factors associated with psychotic symptoms in Parkinson’s disease: a cross-sectional study

Claudia N. Esparza-Hernández, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México
David Garza-Brambila, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México
Carlos D. Acevedo-Castillo, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México
Pablo Ruiz-De las Fuentes, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ciudad de México, México
Elly M. Robles-Rodriguez, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México
Ana M. Molina-Resendiz, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México
Amin Cervantes-Arriaga, Laboratorio Clínico de Enfermedades Neurodegenerativas, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
Karla Salinas-Barboza, Servicio de Neurología, Hospital General de México, Ciudad de México, México
Sara Isais-Millan, Servicio de Neurología, Hospital Regional “General Ignacio Zaragoza” ISSSTE, Ciudad de México, México
Antonio Anaya-Escamilla, Departamento o Servicio, Christus Muguerza Hospital Sur, Nuevo León, Monterrey, México
Arnulfo González-Cantú, Servicio de Neurología, Christus Muguerza Alta Especialidad, Nuevo León, Monterrey. México
Mayela Rodríguez-Violante, Laboratorio Clínico de Enfermedades Neurodegenerativas, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
Daniel Martinez-Ramirez, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Nuevo León, Monterrey, Nuevo León, México

Objective: The study aimed to investigate the relationship between autonomic dysfunction, specifically orthostatic hypotension, and the presence of psychosis in Parkinson’s disease (PD) patients. In addition, we aimed to identify other non-motor factors influencing the development of psychosis. Methods: We conducted a multicentric observational cross-sectional study to investigate the potential association between autonomic dysfunction and psychosis in PD patients. Approval was obtained from the institutional review board. Participants (n = 306) were recruited through non-probabilistic convenience sampling from the Mexican Parkinson Study Group cohort. Data collection occurred between July 2017 and June 2018. Demographic and clinical data were collected, including age, gender, disease duration, medication, and movement disorders society-unified Parkinson’s disease rating scale (MDS-UPDRS) scores. Psychosis symptoms were assessed using MDS-UPDRS item 1.2, whereas autonomic dysfunction was assessed using items 1.10, 1.11, and 1.12. Descriptive statistics, Chi-square tests, Mann–Whitney U tests, and logistic regression were employed for analysis using IBM SPSS version 25. Results: In our multicenter cohort of 306 Mexican PD patients, 18% reported symptoms of psychosis. Among these patients, orthostatic hypotension on standing was significantly associated with symptoms of psychosis (p = 0.001, OR 2.82). Regression analysis identified apathy (p = 0.003), cognitive impairment (p = 0.012), and longer disease duration (p = 0.001) as predictors of symptoms of psychosis. Conclusions: While orthostatic hypotension is associated with symptoms of psychosis, cognitive impairment, apathy, and disease duration significantly contribute to its presence in our cohort. These findings underscore the complexity of factors contributing to psychosis in PD. Recognizing these non-motor factors is crucial for the comprehensive care and management of PD patients, especially those at risk of developing psychosis.

Keywords: Parkinson�??s disease. Psychosis. Apathy. Cognitive impairment. Autonomic dysfunction.