PSYCHIATRIC OUTCOMES IN PD
- Anxiety and Depression common from start, don’t increase much
- Psychosis, Apathy, and ICDs uncommon at start, increase a little
- Sleep problems and Fatigue common at start, and increase
| Variable | Baseline | PD Subjects | ||||
|---|---|---|---|---|---|---|
| (N = 423) | Year 1 (N = 395) | Year 2 (N = 378) | Year 3 (N = 366) | Year 4 (N = 346) | Year 5 (N = 316) | |
| GDS-15 | ||||||
| N | 423 | 395 | 377 | 365 | 342 | 314 |
| <5 | 364 (86.1%) | 330 (83.5%) | 310 (82.2%) | 304 (83.1%) | 283 (82.5%) | 251 (79.9%) |
| 5 or above | 59 (13.9%) | 65 (16.5%) | 67 (17.8%) | 62 (16.9%) | 60 (17.5%) | 63 (20.1%) |
| STAI State | ||||||
| N | 422 | 395 | 378 | 364 | 343 | 313 |
| <40 | 318 (75.4%) | 305 (77.2%) | 295 (78.0%) | 292 (80.2%) | 276 (80.5%) | 246 (78.6%) |
| 40 or above | 104 (24.6%) | 90 (22.8%) | 83 (22.0%) | 72 (19.8%) | 67 (19.5%) | 67 (21.4%) |
| MDS-UPDRS Part I Psychosis | ||||||
| N | 423 | 395 | 378 | 366 | 343 | 316 |
| 0 | 410 (96.9%) | 376 (95.2%) | 350 (92.6%) | 327 (89.3%) | 300 (87.5%) | 276 (87.3%) |
| 1 or above | 13 (3.1%) | 19 (4.8%) | 28 (7.4%) | 39 (10.7%) | 43 (12.5%) | 40 (12.7%) |
| MDS-UPDRS Part I Apathy | ||||||
| N | 423 | 395 | 378 | 366 | 343 | 316 |
| 0,1 | 412 (97.4%) | 366 (92.7%) | 343 (90.7%) | 338 (92.3%) | 309 (90.1%) | 278 (88.0%) |
| 2 or above | 11 (2.6%) | 29 (7.3%) | 35 (9.3%) | 28 (7.7%) | 34 (9.9%) | 38 (12.0%) |
| MDS-UPDRS Part I Fatigue | ||||||
| N | 423 | 395 | 378 | 366 | 345 | 316 |
| 0,1 | — | — | — | — | — | — |
| 2 or above | 47 (11.1%) | 66 (16.7%) | 77 (20.4%) | 73 (19.9%) | 83 (24.1%) | 100 (31.6%) |
| MDS-UPDRS Part I Insomnia | ||||||
| N | 422 | 395 | 378 | 366 | 345 | 310 |
| 0,1 | 323 (76.5%) | 272 (68.9%) | 253 (66.9%) | 236 (64.5%) | 198 (57.4%) | 175 (56.4%) |
| 2 or above | — | 123 (31.1%) | 125 (33.1%) | 130 (35.5%) | 147 (42.6%) | 141 (44.6%) |
| Epworth Sleepiness | ||||||
| N | 423 | — | 377 | 364 | 343 | 313 |
| <10 | 357 (84.4%) | 329 (—) | — | — | 246 (71.7%) | 216 (69.0%) |
| 10 or above | 66 (15.6%) | — | — | — | 97 (28.3%) | 97 (31.0%) |
| RBDSQ | ||||||
| N | 423 | 395 | 378 | 366 | 347 | — |
| <6 | — | 341 (86.3%) | 301 (79.6%) | 280 (76.5%) | 251 (73.2%) | 228 (72.9%) |
| 6 or above | 109 (26.0%) | 54 (13.7%) | 77 (20.4%) | 86 (23.5%) | 92 (26.8%) | 85 (27.2%) |
| QUIP | ||||||
| N | 422 | 395 | — | — | — | — |
| No disorders | 335 (79.4%) | 341 (86.3%) | — | — | — | — |
| Any 1 or more disorders | 87 (20.6%) | 54 (13.7%) | — | — | — | — |
Slide 77. PARKINSON’S PROGRESSION MARKERS INITIATIVE.
CUMULATIVE PREVALENCE OF COGNITIVE AND PSYCHIATRIC DISORDERS OR TREATMENT IN PD
- 50-70% of PD patients screen positive or are treated for depression, anxiety, cognitive impairment, fatigue, insomnia, sleepiness or RBD in first 5 years of PD
- 25% for psychosis and apathy
| Variable | Baseline | PD Subjects | ||||
|---|---|---|---|---|---|---|
| (N = 423) | Year 1 (N = 395) | Year 2 (N = 378) | Year 3 (N = 366) | Year 4 (N = 346) | Year 5 (N = 316) | |
| MoCA <26 | ||||||
| N | 423 | 395 | 378 | 366 | 346 | 316 |
| 26-30 | 330 (78.0%) | 225 (57.0%) | 196 (51.9%) | 173 (47.3%) | 157 (45.4%) | 136 (43.0%) |
| <26 | 93 (22.0%) | 170 (43.0%) | 182 (48.1%) | 193 (52.7%) | 189 (54.6%) | 180 (57.0%) |
| GDS-15 | ||||||
| N | 423 | 395 | 378 | 366 | 346 | 316 |
| <5 | 311 (73.5%) | 252 (63.8%) | 220 (58.2%) | 198 (54.1%) | 180 (52.0%) | 156 (49.4%) |
| 5 or above | 112 (26.5%) | 143 (36.2%) | 158 (41.8%) | 168 (45.9%) | 166 (48.0%) | 160 (50.6%) |
| STAI State | ||||||
| N | 423 | 395 | 378 | 366 | 346 | 316 |
| <40 | 303 (71.6%) | 243 (61.5%) | 206 (54.5%) | 190 (51.9%) | 166 (48.0%) | 145 (45.9%) |
| 40 or above | 120 (28.4%) | 152 (38.5%) | 172 (45.5%) | 176 (48.1%) | 180 (52.0%) | 171 (54.1%) |
| MDS-UPDRS Part I Psychosis | ||||||
| N | 423 | 395 | 378 | 366 | 346 | 316 |
| 0 | 410 (96.9%) | 370 (93.7%) | 336 (88.9%) | 303 (82.8%) | 271 (78.3%) | 231 (73.1%) |
| 1 or above | 13 (3.1%) | 25 (6.3%) | 42 (11.1%) | 63 (17.2%) | 75 (21.7%) | 85 (26.9%) |
| MDS-UPDRS Part I Apathy | ||||||
| N | 423 | 395 | 378 | 366 | 346 | 316 |
| 0,1 | — | — | — | — | — | — |
| 2 or above | 50 (11.8%) | 84 (21.3%) | 111 (29.4%) | 131 (35.8%) | 144 (41.6%) | 146 (46.2%) |
| MDS-UPDRS Part I Fatigue | ||||||
| N | 423 | 395 | 378 | 366 | 346 | 316 |
| 2 or above | — | 222 (56.2%) | — | — | — | — |
| MDS-UPDRS Part I Insomnia | ||||||
| N | 423 | 395 | 378 | 366 | 346 | 316 |
| 0,1 | 311 (73.5%) | 224 (56.7%) | 183 (48.4%) | 152 (41.5%) | (—) | 94 (29.7%) |
| 2 or above | 112 (26.5%) | 171 (43.3%) | 195 (51.6%) | 214 (58.5%) | 222 (64.2%) | 222 (70.3%) |
| Epworth Sleepiness Scale | ||||||
| N | 423 | 395 | 378 | 366 | 346 | 316 |
| <10 | — | — | — | — | — | — |
| 10 or above | — | 129 (—) | 149 (—) | — | 166 (47.5%) | 166 (52.6%) |
| RBDSQ | ||||||
| N | 423 | 395 | 378 | 366 | 346 | 315 |
| <6 | 311 (73.5%) | 251 (63.5%) | 212 (56.1%) | 177 (48.4%) | 153 (44.2%) | 125 (39.6%) |
| 6 or above | 112 (26.5%) | 144 (36.5%) | 166 (43.9%) | 189 (51.6%) | 193 (55.8%) | 191 (60.4%) |
Slide 78. PARKINSON’S PROGRESSION MARKERS INITIATIVE.
PARKINSON DISEASE VS. HEALTHY CONTROLS OVER TIME
depression, psychosis, insomnia, sleepiness, RBD, ICDs and cognitive impairment in PD vs. HCs over time
| Outcome | Year | Year*Group Interaction | ||
|---|---|---|---|---|
| OR (95% CI) | p-value | OR (95% CI) | p-value | |
| GDS-15 | 1.10 (1.03, 1.17) | 0.0022 | 0.85 (0.72, 1.01) | 0.0582 |
| STAI State | 0.96 (0.91, 1.01) | 0.1071 | 0.99 (0.86, 1.14) | 0.8970 |
| MDS-UPDRS Part I Psychosis | 1.33 (1.23, 1.44) | <0.0001 | 0.50 (0.28, 0.92) | 0.0251 |
| MDS-UPDRS Part I Apathy | 1.26 (1.16, 1.37) | <0.0001 | 0.97 (0.71, 1.30) | 0.8170 |
| MDS-UPDRS Part I Fatigue | 1.27 (1.20, 1.34) | <0.0001 | 0.89 (0.74, 1.07) | 0.2212 |
| MDS-UPDRS Part I Insomnia | 1.22 (1.16, 1.28) | <0.0001 | 0.87 (0.80, 0.94) | 0.0005 |
| Epworth Sleepiness Scale | 1.21 (1.14, 1.28) | <0.0001 | 0.86 (0.78, 0.95) | 0.0023 |
| RBDSQ | 1.13 (1.08, 1.19) | <0.0001 | 0.81 (0.73, 0.91) | 0.0003 |
| QUIP | 1.11 (1.05, 1.18) | 0.0003 | 0.84 (0.76, 0.93) | 0.0011 |
PARKINSON’S PROGRESSION MARKERS INITIATIVE.
PD CHARACTERISTICS CONT.
| Variable | Group | Adjusted p values | ||||
|---|---|---|---|---|---|---|
| PD N = 423 | HC N = 194 | LRRK2 N = 208 | GBA N = 184 | HC vs LRRK2 | HC vs GBA | |
| Blood Pressure OH Drop | ||||||
| Systolic Blood Pressure | 4.6 (12.7) | 2.2 (12.3) | -0.7 (11.0) | 0.9 (11.1) | 0.006 | 0.209 |
| Diastolic Blood Pressure | -1.8 (8.4) | -3.5 (8.2) | -3.8 (7.5) | -3.3 (6.9) | 0.671 | 0.773 |
| State Trait Anxiety Score | ||||||
| Mean (SD) | 65.3 (18.3) | 57.1 (14.2) | 61.6 (17.5) | 60.9 (17.6) | 0.022 | 0.099 |
| QUIP | ||||||
| Mean (SD) | 0.3 (0.6) | 0.3 (0.7) | 0.3 (0.7) | 0.4 (0.6) | 0.271 | 0.080 |
| Urate | ||||||
| Mean (SD) | 5.8 (3.5) | 5.6 (3.4) | 5.3 (3.4) | 5.2 (3.4) | 0.070 | 0.058 |
| UPSIT Raw Score | ||||||
| Mean (SD) | 22.4 (8.2) | 34.0 (4.9) | 32.8 (4.3) | 34.1 (4.7) | 0.004 | 0.956 |
| (Min. - Max.) | 1 - 40 | 11 - 40 | 14 - 40 | 13 - 40 | ||
| UPSIT Categories | ||||||
| Normosmia | 39 (9.2%) | 120 (61.9%) | 90 (43.3%) | 111 (60.3%) | <0.001 | 0.835 |
| Hyposmia | 237 (56.0%) | 69 (35.6%) | 114 (54.8%) | 67 (36.4%) | ||
| Anosmia | 147 (34.8%) | 5 (2.6%) | 3 (1.4%) | 4 (2.2%) | ||
| Epworth Sleepiness Scale | ||||||
| Sleepy (>9) | 66 (15.6%) | 23 (11.9%) | 22 (10.6%) | 18 (9.8%) | 0.736 | 0.958 |
| RBD Questionnaire | ||||||
| Positive (> 4) | 158 (37.4%) | 39 (20.1%) | 42 (20.2%) | 38 (20.7%) | 0.724 | 0.904 |
Slide 95. PARKINSON’S PROGRESSION MARKERS INITIATIVE — Play a Part in Parkinson’s Research.
When compared with the HC, both LRRK2 and GBA NMCs had significantly
- Higher scores on the MDS-UPDRS total, Part I, II, III
- Lower MoCA scores
- Higher SCOPA-AUT scores
- These findings were present despite of lack of DAT deficit
- There was no difference in daytime sleepiness and RBD scores in either cohort compared to HC
| Clinical diagnosis | The International Classification of Sleep Disorders (ICSD-3) [1] (1) Repeated episodes of sleep-related vocalization and/or complex motor behaviors. (2) These behaviors are documented by polysomnography to occur during REM sleep or, based on clinical history of dream enactment, are presumed to occur during REM sleep. (3) Polysomnographic recording demonstrates REM sleep without atonia (RWA). (4) The disturbance is not better explained by another sleep disorder, mental disorder, medication or substance abuse. |
| Definite diagnosis | polysomnography (PSG), : excessive EMG activity during REM sleep on video-PSG assessment |
Screening tools of RBD
- RBD screening questionnaire (RBDSQ)
- 10-item, patient self-rating instrument
Uncertain Spans
- 슬라이드 표 일부 셀이 검은색 강조 bullet 텍스트(“Anxiety and Depression common from start, don’t increase much” 등)에 가려져 정확한 숫자/퍼센트 판독이 불가능한 위치가 다수 있다. 본문에서는 가려진 셀을 ”—“로 표기했다.
- “Cumulative Prevalence” 슬라이드의 Epworth Sleepiness Scale 하단 두 행은 큰 폰트 bullet 글자가 직접 표 위로 덮여 있어 cell 내용이 가장자리만 부분적으로 보인다.
- 첫 번째 슬라이드(Psychiatric Outcomes) Year 1 column의 RBDSQ <6 셀과 QUIP 행 일부 cell이 bullet “Sleep problems and Fatigue common at start, and increase”에 가려져 N과 비율이 일관되지 않을 수 있다.
- ICSD-3 행 첫 셀 라벨(“Clinical diagnosis”) 두 줄 중 하단 라벨 “Definite diagnosis”는 사진 좌측 잘림으로 첫 글자 “D”가 가장자리에 있어 줄바꿈 위치만 추정했다.