Frequency and Characteristics of Psychosis in Parkinson’s Disease: A Systematic Review and Meta-Analysis

Article type: Systematic Review

Authors: Chendo, Ines^{a; b; c} | Silva, Carlos^a | Duarte, Gonçalo S.^{d; e} | Prada, Luisa^{d; e} | Voon, Valerie^f | Ferreira, Joaquim J.^{c; d; e; *}

Affiliations: [a] Psychiatry Department, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal | [b] Clínica Universitária de Psiquiatria e de Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal | [c] CNS – Campus Neurológico, Torres Vedras, Portugal | [d] Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal | [e] Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal | [f] Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom

Correspondence: [*] Correspondence to: Prof. Joaquim J. Ferreira, MD, PhD, Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal. Tel.: +351 21 7802120; E-mail: jferreira@medicina.ulisboa.pt.

Abstract: Background:Psychotic symptoms are highly frequent in Parkinson’s disease (PD) patients and are associated with poor prognosis. They include hallucinations, delusions, and minor psychotic phenomena, including sense of presence, passage hallucinations, and illusions. Objective:To evaluate the frequency of psychosis in PD patients. Methods:A systematic review and meta-analysis of clinical trials, prospective and retrospective cohort studies, case-control studies, and cross-sectional studies reporting the frequency of psychosis, hallucinations, and delusions in PD. Results:Electronic database search wielded 3536 articles, an additional 91 were identified through citation chaining. Of these, 163 were fully inspected, 57 removed, and 106 included as relevant for neuropsychiatric events frequency, with 32 meeting our inclusion criteria (psychosis and/or specific psychotic phenomena). The pooled frequency of psychosis was 20.7% (95% CI 14.5 to 28.6; I2 = 94%, 15 studies; combined n = 2919). None of the pre-defined meta-regressions or subgroup analyses were statistically significant or helped explain the statistical heterogeneity. The pooled frequency of any form of hallucination was 21.6% (95% CI 14.7 to 30.6; I2 = 95%; 18 studies; combined n = 3161). Duration of PD at baseline and mean baseline Hoehn & Yahr stage helped explain the statistical heterogeneity in the meta-analysis of hallucinations. Conclusion:Based on the available evidence, around a fifth of PD patients experience psychosis or hallucinations. The risk of developing hallucinations is likely moderated by the disease duration, Hoehn & Yahr stage, and the cognitive status.

Keywords: Parkinson disease, psychotic disorders, systematic review, meta-analysis, hallucinations, delusions, illusions

DOI: 10.3233/JPD-212930

Journal: Journal of Parkinson's Disease, vol. 12, no. 1, pp. 85-94, 2022