Abstract Details

Title Who Should Answer? How to Assess Psychosis in Demented Patients with Parkinson’s Disease or Lewy Body Dementia.

Topic Movement Disorders

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 5-010

Objective In assessing psychotic symptomology, we tested agreements between parkinsonian patients with dementia and their caregivers.

Background Psychosis affects more than 50% of Parkinson’s disease (PD) patients with up to 74% of patients experiencing hallucinations over 20 years. Cognitive decline is often a comorbidity and the two in combination contribute to poor patient outcomes and increased caregiver burden. Prior studies of PD psychosis without concomitant dementia document that hallucinations are often not appreciated by caregivers and patients themselves are the best raters of hallucinations. However, when dementia occurs, poor recall and underreporting may complicate rating.

Design/Methods Nineteen pairs of parkinsonian patients with dementia (MOCA<21, 14 PD, 5 Lewy Body Dementia) and cognitively normal caregivers were independently interviewed to complete the SAPS-PD for hallucinations and delusions. Summary score concordance was assessed by intraclass correlation coefficient (ICC), with a threshold concordance criterion set at ICC > 0.50. Concordance for individual items was assessed using a weighted kappa with a threshold concordance > 0.40.

Results ICC for the summary SAPS-PD score was 0.42, representing poor overall concordance between demented patients and caregivers. Weighted kappas of individual SAPS-PD items were also discordant with only 1/9 items (tactile hallucinations, (κ = 0.61)) meeting criteria for threshold concordance. All other kappa values were < 0.37. As a rule, caregivers scored higher (median SAPS-PD 15.0 (range 0 – 42)) than demented patients ( median 10.0 (range 3 - 25)).

Conclusions Discordance occurred between demented parkinsonian patients and their caregivers on the presence and severity of psychotic symptoms. The higher ratings by caregivers contrasts with previous reports on patients with normal cognition who rated hallucinations more frequently than caregivers. In clinical and research settings, rating scales that assess psychotic behavior in parkinsonism need to have the flexibility to accommodate caregiver input in the context of comorbid dementia.

Authors/Disclosures
Blake Beehler, MD PRESENTER	Dr. Beehler has nothing to disclose.
Michelle H. Tosin, PhD, RN (Rush University Medical Center)	Dr. Tosin has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NeuraLight . The institution of Dr. Tosin has received research support from International Parkinson and Movement Disorders Society. Dr. Tosin has received personal compensation in the range of $500-$4,999 for serving as a Consultant with International Parkinson and Movement Disorders Society.
Glenn T. Stebbins, PhD (Rush University Medical Center)	Dr. Stebbins has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Stebbins has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Partners Healthcare System. Dr. Stebbins has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for CHDI. The institution of Dr. Stebbins has received research support from Department of Defense. Dr. Stebbins has received research support from Cleveland Clinic Health Systems. Dr. Stebbins has received personal compensation in the range of $500-$4,999 for serving as a Course Director with MDS.
Christopher Goetz, MD, FAAN (Rush University Medical Center)	The institution of Dr. Goetz has received research support from Michael J. Fox Foundation. The institution of Dr. Goetz has received research support from NIH. The institution of Dr. Goetz has received research support from Department of Defense. Dr. Goetz has received publishing royalties from a publication relating to health care. Dr. Goetz has received publishing royalties from a publication relating to health care. Dr. Goetz has received publishing royalties from a publication relating to health care.

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