To compare the presence of sleep, anxiety and depressive disorders, and their associated medication use in individuals with advanced Parkinson’s Disease (aPD), PD, and the general population (no-PD).

As PD advances, non-motor symptoms including sleep and mood (e.g., anxiety, depressive) disorders arise, complicating medication regimens and impacting quality-of-life (QoL). Quantification of this increased burden in aPD in real-world settings remains scarce. 

Retrospective analysis using US Commercial and Medicare Advantage claims data from 01/2016–06/2024. Individuals meeting aPD proxy criteria (levodopa-equivalent daily dose ≥1000mg) were propensity-score matched by age, gender, health insurance plan, comorbidity, US region, and index year, to PD (excluding aPD) and no-PD. Device-aided therapy users for aPD were excluded. Descriptive statistics included t-tests and Pearson chi-squared tests.

The study included 9,477 aPD/PD pairs, and 9,477/47,385aPD/no-PD pairs after matching. 17% of aPD individuals had both sleep and mood disorders compared to 13% in PD and 5% in no-PD. Sleep disorders were more frequent in aPD (30%) compared to PD (22%), and three times that of no-PD (9%), with insomnia, sleep apnea, and parasomnia/RBD being the most common. Depressive (30%) and anxiety disorders (27%) were more frequent in aPD compared to PD (27% and 24%, respectively) and no-PD ( 12%, each). Additionally, aPD individuals take more pills per day than PD and twice as those in no-PD for treating these comorbidities. A greater proportion of aPD compared to PD and no-PD were taking selective serotonin reuptake inhibitors (31% vs 27% and 14%, respectively) and benzodiazepines (24% vs 19% and 11%, respectively).

Sleep and mood disorders, and associated medication use was significantly higher in individuals with aPD than PD and no-PD. Further research is needed to investigate the burden of these, and other debilitating neuropsychiatric disorders on QoL and healthcare system in aPD.