Patterns, Prevalence and Management of Neuropsychiatric Symptoms in a Tertiary Atypical Parkinsonian Syndrome Clinic

Introduction 

Atypical parkinsonian syndromes (APS), including progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and corticobasal syndrome (CBS), are relatively rare and clinically heterogeneous. This can result in misdiagnosis, commonly as idiopathic Parkinson’s disease (PD). Recent cohort studies indicate characterising neuropsychiatric symptoms (NPS) could facilitate earlier and more accurate APS diagnosis. We audited the prevalence of NPS and associated management in a specialist APS clinic population.

Methods 

Electronic patient records were reviewed for 97 ‘active’ patients attending the Oxford University Hospitals APS clinic. The audit date was 16 October 2022, with data collected for the preceding 12 months. Clinical documentation was reviewed for the presence and type of NPS, and for prescriptions of psychoactive medications. Research ethics approval was not sought as this work audited routine clinical practice.

Results 

NPS were documented in 59% of APS patients: 57% in PSP, 62% in MSA and 50% in CBS. There was no statistically significant difference in NPS prevalence between diagnostic groups (Fisher’s exact test, p = 0.8337). NPS most often occurred in combination, typically depression with anxiety. The pattern of NPS was not significantly different between diagnostic groups (Fisher’s exact test, p = 0.7733). Among APS patients with NPS, 57% were prescribed at least one psychotropic medication, most commonly sertraline and mirtazapine.

Conclusion 

NPS are highly prevalent in our APS clinic population and frequently coexist. Improved detection of these symptoms may enhance diagnostic accuracy, enabling targeted NPS management in holistic APS care.