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

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Wei Jia Liu1*; Rebecca A Frake2*; Katie Armstrong3; Lucy Carracedo4; Karolien Groenewald5; Ludo Van Hillegondsberg5; Tom Robb2; Michele T Hu2,5

1. University Hospital Southampton; 2. University of Oxford and Oxford University Hospitals NHS Trust

Scientific Research

SP - Parkinson's Disease

Movement disorders

View DOI

Abstract

Introduction
Atypical parkinsonian syndromes (APS), progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and corticobasal degeneration syndrome (CBS), are relatively rare and clinically heterogeneous. This can result in misdiagnosis, usually for idiopathic Parkinson’s disease. Recent cohort studies indicate characterising NPS could facilitate earlier and more accurate APS diagnosis. We audited 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 associated management using a standardised data collection form. Research ethics approval was not sought as this work audited routine clinical practice.

Results
NPS were documented in 62.9% of APS patients: 60.5% in PSP, 62.8% in MSA and 50% in CBD. There was no statistically significant difference between diagnostic groups (Fisher’s exact test, p = 0.8337). NPS most often occurred in combination (28.9%), usually depression with anxiety. The pattern of NPS was not significantly different between diagnostic groups (Fisher’s exact test, p = 0.9055). There was a trend towards higher rates of agitation and combined symptoms in PSP, while patients with MSA more frequently experienced depression and hallucinations. CBD patient numbers were small, but combined symptoms and depression predominated. Over one-third of patients (36.1%) were prescribed at least one psychotropic medication, most commonly sertraline (7.2%) and mirtazapine (6.2%).

Conclusion
NPS are highly prevalent in our APS clinic population and frequently coexist. Improved recognition of these symptoms could improve diagnostic accuracy and enable targeted NPS management as a key component of holistic care in APS.