Risk of Suicidal Ideation and Behavior in Individuals With Parkinson Disease: A Systematic Review and Meta-Analysis

Mortality and causes of death in patients with Parkinson's disease in Taiwan

BackgroundPrevious studies that examined Parkinson's disease (PD) mortality were mostly conducted in Western countries.ObjectsWe compared mortality rates and causes of death in PD patients and persons without PD from Taiwan over 15 years of follow-up.MethodsWithin the National Health Insurance database, we followed 50,290 incident PD patients (2003-2016) and 201,153 matched non-PD participants (controls) until 31/12/2018. We used multivariable Cox proportional-hazards regression models to compare mortality rates and causes of death in PD patients and controls. Due to non-proportionality, we performed stratification by follow-up duration (≤5/>5 years). We examined interactions between PD status participants' characteristics for all-cause mortality.ResultsPD patients had higher all-cause mortality than controls (HR = 1.40, 95% CI = 1.37-1.42); the association was stronger (p < 0.0001) after the first 5 years of follow-up (HR = 1.49 [1.46-1.53]) than before (HR = 1.34 [1.31-1.37]). The strongest associations were observed for suicide (HR = 1.79 [1.52-2.10]), dementia (HR = 1.69 [1.47-1.93]), and pneumonia (HR = 1.57 [1.49-1.65]). The association between PD and death decreased as age increased, and was stronger in patients without comorbidities, depression, and dementia than in those with.ConclusionsTaiwanese PD patients have reduced life expectancy throughout the course of disease with a stronger association after the first 5 years of follow-up. PD had a stronger impact on mortality in younger persons and in those without comorbidities. Prevention of pneumonia and suicide, and appropriate management of dementia and comorbidities would help reduce PD-related mortality. Our findings may help health authorities allocate resources to improve the management of PD patients in order to address PD-related mortality.

Non-motor Symptoms and Treatments in Parkinson's Disease

SYNOPSIS

Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor and non-motor symptoms. The non-motor features may precede the onset of motor symptoms and occur throughout all stages of PD. The non-motor symptoms reflect multisystem involvement of the central and peripheral nervous systems, multiple neurotransmitters, and multiple pathologies. PD management necessitates a comprehensive approach to address non-motor symptoms, including pharmacologic and non-pharmacological interventions and often multiple different disciplines or specialists in the PD care team. This review article discusses symptoms and treatments for the non-motor symptoms of PD including those affecting mood, cognition, behavior, sleep, autonomic function, and sensory systems.

Clozapine for Quetiapine-Refractory Psychosis in Parkinson's Disease: A Long-Term Single-Center Retrospective Study

Background: Hallucinations and delusions are severe long-term complications of Parkinson's disease (PD). Clozapine is the only antipsychotic with proven efficacy in PD psychosis (PDPsy) available outside the United States but apprehensions about its adverse event profile result in a substantial underuse of clozapine. Objectives: To investigate the practical use and long-term efficacy of clozapine in severe psychotic disorders in PD. Methods: In this retrospective study, the author used data collected over a period of 20 years and included all PD patients under his care, who were treated with clozapine for psychotic disorders. Results: During the observation period, 41 PD patients (38 with PDPsy, 2 with psychotic depression, and one with schizoaffective disorder) were started on clozapine. They had responded poorly or only transiently to quetiapine. An overnight switch to clozapine was tolerated in most. Maximum clozapine doses ranged from 12.5 to 150 mg (72.9 ± 29.9 mg). A significant reduction in psychotic symptoms was achieved in 2 days to 6 months. Among the cases tolerating clozapine, 10 had a full, 25 had a good, 3 had a moderate, and 2 had a poor clinical response to clozapine. Treatment lasted up to 12 years. The long-term response was full or good in 23, moderate in 3, and poor in 2 patients. Conclusions: Clozapine is often effective in the treatment of psychotic disorders in PD including PDPsy poorly or only transiently responding to quetiapine. Side effects including agranulocytosis are manageable in the majority of cases. Clozapine treatment should not be delayed if other measures against PDPsy prove ineffective.

The Tormented Soul: Caring for Older Adults with Depression in Home Healthcare

This article explores depression in older adults, addressing types of depression, risk factors, signs and symptoms, prevention strategies, treatments, and the critical role of home care clinicians. It concludes with a discussion on the tragic issue of suicide among older adults, including its risk factors, prevention, and management.

Prasinezumab slows motor progression in Parkinsons disease: beyond the clinical data

A post hoc subgroup analysis has suggested potential therapeutic benefits of prasinezumab, a humanized monoclonal anti-α-synuclein antibody, in patients with rapidly progressing Parkinson's disease (PD), despite initial trials showing limited impact on primary outcomes. Caution is needed due to the retrospective nature of subgroup analyses, and potential confounding factors that may have influenced the observed treatment effects in specific patient subsets. Critical considerations are provided here for designing and implementing preclinical studies and clinical trials involving monoclonal antibodies, suggesting that future research should prioritize refining preclinical models and optimizing biomarker-based patient selection to reduce risks of false trial outcomes, eventually advancing antibody-based therapies in PD effectively and safely.

Suicide attempt in a dopamine agonist withdrawal syndrome in Parkinson's disease

Dopamine agonist withdrawal syndrome (DAWS) results from the reduction or suspension of dopamine agonist medications; it encompasses mainly psychiatric symptoms, including suicidal behaviors. In patients with Parkinson's disease (PD), the impact of DAWS can be significant in terms of distress and disability; however, we must take this syndrome into account as a threatening condition because suicidal behaviors could be developing in the context of DAWS. Here we present a brief case of DAWS affecting a young man with PD, whom abruptly discontinued DA treatment and developed psychiatric symptoms within two weeks which led to a suicidal attempt.

Louis EK, Noyce AJ. Ethical Considerations for Identifying Individuals in the Prodromal/Early Phase of Parkinson's Disease: A Narrative Review

The ability to identify individuals in the prodromal phase of Parkinson's disease has improved in recent years, raising the question of whether and how those affected should be informed about the risk of future disease. Several studies investigated prognostic counselling for individuals with isolated REM sleep behavior disorder and have shown that most patients want to receive information about prognosis, but autonomy and individual preferences must be respected. However, there are still many unanswered questions about risk disclosure or early diagnosis of PD, including the impact on personal circumstances, cultural preferences and specific challenges associated with different profiles of prodromal symptoms, genetic testing or biomarker assessments. This narrative review aims to summarize the current literature on prognostic counselling and risk disclosure in PD, as well as highlight future perspectives that may emerge with the development of new biomarkers and their anticipated impact on the definition of PD.