TY - JOUR
T1 - The impact of psychiatric comorbidity on Parkinson's disease outcomes
T2 - a systematic review and meta-analysis
AU - Burchill, Ella
AU - Watson, Cameron James
AU - Fanshawe, Jack B.
AU - Badenoch, James Brunton
AU - Rengasamy, Emma
AU - Ghanem, Dory Anthony
AU - Holle, Constantine
AU - Conti, Isabella
AU - Sadeq, Mohammed Ahmed
AU - Saini, Aman
AU - Lahmar, Abdelilah
AU - Cross, Ben
AU - McGuigan, Gareth
AU - Nandrha, Amar
AU - Kane, Edward J.
AU - Wozniak, Julia
AU - Farouk Ghorab, Reem Mohamed
AU - Song, Jia
AU - Sommerlad, Andrew
AU - Lees, Andrew
AU - Zandi, Michael S.
AU - David, Anthony S.
AU - Lewis, Glyn
AU - Carter, Ben
AU - Rogers, Jonathan P.
N1 - Funding Information:
JBF is supported by an NIHR Academic Clinical Fellowship (ACF-2023-13-016).
Funding Information:
A Lahmar, A Saini, DAG, EB, ER, GM, IC, JBF, JS, JW, MAS, RMFG, AN, B Cross, CH extracted the data. Where there were disagreements, a third author (CJW, DAG, ER, IC, JBB, JBF) arbitrated. Throughout this process, one author (CJW) ensured consistency of format for data extraction items. A Lahmar, AN, A Saini, B Cross, CH, EB, ER, GM, IC, JBF, JPR, JS, MS and RMFG conducted quality assessment. A Lahmar, A Saini, B Cross, ER and JBB arbitrated quality assessment if overall rating differed between reviewers. CJW calculated descriptive statistics. CJW conducted the meta-analysis, supported by JPR, EB and B Carter. CJW created figures. JPR made the PRISMA flow chart. EB sorted references. EB checked adherence to PRISMA guidelines. EB and JPR drafted the original manuscript. EB checked the completed manuscript. EB created tables. EB sorted funding statements. EB formatted the manuscript. AD, GL, B Carter, A Lees, MSZ and A Sommerlad advised on the interpretation of the findings and the final manuscript. EB and JPR are responsible for the overall content of the study. All authors had full access to all the data included in this study and included data was verified by EB and CW. All authors had final responsibility for the decision to submit for publication.
Funding Information:
Funding: JPR is supported by a Wellcome Trust Clinical Training Fellowship (220659/Z/20/Z).
Funding Information:
CJW is supported by an NIHR Academic Clinical Fellowship (ACF-2022-17-009).
Publisher Copyright:
© 2024
PY - 2024/4
Y1 - 2024/4
N2 - Background: The burden of psychiatric symptoms in Parkinson's disease includes depression, anxiety, apathy, psychosis, and impulse control disorders. However, the relationship between psychiatric comorbidities and subsequent prognosis and neurological outcomes is not yet well understood. In this systematic review and meta-analysis, in individuals with Parkinson's disease, we aimed to characterise the association between specific psychiatric comorbidities and subsequent prognosis and neurological outcomes: cognitive impairment, death, disability, disease progression, falls or fractures and care home admission. Methods: We searched MEDLINE, Embase, PsycINFO and AMED up to 13th November 2023 for longitudinal observational studies which measured disease outcomes in people with Parkinson's disease, with and without specific psychiatric comorbidities, and a minimum of two authors extracted summary data. Studies of individuals with other parkinsonian conditions and those with outcome measures that had high overlap with psychiatric symptoms were excluded to ensure face validity. For each exposure-outcome pair, a random-effects meta-analysis was conducted based on standardised mean difference, using adjusted effect sizes–where available–in preference to unadjusted effect sizes. Study quality was assessed using the Newcastle–Ottawa Scale. Between-study heterogeneity was assessed using the I2 statistic and publication bias was assessed using funnel plots. PROSPERO Study registration number: CRD42022373072. Findings: There were 55 eligible studies for inclusion in meta-analysis (n = 165,828). Data on participants’ sex was available for 164,514, of whom 99,182 (60.3%) were male and 65,460 (39.7%) female. Study quality was mostly high (84%). Significant positive associations were found between psychosis and cognitive impairment (standardised mean difference [SMD] 0.44, [95% confidence interval [CI] 0.23–0.66], I2 30.9), psychosis and disease progression (SMD 0.46, [95% CI 0.12–0.80], I2 70.3%), depression and cognitive impairment (SMD 0.37 [95% CI 0.10–0.65], I2 27.1%), depression and disease progression (SMD 0.46 [95% CI 0.18–0.74], I2 52.2), depression and disability (SMD 0.42 [95% CI 0.25–0.60], I2 7.9%), and apathy and cognitive impairment (SMD 0.60 [95% CI 0.02–1.19], I2 27.9%). Between-study heterogeneity was moderately high. Interpretation: Psychosis, depression, and apathy in Parkinson's disease are all associated with at least one adverse outcome, including cognitive impairment, disease progression and disability. Whether this relationship is causal is not clear, but the mechanisms underlying these associations require exploration. Clinicians should consider these psychiatric comorbidities to be markers of a poorer prognosis in people with Parkinson's disease. Future studies should investigate the underlying mechanisms and which treatments for these comorbidities may affect Parkinson's disease outcomes. Funding:Wellcome Trust, UKNational Institute for Health Research (NIHR),National Institute for Health Research (NIHR)Biomedical Research Centre (BRC) atSouth London and Maudsley NHS Foundation Trust and King's College London,National Institute for Health Research (NIHR)Biomedical Research Centre (BRC) atUniversity College London Hospitals NHS Foundation Trust, National Brain Appeal.
AB - Background: The burden of psychiatric symptoms in Parkinson's disease includes depression, anxiety, apathy, psychosis, and impulse control disorders. However, the relationship between psychiatric comorbidities and subsequent prognosis and neurological outcomes is not yet well understood. In this systematic review and meta-analysis, in individuals with Parkinson's disease, we aimed to characterise the association between specific psychiatric comorbidities and subsequent prognosis and neurological outcomes: cognitive impairment, death, disability, disease progression, falls or fractures and care home admission. Methods: We searched MEDLINE, Embase, PsycINFO and AMED up to 13th November 2023 for longitudinal observational studies which measured disease outcomes in people with Parkinson's disease, with and without specific psychiatric comorbidities, and a minimum of two authors extracted summary data. Studies of individuals with other parkinsonian conditions and those with outcome measures that had high overlap with psychiatric symptoms were excluded to ensure face validity. For each exposure-outcome pair, a random-effects meta-analysis was conducted based on standardised mean difference, using adjusted effect sizes–where available–in preference to unadjusted effect sizes. Study quality was assessed using the Newcastle–Ottawa Scale. Between-study heterogeneity was assessed using the I2 statistic and publication bias was assessed using funnel plots. PROSPERO Study registration number: CRD42022373072. Findings: There were 55 eligible studies for inclusion in meta-analysis (n = 165,828). Data on participants’ sex was available for 164,514, of whom 99,182 (60.3%) were male and 65,460 (39.7%) female. Study quality was mostly high (84%). Significant positive associations were found between psychosis and cognitive impairment (standardised mean difference [SMD] 0.44, [95% confidence interval [CI] 0.23–0.66], I2 30.9), psychosis and disease progression (SMD 0.46, [95% CI 0.12–0.80], I2 70.3%), depression and cognitive impairment (SMD 0.37 [95% CI 0.10–0.65], I2 27.1%), depression and disease progression (SMD 0.46 [95% CI 0.18–0.74], I2 52.2), depression and disability (SMD 0.42 [95% CI 0.25–0.60], I2 7.9%), and apathy and cognitive impairment (SMD 0.60 [95% CI 0.02–1.19], I2 27.9%). Between-study heterogeneity was moderately high. Interpretation: Psychosis, depression, and apathy in Parkinson's disease are all associated with at least one adverse outcome, including cognitive impairment, disease progression and disability. Whether this relationship is causal is not clear, but the mechanisms underlying these associations require exploration. Clinicians should consider these psychiatric comorbidities to be markers of a poorer prognosis in people with Parkinson's disease. Future studies should investigate the underlying mechanisms and which treatments for these comorbidities may affect Parkinson's disease outcomes. Funding:Wellcome Trust, UKNational Institute for Health Research (NIHR),National Institute for Health Research (NIHR)Biomedical Research Centre (BRC) atSouth London and Maudsley NHS Foundation Trust and King's College London,National Institute for Health Research (NIHR)Biomedical Research Centre (BRC) atUniversity College London Hospitals NHS Foundation Trust, National Brain Appeal.
KW - Depression
KW - Meta-analysis
KW - Neuropsychiatry
KW - Parkinson's disease
KW - Psychosis
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85184614866&partnerID=8YFLogxK
U2 - 10.1016/j.lanepe.2024.100870
DO - 10.1016/j.lanepe.2024.100870
M3 - Article
AN - SCOPUS:85184614866
SN - 2666-7762
VL - 39
JO - The Lancet Regional Health - Europe
JF - The Lancet Regional Health - Europe
M1 - 100870
ER -