The impact of psychiatric comorbidity on Parkinson's disease outcomes: a systematic review and meta-analysisResearch in context
Summary: 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 understo...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-04-01
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| Series: | The Lancet Regional Health. Europe |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S266677622400036X |
| _version_ | 1797317443804200960 |
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| author | Ella Burchill Cameron James Watson Jack B. Fanshawe James Brunton Badenoch Emma Rengasamy Dory Anthony Ghanem Constantine Holle Isabella Conti Mohammed Ahmed Sadeq Aman Saini Abdelilah Lahmar Ben Cross Gareth McGuigan Amar Nandrha Edward J. Kane Julia Wozniak Reem Mohamed Farouk Ghorab Jia Song Andrew Sommerlad Andrew Lees Michael S. Zandi Anthony S. David Glyn Lewis Ben Carter Jonathan P. Rogers |
| author_facet | Ella Burchill Cameron James Watson Jack B. Fanshawe James Brunton Badenoch Emma Rengasamy Dory Anthony Ghanem Constantine Holle Isabella Conti Mohammed Ahmed Sadeq Aman Saini Abdelilah Lahmar Ben Cross Gareth McGuigan Amar Nandrha Edward J. Kane Julia Wozniak Reem Mohamed Farouk Ghorab Jia Song Andrew Sommerlad Andrew Lees Michael S. Zandi Anthony S. David Glyn Lewis Ben Carter Jonathan P. Rogers |
| author_sort | Ella Burchill |
| collection | DOAJ |
| description | Summary: 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, UK National Institute for Health Research (NIHR), National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London, National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at University College London Hospitals NHS Foundation Trust, National Brain Appeal. |
| first_indexed | 2024-03-08T03:35:01Z |
| format | Article |
| id | doaj.art-4413b43557224f86bc37a9d5c3641e4d |
| institution | Directory Open Access Journal |
| issn | 2666-7762 |
| language | English |
| last_indexed | 2024-03-08T03:35:01Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Europe |
| spelling | doaj.art-4413b43557224f86bc37a9d5c3641e4d2024-02-10T04:45:38ZengElsevierThe Lancet Regional Health. Europe2666-77622024-04-0139100870The impact of psychiatric comorbidity on Parkinson's disease outcomes: a systematic review and meta-analysisResearch in contextElla Burchill0Cameron James Watson1Jack B. Fanshawe2James Brunton Badenoch3Emma Rengasamy4Dory Anthony Ghanem5Constantine Holle6Isabella Conti7Mohammed Ahmed Sadeq8Aman Saini9Abdelilah Lahmar10Ben Cross11Gareth McGuigan12Amar Nandrha13Edward J. Kane14Julia Wozniak15Reem Mohamed Farouk Ghorab16Jia Song17Andrew Sommerlad18Andrew Lees19Michael S. Zandi20Anthony S. David21Glyn Lewis22Ben Carter23Jonathan P. Rogers24Division of Psychiatry, University College London, London, UK; Corresponding author. Division of Psychiatry, University College London, London, W1T 7BN, UK.Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, UKDepartment of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UKDepartment of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UKDepartment of Public Health and Primary Care, University of Cambridge, UKMedical School, University College London, London, UKMedical School, University College London, London, UKInstitute of Psychiatry, Psychology & Neuroscience, King's College London, London, UKFaculty of Medicine, Misr University for Science and Technology, 6th of October City, EgyptMedical School, University College London, London, UKFaculty of Medicine, Mohamed First University, Oujda, MoroccoMersey Care NHS Foundation Trust, Liverpool, UKAyrshire & Arran NHS Foundation Trust, Scotland, UKMedical School, University College London, London, UKSouth London and Maudsley NHS Foundation Trust, UKMedical School, University College London, London, UKFaculty of Medicine, Misr University for Science and Technology, 6th of October City, EgyptCamden and Islington NHS Foundation Trust, London, UKDivision of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UKUCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UKUCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UKDivision of Psychiatry, University College London, London, UK; UCL Institute of Mental Health, University College London, London, UKDivision of Psychiatry, University College London, London, UKDepartment of Biostatistics and Health Informatics, King's College London, London, UKDivision of Psychiatry, University College London, London, UKSummary: 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, UK National Institute for Health Research (NIHR), National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London, National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at University College London Hospitals NHS Foundation Trust, National Brain Appeal.http://www.sciencedirect.com/science/article/pii/S266677622400036XParkinson's diseaseNeuropsychiatryDepressionPsychosisSystematic reviewMeta-analysis |
| spellingShingle | Ella Burchill Cameron James Watson Jack B. Fanshawe James Brunton Badenoch Emma Rengasamy Dory Anthony Ghanem Constantine Holle Isabella Conti Mohammed Ahmed Sadeq Aman Saini Abdelilah Lahmar Ben Cross Gareth McGuigan Amar Nandrha Edward J. Kane Julia Wozniak Reem Mohamed Farouk Ghorab Jia Song Andrew Sommerlad Andrew Lees Michael S. Zandi Anthony S. David Glyn Lewis Ben Carter Jonathan P. Rogers The impact of psychiatric comorbidity on Parkinson's disease outcomes: a systematic review and meta-analysisResearch in context The Lancet Regional Health. Europe Parkinson's disease Neuropsychiatry Depression Psychosis Systematic review Meta-analysis |
| title | The impact of psychiatric comorbidity on Parkinson's disease outcomes: a systematic review and meta-analysisResearch in context |
| title_full | The impact of psychiatric comorbidity on Parkinson's disease outcomes: a systematic review and meta-analysisResearch in context |
| title_fullStr | The impact of psychiatric comorbidity on Parkinson's disease outcomes: a systematic review and meta-analysisResearch in context |
| title_full_unstemmed | The impact of psychiatric comorbidity on Parkinson's disease outcomes: a systematic review and meta-analysisResearch in context |
| title_short | The impact of psychiatric comorbidity on Parkinson's disease outcomes: a systematic review and meta-analysisResearch in context |
| title_sort | impact of psychiatric comorbidity on parkinson s disease outcomes a systematic review and meta analysisresearch in context |
| topic | Parkinson's disease Neuropsychiatry Depression Psychosis Systematic review Meta-analysis |
| url | http://www.sciencedirect.com/science/article/pii/S266677622400036X |
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