Increases in institutionalization, healthcare resource utilization, and mortality risk associated with Parkinson disease psychosis: Retrospective cohort study


      • Psychosis can develop in patients with Parkinson disease (PD).
      • Over a mean follow-up of 1.8 years, risk of death increased 34% with psychosis.
      • Psychosis patients had a >330% increased risk of need for custodial care (CC).
      • Women had a >20% lower risk of death, but a higher risk of CC, than men.
      • Healthcare costs were roughly double for PD patients who developed psychosis.



      Patients with Parkinson disease (PD) often develop psychosis (P). The association of PDP with death and long-term custodial care (CC) has not been well studied.


      Medicare Parts A, B, and D data, 2007–2015, were used to define cohorts of PD and PDP patients. PD was defined by ≥ 2 ICD-9-CM codes (332.0x) at least 30, but no more than 365, days apart, and PDP by ≥ 2 codes for psychotic symptoms. Outcomes were CC use, defined as nursing home stays of >100 consecutive days, and death. To compare the association of PDP with outcomes, PDP patients were matched to PD patients without psychosis.


      Within 1 year of PDP diagnosis, 12.1% of PDP patients used CC, versus 3.5% of non-PDP patients 1 year after the matching date; corresponding percentages at 5 years were 25.8% and 10.0%. Cumulative incidence curves for CC and for death differed significantly (P < 0.0001). PDP was associated with RRs of 3.38 (95% CI, 2.93–3.90) for CC and 1.34 (1.23–1.45) for death. Other factors associated with CC were age (3.57, 2.08–6.14, age ≥90 versus ≤70 years) and female sex (1.37, 1.18–1.58). Female sex was associated with a lower RR for death (0.76, 0.70–0.82). Health care utilization and costs were substantially higher for PDP than for non-PDP patients.


      In PD patients, psychosis was associated with a more than 3-fold increased risk of CC and a nearly one-third increased risk of death. Women entered CC more often than men, likely because they lived longer in the setting of PD.


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