Objective:

The study aimed to investigate the relationship between autonomic dysfunction, specifically orthostatic hypotension, and the presence of psychosis in Parkinson's disease (PD) patients. In addition, we aimed to identify other non-motor factors influencing the development of psychosis.

Methods:

We conducted a multicentric observational cross-sectional study to investigate the potential association between autonomic dysfunction and psychosis in PD patients. Approval was obtained from the institutional review board. Participants (n = 306) were recruited through non-probabilistic convenience sampling from the Mexican Parkinson Study Group cohort. Data collection occurred between July 2017 and June 2018. Demographic and clinical data were collected, including age, gender, disease duration, medication, and movement disorders society-unified Parkinson's disease rating scale (MDS-UPDRS) scores. Psychosis symptoms were assessed using MDS-UPDRS item 1.2, whereas autonomic dysfunction was assessed using items 1.10, 1.11, and 1.12. Descriptive statistics, Chi-square tests, Mann–Whitney U tests, and logistic regression were employed for analysis using IBM SPSS version 25.

Results:

In our multicenter cohort of 306 Mexican PD patients, 18% reported symptoms of psychosis. Among these patients, orthostatic hypotension on standing was significantly associated with symptoms of psychosis (p = 0.001, OR 2.82). Regression analysis identified apathy (p = 0.003), cognitive impairment (p = 0.012), and longer disease duration (p = 0.001) as predictors of symptoms of psychosis.

Conclusions:

While orthostatic hypotension is associated with symptoms of psychosis, cognitive impairment, apathy, and disease duration significantly contribute to its presence in our cohort. These findings underscore the complexity of factors contributing to psychosis in PD. Recognizing these non-motor factors is crucial for the comprehensive care and management of PD patients, especially those at risk of developing psychosis.

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