Trends and Contributing Factors for Prescribing Antipsychotics in Newly Diagnosed Parkinson’s Disease Patients: A Population-Based Study

Figures & data

Table 1 Patient Demographics

Demographics	Mean (SD) or n (%) N=9142
Age, years (at PD incidence)	73.7 (9.8)
Age group
40–60 years	845 (9.2)
61–80 years	5670 (62)
>80 years	2627 (28.8)
Sex, male	5358 (58.6)
Health board (geographical health board location)
Abertawe Bro Morgannwg	2128 (23.28)
Aneurin Bevan	1408 (15.4)
Betsi Cadwaladr	2005 (21.93)
Cardiff and Vale	1275 (13.95)
Cwm Taf	845 (9.24)
Hywel Dda	1158 (12.67)
Powys	323 (3.53)
Year of PD diagnosis
2000–2008	4551 (49.8)
2009–2016	4591 (50.2)
PD medications*
Amantadine	22 (0.2)
Anticholinergics	325 (3.6)
COMT inhibitors	58 (0.6)
Dopamine agonists	1291 (14.1)
Levodopa	7366 (80.6)
MAO-B inhibitors	719 (7.9)
PD patients with a diagnosis of psychosis without antipsychotics and/or anti dementia drugs (within 1 year after PD diagnosis)	1994 (21.8)
PD patients with a diagnosis of psychosis and received antipsychotics (within 1 year after PD diagnosis)	1095 (12)
Antipsychotics medications
First generation antipsychotics	245 (2.7)
Second generation antipsychotics	850 (9.3)
Anti-dementia drugs likely used to treat psychosis (PD patients with a dementia diagnosis were excluded, n = 255, so the total PD patients, n = 8887)
Cholinesterase inhibitors anti dementia (Donepezil, Galantamine, Rivastigmine)	247 (2.7)
NMDA antagonist anti dementia (Memantine)	12 (0.1)

Note: *It is possible that a patient can take more than one of the following medications.

Abbreviations: COMT inhibitors, catechol-O-methyltransferase inhibitors; MAO-B inhibitors, monoamine oxidase B inhibitors; NMDA antagonist, N-methyl-D-aspartate receptor antagonist; PD, Parkinson’s disease.

Figure 1 Trend of new antipsychotics use during the first year of PD diagnosis grouped by drug class.

Abbreviations: FGA, first-generation antipsychotics; SGA, second-generation antipsychotics.

Figure 2 Trend of new antipsychotics use during the first year of PD diagnosis grouped by drug name.

Abbreviations: FGA, first-generation antipsychotics; SGA, second-generation antipsychotics.

Table 2 Multiple Logistic Regression Examining Potential Factors Affecting the Trend Antipsychotics Use in PD Patients Within the First Year of Their PD Diagnosis

Variables	OR (95% CI)	P-value
Year of PD diagnosis (ref = 2000–2008)	0.37 (0.32–0.43)	0.000
Age groups (years)
40–60	Reference
61–80	1.44 (1.11–1.86)	0.005
>80	1.21 (0.91–1.6)	0.186
Sex, (ref = male)	0.99 (0.87–1.13)	0.894
Comorbidities
Myocardial infarction	1.59 (1.15–2.2)	0.005
Dementia	3.16 (2.35–4.24)	0.000
Peptic ulcer	2.27 (1.06–4.83)	0.034
WIMD (Welsh index of multiple deprivation)
Most deprived (WIMD 1 and 2)	Reference
Middle deprived (WIMD 3)	0.87 (0.73–1.04)	0.130
Least deprived (WIMD 4 and 5)	0.93 (0.81–1.08)	0.366
PD medications
Levodopa	0.93 (0.77–1.13)	0.484
MAO-B inhibitors	0.56 (0.4–0.79)	0.001
Anticholinergics	3.19 (2.43–4.2)	0.000
Previous use of psychosis-induced medications
Beta blockers	1.19 (1.02–1.39)	0.031
Calcium channel blockers	0.88 (0.74–1.06)	0.176
ACE inhibitors	0.9 (0.76–1.06)	0.205
ARB blockers	0.63 (0.46–0.87)	0.005
TCA	1.43 (1.17–1.75)	0.001
SSRI antidepressant	1.64 (1.39–1.92)	0.000
Other antidepressants	2.17 (1.69–2.77)	0.000

Note: Bold numbers indicate statistically significant differences.

Abbreviations: MAO-B inhibitors, monoamine oxidase B inhibitors; PD, Parkinson’s disease; ACE, angiotensin-converting enzyme; ARB, angiotensin receptors blockers; TCA, tricyclic antidepressants; SSRI, selective serotonin reuptake inhibitors.

Table 3 Multiple Logistic Regression Examining Potential Factors Affecting the Trend of Anti-Dementia Use to Treat Psychosis in PD Patients Within the First Year of Their PD Diagnosis

Variables	OR (95% CI)	P-value
Year of PD diagnosis (continuous)	0.78 (0.52–1.07)	0.422
Age groups (years)
40–60	Reference
61–80	1.12 (0.67–1.88)	0.657
>80	0.53 (0.28–0.98)	0.043
Sex, (ref = male)	0.74 (0.56–1)	0.047
Comorbidities
Cerebrovascular accidents	0.71 (0.21–2.47)	0.595
Congestive heart failure	0.47 (0.11–2.1)	0.323
Diabetic type 2	0.53 (0.26–1.06)	0.072
Pulmonary diseases	0.8 (0.38–1.69)	0.558
WIMD (Welsh index of multiple deprivation)
Most deprived (WIMD 1 and 2)	Reference
Middle deprived (WIMD 3)	1.16 (0.78–1.72)	0.477
Least deprived (WIMD 4 and 5)	1.62 (1.17–2.24)	0.004
PD medications
Levodopa	1.15 (0.76–1.74)	0.505
Dopamine agonists	1.67 (1.05–2.64)	0.029
Current use of antipsychotics	104.66 (68.07–160.93)	0.000
Previous use of psychosis induced medications
Beta blockers	1.22 (0.89–1.67)	0.219
NSAIDs/COX2 inhibitors	1.7 (1.22–2.35)	0.002
SSRI antidepressant	0.84 (0.59–1.2)	0.330

Note: Bold numbers indicate statistically significant differences.

Abbreviations: PD, Parkinson’s disease; NSAIDs, non-steroidal anti-inflammatory; COX2, cyclooxigenease-2; SSRI, selective serotonin reuptake inhibitors.

Figure 3 Trend of new anti dementia use to treat psychosis during the first year of PD diagnosis.