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Quetiapine, Clozapine May Benefit Patients with Parkinson's Disease and Hallucinations: Presented at AAN

By Jill Stein

Special to DG News

DENVER, CO -- April 19, 2002 -- Preliminary data suggest the atypical antipsychotics quetiapine and clozapine may provide long-term benefits in patients with Parkinson's disease and drug-induced psychotic symptoms such as hallucinations.

The data were reported here yesterday at the 54^th Annual Meeting of the American Academy of Neurology (AAN).

Dr. Jorge Juncos and colleagues at Emory University in Atlanta, Georgia, United States, reviewed the records of 27 patients with advanced Parkinson's disease (PD) and hallucinations treated with quetiapine or clozapine between 1996 and 2001. All patients were followed by one of three movement disorder specialists who corroborated medical record information as needed. These data were compared to results obtained in one small study looking at the low doses of typical antipsychotics used prior to 1996.

Results showed that both quetiapine and clozapine led to a sustained reduction in hallucinations and agitation. The 50 percent incidence of nursing home placement at 36 months among hallucinating outpatients in the current study compared favorably with the 80 percent at 21 months reported in a study conducted in 1993, Dr. Juncos said.

The earlier study found that psychotic symptoms are an important source of morbidity and mortality in patients with advanced PD and that psychotic symptoms convey a higher risk of nursing home placement compared to the motor and cognitive symptoms of PD. Those conclusions, however, were based on a limited number of case-controlled observations, Dr. Juncos said.

In the current study, the odds ratio of becoming demented in three years for patients with PD and hallucinations was 5.7. Results of the present study suggest that the overall mortality for hallucinating PD patients may have improved with the increasing use of atypical antipsychotics since 1996.

Dr. Juncos said that better case-controlled data from before 1996 are needed to draw firm conclusions regarding the potential cost savings that these agents may provide to hallucinating patients with PD at risk of nursing home placement.

Pending completion of a larger case-controlled review of the study investigators' own data from that period, the current study suggest that the judicious long-term use of quetiapine and clozapine may translate into a sustained improvement in quality of life, a reduced risk of nursing home placement, and reduced mortality in many of these patients, Dr. Juncos said.

The study was supported by Emory's APDA Center of Excellence in PD Research and the Fauver Family Foundation.

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