Enhanced Scale Helps Accurately Identify Psychotic Symptoms in Parkinson Disease

Using information from these assessments, investigators identified participants as having either major psychotic symptoms, isolated minor psychotic symptoms, or no psychotic symptoms.

A study published in Parkinsonism and Related Disorders demonstrates that the enhanced Scale for the Assessment of Positive Symptoms in Parkinson disease (eSAPS-PD), a clinical interview based on the SAPS-PD that includes additional questions about delusions as well as about olfactory, gustatory, and minor hallucinations, improves identification of psychotic symptoms in PD.

A total of 199 consecutive outpatients with PD were included in this cross-sectional analysis. Participants were administered the Unified Parkinson Disease Rating Scale and the Non-Motor Symptoms Questionnaire as well as the eSAPS-PD.

Using information from these assessments, investigators identified participants as having either major psychotic symptoms (hallucinations or delusions [PD psychosis-major], n=28), isolated minor psychotic symptoms (passage hallucinations, presence hallucinations, or illusions [PD psychosis-minor], n=30), or no psychotic symptoms (PD controls, n=141). Nearly one-third (29%) of study participants had psychotic symptoms. Additionally, a total of 56 patients had hallucinations.

Compared with all other assessments combined, the eSAPS-PD identified more participants with psychotic symptoms (55 vs 22, respectively). Participants categorized as PD psychosis-minor had a higher burden of nonmotor symptoms on the Non-Motor Symptoms Scale (37 vs 18, respectively; P <.001) as well as lower scores in quality of life (PD Quality of Life Questionnaire, 138 vs 149, respectively; P =.01) compared with PD controls.

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Because the study cohort was comprised of primarily highly educated participants with preserved cognitive function, findings may not generalize across the larger PD population.

Findings from this study “demonstrate the utility of a comprehensive scale such as the eSAPS-PD to identify this at-risk population, even when there is no clinical suspicion of psychotic symptoms.”


Kulick CV, Montgomery KM, Nirenberg MJ. Comprehensive identification of delusions and olfactory, tactile, gustatory, and minor hallucinations in Parkinson’s disease psychosis [published online April 4, 2018]. Parkinsonism Relat Disord. doi: 10.1016/j.parkreldis.2018.04.008