{"doi":"10.1002/mds.28193","title":"Clinical Follow‐up of Parkinson's Disease With Newly Prescribed Quetiapine","abstract":"Psychosis is a significant psychiatric disorder in Parkinson's disease (PD), with a long-term cumulative prevalence of 60%,1 Approximately 50% of patients with PD psychosis (PDP) are treated with an antipsychotic (AP), most commonly quetiapine.2 Large-scale pharmacoepidemiological research in PD demonstrated that AP treatment is associated with increased mortality3 and morbidity,4 but little is known about mortality and morbidity at the individual patient level. Using administrative and clinical record data from 6 specialty PD centers, we assessed correlates of negative outcomes in patients initiating quetiapine. The study included 261 patients receiving care at a US Veterans Affairs PD center (PADRECC), with idiopathic PD, stable physical health, and a new quetiapine prescription.3, 4 Two raters abstracted data from medical notes in the year preceding quetiapine treatment. Administrative data included a diagnosis of depression, use of nonpsychiatric medications, and medical comorbidity. We used a combined physical morbidity-mortality outcome of a VA emergency room (ER) visit, VA hospitalization, or death as a “negative” outcome. Comparisons between those with and without a negative outcome during the 180 days of follow-up were made using the χ2 test or 2-sample t test. A Cox regression model was used to model time to first occurrence of a negative outcome, adding clinical measures individually after adjusting for administrative data-based measures. Adjusted hazard ratios (AHRs) are reported for clinical measures, and analyses were repeated after multiply imputing the missing measures. The study cohort of 261 newly treated quetiapine patients was elderly (mean age, 75 years), nearly all male (99.2%), diverse in terms of PD severity based on Hoehn & Yahr stage, and with high rates of cognitive (80%) and gait (90%) impairment, indicating a vulnerable population. Prevalence of a negative outcome was high, with 104 individuals (39.8%) having at least 1 over the 180-day follow-up period. This included (groups not mutually exclusive) 18 individuals who died (17.3%), 88 with an ER visit (33.7%), and 57 who were hospitalized (21.8%). In bivariate analyses a comorbid depression diagnosis and greater medical comorbidity were correlates of a negative outcome. Of the chart abstraction-based measures, PD severity, decreased mobility, and orthostasis were predictive of a negative outcome (Table 1). In the Cox models greater PD severity (AHR, 3.37; 95% CI, 2.14–5.30), impaired balance (AHR, 2.14; 95% CI, 1.18–3.86), and gait impairment (AHR, 2.02; 95% CI, 1.19–3.42) predicted a negative outcome (Supplementary Table 1). When the analyses were repeated using 25 multiply imputed data sets, a positive association for gait and balance impairment remained significant. The clinical correlates of a negative outcome with quetiapine treatment fit into 3 categories: severe disease, autonomic dysfunction, and comorbidity. APs can worsen parkinsonism, and the association between more severe disease and a negative outcome might be mediated by injuries. Orthostasis is common in PD and a side effect of low-potency APs. Comorbid medical conditions and depression might be associated with a risk of negative outcomes through interactions with neurobiological and psychological factors or concomitant medications. Study limitations include no matched comparison of nontreated patients to determine if predictors of a negative outcome are different for quetiapine-treated versus nontreated patients, examination of quetiapine only, examination of male veterans only, retrospective study design with some missing chart-abstracted variables, and lack of data on the cause of negative outcomes, PD or psychosis duration, dose or duration of quetiapine treatment, or use of other APs during the observation period. These data would allow further understanding of the potential role of these variables in negative outcomes. Initiation of AP for PDP needs to be informed by the risks","journal":"Movement Disorders","year":2020,"id":114295,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9629,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":537800,"name":"Claire Chiang","orcid":"0000-0002-8582-963X","position":1,"is_corresponding":false},{"id":463531,"name":"Hyungjin Myra Kim","orcid":"0000-0002-0604-8027","position":2,"is_corresponding":false},{"id":537801,"name":"Jayne Wilkinson","orcid":"0000-0002-9224-4656","position":3,"is_corresponding":false},{"id":341997,"name":"Connie Marras","orcid":"0000-0002-9236-9328","position":4,"is_corresponding":false},{"id":538340,"name":"Barbara Stanislawski","orcid":null,"position":5,"is_corresponding":false},{"id":537802,"name":"Eugenia Mamikonyan","orcid":"0009-0007-7414-9480","position":6,"is_corresponding":false},{"id":515070,"name":"Helen C. Kales","orcid":"0000-0002-2032-370X","position":7,"is_corresponding":false},{"id":80309,"name":"Daniel Weintraub","orcid":"0000-0003-0633-7168","position":0,"is_corresponding":true}],"reference_count":4,"raw_metadata":null,"created_at":"2026-07-18T23:13:29.674622Z","pmid":"32725640","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}