- Email: [email protected]
III.P3 One year follow-up study for hallucinations in patients with Parkinson's Disease
30
Poster Presentations
Results: There was a statistically significant difference in median GTE score of DLB (11), AD (4.75), and SMC (2.5) patients (p < 0.001). The difference between DLB and AD patients was also significant (p < 0.001). ROC analyses resulted in a sensitivity of 72% and a specificity of 85% if a GTE cut-off of 9.5 was used. The association between GTE and DLB was independent of age, gender, MMSE, and medication use. Conclusions: The GTE is a simple EEG scoring method that can be helpful in the differential diagnosis between DLB and AD with a good sensitivity and specificity.
Section III: Psychotic Manifestations and Mood Disorders III.P1 Visual hallucinations in Parkinson’s Disease; the relationship with visual processing and attention T. van Laar° Department of Neurology, University Medical Centre Groningen, The Netherlands Introduction: Visual hallucinations occur in about 30−40% of Parkinson’s Disease (PD) patients [1]. The precise mechanisms behind VH in PD are yet unknown. Several hypotheses have been raised. There is consisting evidence that decreased cholinergic activation of the cortex plays an important role in the occurrence of VH [2,3]. Also dopaminergic overstimulation may cause VH, but very likely only in combination with a cholinergic deficit. The cholinergic deficiency in PD causes impaired attention as well, and also impairs the visual selection, which both may result in VH [4]. The recent finding that suppletion of the cholinergic deficit reduces the severity and frequency of VH, also supports the cholinergic hypothesis of VH [5]. Objective: To review the pathogenesis and treatment of visual hallucinations (VH) in Parkinson’s Disease (PD), based on own data and a review of the literature. Methods: In order to test the suggested cholinergic deficiency in the pathophysiology of PD-related visual hallucinations, the Visual Object and Space Perception battery (VOSP) and sustained visual attention tests were used [6]. Results: The VOSP battery showed that especially PD patients with VH had problems with object and space recognition, which was significantly worse as compared to PD patients without VH. Also the attention tests showed the worst data in PD patients with VH [submitted data]. Conclusion: These data seem to support the hypothesis that VH occur as a result of inadequate cortical selection and processing of (visual) stimuli, which results in the generation of internal images, build on previously stored information. References [1] Fenelon G, Mahieux F, Huon R, Ziegler M. Hallucinations in Parkinson’s Disease: prevalence, phenomenology and risk factors. Brain 2000; 123: 733–745. [2] Manford M, Andermann F. Complex visual hallucinations. Clinical and neurobiological insights. Brain 1998; 121: 1819–1840. [3] Perry EK, Perry RH. Acetylcholine and hallucinations: disease-related compared to drug-induced alterations in human consciousness. Brain Cogn 1995; 28: 240–258. [4] Collerton D, Perry E, McKeith I. Why people see things that are not there: A novel Perception and Attention Deficit model for recurrent complex visual hallucinations. Behav Brain Sci 2005; 28: 737–757. [5] Emre M, Aarsland D, Albanese A, Byrne J, Deuschl G, De Deyn PP, Durif F, Kulisevsky J, van Laar T, Lees AJ, Poewe W, Robillard A, Rosa M, Wolters EC, Quarg P, Tekin S, Lane ?. Efficacy and safety of rivastigmine in dementia associated with Parkinson’s Disease; a randomized, double-blind, placebo-controlled study.NEJM 2004; 351: 2509–2518. [6] Warrington EK. The visual object and space perception battery. Bury St. Edmonds UK: Thames Valley Test Company; 1991.
III.P2 Long term follow-up (24 months) of quetiapine-treated Parkinson’s Disease psychotic patients J.M. Rabey° , T. Prokhorov, C. Klein Department of Neurology, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel Aviv University, Israel Introduction: Parkinson’s Disease (PD) patients long term treated with Levodopa (LD) frequently develop psychosis which is difficult to treat. Among the different available atypical antipsychotics in use clozapine (CLOZ) has been shown to be the most effective drug although its safety profile requires a close follow-up (Klein et al., Clinical Neuropharmacol. 2003). Quetiapine (QTP) is the second most common drug used. However the experience of long term follow up is limited. The objective of this study was to evaluate the long term outcome of QTP use for PD psychotic patients. Methods: Thirty five PD psychotic patients (mean age 76.1+5.9 y; mean disease duration 10.3+5.3 y, 19 of them demented) were followed up for 24 months. Patients included 9 who suffered from only visual hallucinations and 26 who suffered from delusions or a combination with hallucinations. Alls pts were treated with LD (mean daily dose 685.3+313 mg) and some of them (n = 10) received also dopamine agonists (mean daily dose of pergolide [or its equivalent] 0.91+0.5 mg). QTP was given in a flexible dose (mean daily dose 93+79 mg). The evaluation included a clinical interview or telephone screening. Results: After two years 11 pts (31%) continued treatment with QTP (7 of them with dementia). In this group a complete resolution of symptoms was observed in 7 pts and a partial resolution in 4 pts. Treatment was stopped in 24 pts: fifteen (42%) due to lack of response (11 within the first 3 months); 3 pts due to marked improvement with resolution of symptoms; 1 due to severe somnolence; 3 pts due to personal (economic) reasons (one of them by the time of stopping QTP was a good responder); 2 passed away. We did not find any demographic and clinical difference among patients who continued or stopped treatment. Among 15 pts with poor outcome on QTP, 12 were switched to CLOZ (7 demented, mean dose CLOZ 27.2+14.3 mg) and in 3 a combination of QTP and CLOZ was used. Under CLOZ treatment a complete resolution of symptoms was observed in 9 pts and partial improvement in 3 pts. Three pts (3/35; 9%) were resistant to both treatments. Conclusion: Long term treatment (24 months) with QTP showed beneficial effect in 43% (15/35) of psychotic PD pts. In resistant QTP patients CLOZ is undoubtedly an useful alternative.
III.P3 One year follow-up study for hallucinations in patients with Parkinson’s Disease M. Svetel° , T. Smiljkovic, T. Pekmezovic, N. Dragasevic, V. Kostic Institute of Neurology, CCS, Department of Movement Disorders, Belgrade, Serbia Introduction: Hallucinations are not rarely encountered in PD. Pathogenesis and pathophysiology are not fully understood. It is still not clear whether they are drug induced phenomena or a common complication of PD. Objective: To assess the relationships between hallucinations and demographic, disease, and therapy factors in a prospective, one-year follow up study. Methods: One hundred eighty-three patients were enrolled in the study at the baseline. They all fulfilled the QSB criteria for PD. Original questionnaire was performed to obtain demographic, disease, and treatment data as well as presence of hallucinations, their clinical features, frequency, type and severity. UPDRS, MMSE, H-Y, NPI, Hamilton’s scale were applied. Results: The number of patients experiencing hallucinations increased over time from 11.8% at the baseline to 41.5% after one year period. The most frequent were visual, benign hallucinations. After a year of follow up the higher risk for their commence was associated with decline in MMSE score. Also, increased Hamilton’s depression rating score, UPDRS score
Section III: Psychotic Manifestations and Mood Disorders and advanced stage of PD were significant risk factors for their appearance. Female patients and those with younger onset of PD were in higher risk for hallucinations. We did not find duration of PD as a risk factor for hallucinations. Conclusion: Results of the study suggest that hallucinations are not rare in PD. Younger age at PD onset, cognitive decline as well as advanced PD, which contributes with more advanced neurodegeneration, are important risk factors for the emergence of hallucinations.
31
randomized to placebo. ACP-103 did not worsen motor symptoms in PD as assessed by the UPDRS Parts II and III. However, there was a trend to significant improvement in UPDRS Part IV score in ACP-103-treated patients compared to placebo (p < 0.06). Conclusion: ACP-103 reduced psychotic symptoms without impairing motor function in PD and may be useful in treating a variety of other dysfunctions in PD.
III.P6 Regular exposure to pesticides is related to depression associated with Parkinson’s Disease: Evidence from two independent Australian samples
III.P4 REM Sleep behaviour disorder predicts visual hallucinations in Parkinson’s Disease M.D. Gjerstad° , J.P. Larsen, D. Aarsland The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
N. Dissanayaka° , A. Sellbach, S. Matheson, R. Marsh, P. Silburn, J. O’Sullivan, G. Byrne, G. Mellick The University of Queensland, School of Medicine, Queensland, Australia
Objective: To explore the relationship between REM sleep behavior disorder (RBD) and the course of motor and neuropsychiatric symptoms in PD. Methods: 231 community-based patients with PD were assessed at baseline and after four years. Standardized rating scales of parkinsonism (UPDRS motor subscale), cognition (MMSE), depression (MADRS), and visual hallucinations (UPDRS thought disorder item) were employed. The patients and a relative were asked to rate the severity of motor and vocal activity during sleep. RBD was operationally defined as a score of 2 (very active during sleep, tend to wake up spouse) or 3 (very active physically and verbally, have been hitting or hurting myself or caregiver while sleeping). Results: 34 (15%) PD patients had RBD at baseline. 143 completed the follow-up-evaluation (87 had died); 39 (27%) had RBD. 46 (32%) of the patients completing follow-up had RBD at baseline or at follow-up. At baseline, patients with RBD were slightly younger, and received more often dopamine agonists and higher levodopa dosage than those without RBD, whereas gender or other clinical features did not differ. At followup, subjects with RBD had more often visual hallucinations (57% vs 23%, p < 0.005) and higher MADRS score (7.3 vs 3.6, p < 0.05). UPDRS motor score and MMSE did not differ. Conclusion: The presence of RBD was associated with a higher risk of developing visual hallucinations, indicating a possible common etiology. The findings support the hypothesis that visual hallucinations in PD are at least partially due to REM sleep intrusion during waking and should be further investigated.
Introduction: Depression in PD is common, yet studies investigating risk factors are limited. Objective: To examine the relationship between various factors and depression in PD. Methods: The study design was two-fold. Sample 1 consisted of a consecutive series of PD patients (n = 78) recruited from two Neurology clinics. The subjects were interviewed via telephone to collect risk factor data. A diagnosis of depressive disorder was made according to DSMIV criteria. Sample 2 surveyed a convenience sample of 410 PD patients for risk factors and identified depression using a screening question of known specificity (98%). Appropriate univariate analyses were performed and stepwise binary logistic regression models were constructed including variables such as gender, age, onset age, smoking status, family history of PD, farming history and exposure to pesticides. Results: Weekly exposure to pesticides for a period of 6 months or more significantly increased the risk of depression. The risk was six-fold in sample 1 and two-fold in sample 2. Other independent risk factors did not show any significant relationship with depression at p < 0.05 in sample 1; however in sample 2 females were at 1.8 times higher risk of being depressed compared to males. Further analyses suggested that depressed males had higher exposure to pesticides and cigarette smoking compared to depressed females. Conclusion: These preliminary findings open many avenues to further investigate the causal relationships between depression, PD and pesticide exposure.
III.P5 ACP-103 Reduces psychosis without impairing motor function in Parkinson’s Disease D.P. van Kammen° , E.M. Taylor, D.M. Weiner, K.E. Vanover, R.E. Davis ACADIA Pharmaceuticals Inc., Department of Clinical Development, 3911 Sorrento Valley Blvd., San Diego, CA, USA
III.P7 Happy or sad? Semantical content interferes with emotional prosody in Parkinson’s Disease
Objective: A Phase II double-blind, placebo-controlled study was conducted to evaluate antipsychotic efficacy and motoric tolerability of ACP-103, a 5-HT2A inverse agonist/antagonist, in patients with Parkinson’s Disease (PD) and treatment-induced psychosis. Methods: Sixty patients received oral ACP-103 or placebo once-daily for 28 days. The starting dose of ACP-103 was 20 mg with escalations to 40 mg and 60 mg permitted at Day 8 and Day 15, respectively. Antipsychotic efficacy of ACP-103 was assessed using UPDRS Part I, the Scale for Assessment of Positive Symptoms (SAPS), and the Clinical Global Impression – Severity scale (CGI-S). Results: ACP-103 significantly reduced the UPDRS Part I score compared to placebo (p < 0.05). In addition, the percent change from baseline in the Total SAPS was significantly greater with ACP-103 than placebo (p = 0.05) and analysis of the absolute change from baseline showed a trend to significance (p < 0.09). There was no significant difference between ACP-103 and placebo as measured by the CGI-S, though more subjects treated with ACP-103 improved on the CGI-S compared to the subjects
C. Schr¨oder° , S. Kotz, J. M¨obes, W. Nager, R. Dengler Neurological Rehabilitation Centre, Leipzig, Germany Introduction: Besides the well described changes of motor function in Parkinson’s Disease (PD), recently the impact of PD on emotional processing and cognitive functions has become increasingly apparent. Furthermore, recent data provide evidence for an early, preattentive dysfunction of emotional prosody processing in PD [1]. However, in every-day social life one has to infer the emotional state of a speaker by integrating prosodic and semantic information. Objective: The objective of the present study is to investigate the influence of semantic content on emotional prosody processing in PD. Methods: 10 PD patients (Hoehn and Yahr scale 1−2, tested on medication) and 10 matched healthy controls (HC) were included. Sentences differing in emotional prosody (positive, neutral, negative) and emotional semantic content (positive, neutral, negative) were presented in a 3×3 design via headphones. Participants had to make a prosodic judgment (irrespective of emotional semantic content) by pressing a button; the correct answer percentage was calculated. Results: Data reveal that PD patients make more errors when emotional prosody and emotional semantic content were incongruent. Interestingly,
Poster Presentations
Results: There was a statistically significant difference in median GTE score of DLB (11), AD (4.75), and SMC (2.5) patients (p < 0.001). The difference between DLB and AD patients was also significant (p < 0.001). ROC analyses resulted in a sensitivity of 72% and a specificity of 85% if a GTE cut-off of 9.5 was used. The association between GTE and DLB was independent of age, gender, MMSE, and medication use. Conclusions: The GTE is a simple EEG scoring method that can be helpful in the differential diagnosis between DLB and AD with a good sensitivity and specificity.
Section III: Psychotic Manifestations and Mood Disorders III.P1 Visual hallucinations in Parkinson’s Disease; the relationship with visual processing and attention T. van Laar° Department of Neurology, University Medical Centre Groningen, The Netherlands Introduction: Visual hallucinations occur in about 30−40% of Parkinson’s Disease (PD) patients [1]. The precise mechanisms behind VH in PD are yet unknown. Several hypotheses have been raised. There is consisting evidence that decreased cholinergic activation of the cortex plays an important role in the occurrence of VH [2,3]. Also dopaminergic overstimulation may cause VH, but very likely only in combination with a cholinergic deficit. The cholinergic deficiency in PD causes impaired attention as well, and also impairs the visual selection, which both may result in VH [4]. The recent finding that suppletion of the cholinergic deficit reduces the severity and frequency of VH, also supports the cholinergic hypothesis of VH [5]. Objective: To review the pathogenesis and treatment of visual hallucinations (VH) in Parkinson’s Disease (PD), based on own data and a review of the literature. Methods: In order to test the suggested cholinergic deficiency in the pathophysiology of PD-related visual hallucinations, the Visual Object and Space Perception battery (VOSP) and sustained visual attention tests were used [6]. Results: The VOSP battery showed that especially PD patients with VH had problems with object and space recognition, which was significantly worse as compared to PD patients without VH. Also the attention tests showed the worst data in PD patients with VH [submitted data]. Conclusion: These data seem to support the hypothesis that VH occur as a result of inadequate cortical selection and processing of (visual) stimuli, which results in the generation of internal images, build on previously stored information. References [1] Fenelon G, Mahieux F, Huon R, Ziegler M. Hallucinations in Parkinson’s Disease: prevalence, phenomenology and risk factors. Brain 2000; 123: 733–745. [2] Manford M, Andermann F. Complex visual hallucinations. Clinical and neurobiological insights. Brain 1998; 121: 1819–1840. [3] Perry EK, Perry RH. Acetylcholine and hallucinations: disease-related compared to drug-induced alterations in human consciousness. Brain Cogn 1995; 28: 240–258. [4] Collerton D, Perry E, McKeith I. Why people see things that are not there: A novel Perception and Attention Deficit model for recurrent complex visual hallucinations. Behav Brain Sci 2005; 28: 737–757. [5] Emre M, Aarsland D, Albanese A, Byrne J, Deuschl G, De Deyn PP, Durif F, Kulisevsky J, van Laar T, Lees AJ, Poewe W, Robillard A, Rosa M, Wolters EC, Quarg P, Tekin S, Lane ?. Efficacy and safety of rivastigmine in dementia associated with Parkinson’s Disease; a randomized, double-blind, placebo-controlled study.NEJM 2004; 351: 2509–2518. [6] Warrington EK. The visual object and space perception battery. Bury St. Edmonds UK: Thames Valley Test Company; 1991.
III.P2 Long term follow-up (24 months) of quetiapine-treated Parkinson’s Disease psychotic patients J.M. Rabey° , T. Prokhorov, C. Klein Department of Neurology, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel Aviv University, Israel Introduction: Parkinson’s Disease (PD) patients long term treated with Levodopa (LD) frequently develop psychosis which is difficult to treat. Among the different available atypical antipsychotics in use clozapine (CLOZ) has been shown to be the most effective drug although its safety profile requires a close follow-up (Klein et al., Clinical Neuropharmacol. 2003). Quetiapine (QTP) is the second most common drug used. However the experience of long term follow up is limited. The objective of this study was to evaluate the long term outcome of QTP use for PD psychotic patients. Methods: Thirty five PD psychotic patients (mean age 76.1+5.9 y; mean disease duration 10.3+5.3 y, 19 of them demented) were followed up for 24 months. Patients included 9 who suffered from only visual hallucinations and 26 who suffered from delusions or a combination with hallucinations. Alls pts were treated with LD (mean daily dose 685.3+313 mg) and some of them (n = 10) received also dopamine agonists (mean daily dose of pergolide [or its equivalent] 0.91+0.5 mg). QTP was given in a flexible dose (mean daily dose 93+79 mg). The evaluation included a clinical interview or telephone screening. Results: After two years 11 pts (31%) continued treatment with QTP (7 of them with dementia). In this group a complete resolution of symptoms was observed in 7 pts and a partial resolution in 4 pts. Treatment was stopped in 24 pts: fifteen (42%) due to lack of response (11 within the first 3 months); 3 pts due to marked improvement with resolution of symptoms; 1 due to severe somnolence; 3 pts due to personal (economic) reasons (one of them by the time of stopping QTP was a good responder); 2 passed away. We did not find any demographic and clinical difference among patients who continued or stopped treatment. Among 15 pts with poor outcome on QTP, 12 were switched to CLOZ (7 demented, mean dose CLOZ 27.2+14.3 mg) and in 3 a combination of QTP and CLOZ was used. Under CLOZ treatment a complete resolution of symptoms was observed in 9 pts and partial improvement in 3 pts. Three pts (3/35; 9%) were resistant to both treatments. Conclusion: Long term treatment (24 months) with QTP showed beneficial effect in 43% (15/35) of psychotic PD pts. In resistant QTP patients CLOZ is undoubtedly an useful alternative.
III.P3 One year follow-up study for hallucinations in patients with Parkinson’s Disease M. Svetel° , T. Smiljkovic, T. Pekmezovic, N. Dragasevic, V. Kostic Institute of Neurology, CCS, Department of Movement Disorders, Belgrade, Serbia Introduction: Hallucinations are not rarely encountered in PD. Pathogenesis and pathophysiology are not fully understood. It is still not clear whether they are drug induced phenomena or a common complication of PD. Objective: To assess the relationships between hallucinations and demographic, disease, and therapy factors in a prospective, one-year follow up study. Methods: One hundred eighty-three patients were enrolled in the study at the baseline. They all fulfilled the QSB criteria for PD. Original questionnaire was performed to obtain demographic, disease, and treatment data as well as presence of hallucinations, their clinical features, frequency, type and severity. UPDRS, MMSE, H-Y, NPI, Hamilton’s scale were applied. Results: The number of patients experiencing hallucinations increased over time from 11.8% at the baseline to 41.5% after one year period. The most frequent were visual, benign hallucinations. After a year of follow up the higher risk for their commence was associated with decline in MMSE score. Also, increased Hamilton’s depression rating score, UPDRS score
Section III: Psychotic Manifestations and Mood Disorders and advanced stage of PD were significant risk factors for their appearance. Female patients and those with younger onset of PD were in higher risk for hallucinations. We did not find duration of PD as a risk factor for hallucinations. Conclusion: Results of the study suggest that hallucinations are not rare in PD. Younger age at PD onset, cognitive decline as well as advanced PD, which contributes with more advanced neurodegeneration, are important risk factors for the emergence of hallucinations.
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randomized to placebo. ACP-103 did not worsen motor symptoms in PD as assessed by the UPDRS Parts II and III. However, there was a trend to significant improvement in UPDRS Part IV score in ACP-103-treated patients compared to placebo (p < 0.06). Conclusion: ACP-103 reduced psychotic symptoms without impairing motor function in PD and may be useful in treating a variety of other dysfunctions in PD.
III.P6 Regular exposure to pesticides is related to depression associated with Parkinson’s Disease: Evidence from two independent Australian samples
III.P4 REM Sleep behaviour disorder predicts visual hallucinations in Parkinson’s Disease M.D. Gjerstad° , J.P. Larsen, D. Aarsland The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
N. Dissanayaka° , A. Sellbach, S. Matheson, R. Marsh, P. Silburn, J. O’Sullivan, G. Byrne, G. Mellick The University of Queensland, School of Medicine, Queensland, Australia
Objective: To explore the relationship between REM sleep behavior disorder (RBD) and the course of motor and neuropsychiatric symptoms in PD. Methods: 231 community-based patients with PD were assessed at baseline and after four years. Standardized rating scales of parkinsonism (UPDRS motor subscale), cognition (MMSE), depression (MADRS), and visual hallucinations (UPDRS thought disorder item) were employed. The patients and a relative were asked to rate the severity of motor and vocal activity during sleep. RBD was operationally defined as a score of 2 (very active during sleep, tend to wake up spouse) or 3 (very active physically and verbally, have been hitting or hurting myself or caregiver while sleeping). Results: 34 (15%) PD patients had RBD at baseline. 143 completed the follow-up-evaluation (87 had died); 39 (27%) had RBD. 46 (32%) of the patients completing follow-up had RBD at baseline or at follow-up. At baseline, patients with RBD were slightly younger, and received more often dopamine agonists and higher levodopa dosage than those without RBD, whereas gender or other clinical features did not differ. At followup, subjects with RBD had more often visual hallucinations (57% vs 23%, p < 0.005) and higher MADRS score (7.3 vs 3.6, p < 0.05). UPDRS motor score and MMSE did not differ. Conclusion: The presence of RBD was associated with a higher risk of developing visual hallucinations, indicating a possible common etiology. The findings support the hypothesis that visual hallucinations in PD are at least partially due to REM sleep intrusion during waking and should be further investigated.
Introduction: Depression in PD is common, yet studies investigating risk factors are limited. Objective: To examine the relationship between various factors and depression in PD. Methods: The study design was two-fold. Sample 1 consisted of a consecutive series of PD patients (n = 78) recruited from two Neurology clinics. The subjects were interviewed via telephone to collect risk factor data. A diagnosis of depressive disorder was made according to DSMIV criteria. Sample 2 surveyed a convenience sample of 410 PD patients for risk factors and identified depression using a screening question of known specificity (98%). Appropriate univariate analyses were performed and stepwise binary logistic regression models were constructed including variables such as gender, age, onset age, smoking status, family history of PD, farming history and exposure to pesticides. Results: Weekly exposure to pesticides for a period of 6 months or more significantly increased the risk of depression. The risk was six-fold in sample 1 and two-fold in sample 2. Other independent risk factors did not show any significant relationship with depression at p < 0.05 in sample 1; however in sample 2 females were at 1.8 times higher risk of being depressed compared to males. Further analyses suggested that depressed males had higher exposure to pesticides and cigarette smoking compared to depressed females. Conclusion: These preliminary findings open many avenues to further investigate the causal relationships between depression, PD and pesticide exposure.
III.P5 ACP-103 Reduces psychosis without impairing motor function in Parkinson’s Disease D.P. van Kammen° , E.M. Taylor, D.M. Weiner, K.E. Vanover, R.E. Davis ACADIA Pharmaceuticals Inc., Department of Clinical Development, 3911 Sorrento Valley Blvd., San Diego, CA, USA
III.P7 Happy or sad? Semantical content interferes with emotional prosody in Parkinson’s Disease
Objective: A Phase II double-blind, placebo-controlled study was conducted to evaluate antipsychotic efficacy and motoric tolerability of ACP-103, a 5-HT2A inverse agonist/antagonist, in patients with Parkinson’s Disease (PD) and treatment-induced psychosis. Methods: Sixty patients received oral ACP-103 or placebo once-daily for 28 days. The starting dose of ACP-103 was 20 mg with escalations to 40 mg and 60 mg permitted at Day 8 and Day 15, respectively. Antipsychotic efficacy of ACP-103 was assessed using UPDRS Part I, the Scale for Assessment of Positive Symptoms (SAPS), and the Clinical Global Impression – Severity scale (CGI-S). Results: ACP-103 significantly reduced the UPDRS Part I score compared to placebo (p < 0.05). In addition, the percent change from baseline in the Total SAPS was significantly greater with ACP-103 than placebo (p = 0.05) and analysis of the absolute change from baseline showed a trend to significance (p < 0.09). There was no significant difference between ACP-103 and placebo as measured by the CGI-S, though more subjects treated with ACP-103 improved on the CGI-S compared to the subjects
C. Schr¨oder° , S. Kotz, J. M¨obes, W. Nager, R. Dengler Neurological Rehabilitation Centre, Leipzig, Germany Introduction: Besides the well described changes of motor function in Parkinson’s Disease (PD), recently the impact of PD on emotional processing and cognitive functions has become increasingly apparent. Furthermore, recent data provide evidence for an early, preattentive dysfunction of emotional prosody processing in PD [1]. However, in every-day social life one has to infer the emotional state of a speaker by integrating prosodic and semantic information. Objective: The objective of the present study is to investigate the influence of semantic content on emotional prosody processing in PD. Methods: 10 PD patients (Hoehn and Yahr scale 1−2, tested on medication) and 10 matched healthy controls (HC) were included. Sentences differing in emotional prosody (positive, neutral, negative) and emotional semantic content (positive, neutral, negative) were presented in a 3×3 design via headphones. Participants had to make a prosodic judgment (irrespective of emotional semantic content) by pressing a button; the correct answer percentage was calculated. Results: Data reveal that PD patients make more errors when emotional prosody and emotional semantic content were incongruent. Interestingly,