Comparing Antipsychotic Medications in LBD Over Time
- Conditions
- Dementia With Lewy BodiesParkinson's Disease Psychosis
- Interventions
- Registration Number
- NCT05590637
- Brief Summary
The primary objective of this study is to determine whether treatment with pimavanserin or quetiapine is associated with a greater improvement in psychosis when used in a routine clinical setting to treat hallucinations and/or delusions due to Parkinson's disease (PD) or dementia with Lewy bodies (DLB) - collectively referred to as Lewy body disease (LBD).
- Detailed Description
Psychosis (hallucinations and delusions) is a common problem in Parkinson's disease (PD) and dementia with Lewy bodies (DLB). PD is a common neurodegenerative disorder that causes movement, cognitive, and psychiatric symptoms. DLB is a similar disorder, though causes more severe cognitive and psychiatric problems. Psychosis is highly prevalent among people with PD and DLB, often manifesting as visual hallucinations or paranoid delusions. Up to 60% of people with PD will experience psychosis over the course of their disease. Psychosis is associated with increased mortality, caregiver burden, and poorer quality of life.
More study is needed to determine the best way to treat psychosis in PD and DLB. Currently, both quetiapine and pimavanserin are used in clinical practice for psychosis in PD and DLB. However, few comparison studies have been done and it is unclear if one medication is superior to the other. This will be a clinical trial comparing quetiapine and pimavanserin among patients with psychosis due to PD or DLB requiring initiation of a medication. Patients will be randomized to quetiapine or pimavanserin and improvement in psychosis at 6 months will be compared between the groups.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 94
- Patients seen in the neurology clinic at UT Health San Antonio
- Diagnosed with psychosis due to PD or DLB
- Requiring initiation of an antipsychotic medication
- Clinical equipoise between quetiapine and pimavanserin must exist
- The prescribing provider must be comfortable prescribing and managing both quetiapine and pimavanserin
- Medical contraindication to either medication
- Caregiver unavailable to complete NPI-Q
- Currently taking an antipsychotic medication
- Prescribing provider unwilling to manage either medication
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description quetiapine Quetiapine Elderly patients with dementia-related psychosis will be treated with quetiapine, an atypical antipsychotic indicated for the treeatment of: schizophrenia, bipolar I manic episodes and bipolar depressive episodes. pimavanserin Pimavanserin Elderly patients with dementia-related psychosis will be treated with pimavanserin, an atypical antipsychotic indicated for treatment of hallucinations and delusions associated with Parkinson's disease.
- Primary Outcome Measures
Name Time Method Neuropsychiatry Inventory Questionnaire (NPI-Q), Hallucinations + Delusions (H+D) Baseline to 6 months Change in the Hallucinations + Delusions sub-score of the neuropsychiatric inventory questionnaire. Each NPI-Q item is scored by severity (1-3), and distress to caregiver (0-5), then added together (range 0-8) with a higher score indicating greater severity.
- Secondary Outcome Measures
Name Time Method Neuropsychiatry Inventory Questionnaire (NPI-Q) total score Baseline to 6 months Change in the total neuropsychiatric inventory questionnaire score, which includes 12 items, each scored from 0-8 with a higher score indicating more severe symptoms.
Neuropsychiatry Inventory Questionnaire (NPI-Q) (anxiety) Baseline to 6 months Change in the neuropsychiatric inventory questionnaire item for anxiety, scored from 0-8 with a higher score indicating more severe anxiety.
MDS-UPDRS part 3 Baseline to 6 months Unified Parkinson's Disease Rating Scale, motor score. The motor examination scale consists of 33 items graded 0-4 points with an overall possible score of 0-132 points. A higher score indicates a higher burden of motor symptoms.
Neuropsychiatry Inventory Questionnaire (NPI-Q) (agitation) Baseline to 6 months Change in the neuropsychiatric inventory questionnaire for agitation, scored from 0-8 with a higher score indicating more severe agitation.
Mortality 6 months Number of subjects who survived until the 6 month study assessment visit
Time to discontinuation of per-protocol medication Baseline to 6 months Will examine whether participants continued the chosen medication until study completion or if they either discontinued the study medication or added the other study medication.
Neuropsychiatry Inventory Questionnaire (NPI-Q) (nighttime behaviors) Baseline to 6 months Change in the neuropsychiatric inventory questionnaire for sleep disturbance, scored from 0-8 with a higher score indicating more severe sleep disturbances.
CGIC, PGIC, CGI-C:CVR Baseline to 6 months Clinician, patient, and caregiver global impressions of change. Each is a single item assessment rated from 1 (very much improved) to 7 (very much worse). A higher score indicates worsening symptoms.
Trial Locations
- Locations (2)
University Health System
🇺🇸San Antonio, Texas, United States
UT Health Science Center - San Antonio
🇺🇸San Antonio, Texas, United States