Summary: Study reveals patients with bipolar disorder have a significantly increased risk of developing Parkinson’s disease compared with the general population.

Source: JAMA

A new systematic review and meta-analysis combined the results of seven studies with 4.3 million participants to examine a potential association between bipolar disorder with a later diagnosis of Parkinson’s disease of unknown cause.

The findings suggest that a previous diagnosis of bipolar disorder was associated with an increased likelihood of a subsequent Parkinson’s disease diagnosis but subgroup analyses suggest the possibility of an overestimation of the magnitude of the associations.

The main limitation of the study is analysis that suggests a greater likelihood of a Parkinson’s disease diagnosis in shorter studies which raises concerns over misdiagnosis.

Source:
JAMA
Media Contacts:
Joaquim J. Ferreira – JAMA
Image Source:
The image is in the public domain.

Original Research: Open access
“Risk of Developing Parkinson Disease in Bipolar Disorder”. Joaquim J. Ferreira, M.D., Ph.D et al.
Neuron doi:10.1001/jamaneurol.2019.3446.

Abstract

Risk of Developing Parkinson Disease in Bipolar Disorder

Importance
Parkinson disease (PD) manifests by motor and nonmotor symptoms, which may be preceded by mood disorders by more than a decade. Bipolar disorder (BD) is characterized by cyclic episodes of depression and mania. It is also suggested that dopamine might be relevant in the pathophysiology of BD.

Objective
To assess the association of BD with a later diagnosis of idiopathic PD.

Data Sources
An electronic literature search was performed of Cochrane Controlled Register of Trials, MEDLINE, Embase, and PsycINFO from database inception to May 2019 using the terms Parkinson disease, bipolar disorder, and mania, with no constraints applied.

Study Selection
Studies that reported data on the likelihood of developing PD in BD vs non-BD populations were included. Two review authors independently conducted the study selection.

Data Extraction and Synthesis
Two review authors independently extracted study data. Data were pooled using a random-effects model, results were abstracted as odds ratios and 95% CIs, and heterogeneity was reported as I2.

Main Outcome and Measures
Odds ratios of PD.

Results
Seven studies were eligible for inclusion and included 4 374 211 participants overall. A previous diagnosis of BD increased the likelihood of a subsequent diagnosis of idiopathic PD (odds ratio, 3.35; 95% CI, 2.00-5.60; I2 = 92%). A sensitivity analysis was performed by removing the studies that had a high risk of bias and also showed an increased risk of PD in people with BD (odds ratio, 3.21; 95% CI, 1.89-5.45; I2 = 94%). Preplanned subgroup analyses according to study design and diagnostic certainty failed to show a significant effect.

Conclusions and Relevance
This review suggests that patients with BD have a significantly increased risk of developing PD compared with the general population. Subgroup analyses suggested a possible overestimation in the magnitude of the associations. These findings highlight the probability that BD may be associated with a later development of PD and the importance of the differential diagnosis of parkinsonism features in people with BD.