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The cohort was split into a subset of 213 BSD\u2010PD patients, compared with 426 matched PD patients without BSDs, and a subset of 34 BSD\u2010PD and 79 PD patients carrying <jats:italic>GBA<\/jats:italic> or <jats:italic>PRKN<\/jats:italic> mutations. Carriers of mutations absent in BSD\u2010PD patients and of synuclein triplication were excluded. Structured clinical interviews and mood disorder questionnaires assessed BSDs. Linear mixed models evaluated the assessment scales over time. Thirteen BSD\u2010PD patients underwent subthalamic nucleus deep brain stimulation (STN\u2010DBS) and were compared with 27 matched STN\u2010DBS\u2010treated PD patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to PD patients, BSD\u2010PD showed (1) higher frequency of family history of PD (odds ratio [OR] 3.31; 2.32\u20134.71) and BSDs (OR 6.20; 4.11\u20139.35) 5); (2) higher incidence of impulse control disorders (hazard ratio [HR] 5.95, 3.89\u20139.09); (3) higher frequency of functional disorders occurring before PD therapy (HR, 5.67, 3.95\u20138.15); (4) earlier occurrence of delusions or mild dementia (HR, 7.70, 5.55\u201310.69; HR, 1.43, 1.16\u20131.75); and (5) earlier mortality (1.48; 1.11\u20131.97). Genetic BSD\u2010PD subjects exhibited clinical features indistinguishable from nongenetic BSD\u2010PD subjects. STN\u2010DBS\u2010treated BSD\u2010PD patients showed no improvements in quality of life compared to the control group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>BSDs as a prodrome to PD unfavorably shape their course and are associated with detrimental neuropsychiatric features and treatment outcomes. \u00a9 2021 The Authors. <jats:italic>Movement Disorders<\/jats:italic> published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society<\/jats:p><\/jats:sec>","DOI":"10.1002\/mds.28745","type":"journal-article","created":{"date-parts":[[2021,8,24]],"date-time":"2021-08-24T06:48:50Z","timestamp":1629787730000},"page":"2840-2852","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Preexisting Bipolar Disorder Influences the Subsequent Phenotype of Parkinson's Disease"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0480-2495","authenticated-orcid":false,"given":"Marco","family":"Onofrj","sequence":"first","affiliation":[{"name":"Department of Neuroscience, Imaging, and Clinical Sciences \"G. d'Annunzio\" University of Chieti\u2010Pescara  Chieti Italy"},{"name":"Center of Advanced Studies and Technology \"G. d'Annunzio\" University of Chieti\u2010Pescara  Chieti Italy"},{"name":"YDA Foundation Institute of Immune Therapy and Advanced Biological Treatments  Pescara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Di Iorio","sequence":"additional","affiliation":[{"name":"Department of Aging Sciences \"G. d'Annunzio\" University of Chieti\u2010Pescara  Chieti Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Carrarini","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Imaging, and Clinical Sciences \"G. d'Annunzio\" University of Chieti\u2010Pescara  Chieti Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirella","family":"Russo","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Imaging, and Clinical Sciences \"G. d'Annunzio\" University of Chieti\u2010Pescara  Chieti Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaella","family":"Franciotti","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Imaging, and Clinical Sciences \"G. d'Annunzio\" University of Chieti\u2010Pescara  Chieti Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3389-136X","authenticated-orcid":false,"given":"Alberto J.","family":"Espay","sequence":"additional","affiliation":[{"name":"Department of Neurology, James J. and Joan A. 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