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Abstract
Résumé:Objective:La fréquence de la dépression au cours de la maladie de Parkinson (MP) conduit à s’interroger sur les difficultés du diagnostic et sur les liens entre la dépression et l’histoire naturelle de la maladie.Méthodes:Une série consécutive de 135 sujets atteints d’une MPidiopathique a été examinée sur le plan psychiatrique (DSM-III-R, échelle de dépression de Goldberg), neurologique (en distinguant les signes “axiaux” des autres signes parkinsoniens), neuropsychologique ( et en particulier tests frontaux).Résultats:Plus de la moitié des sujets ont une dépression qui apparaît plus fréquente dans les formes akinétiques et les formes fluctuantes de la maladie. Les sujets déprimés n’ont pas de déficit cognitif plus marqué mais leurs scores aux tests frontaux sont plus élevés. En outre les signes axiaux de la maladie (instabilité posturale, rigidité axiale) sont plus marqués chez les parkinsoniens déprimés, suggérant un lien entre la dépression et les lésions non dopaminergiques de la maladie. Alors que le ralentissement, les troubles de l’appétit et du sommeil, la fatigue peuvent être observés même chez des parkinsoniens non dépressifs, la séparation de la population parkinsonienne en plusieurs groupes montre que certains symptômes ne sont jamais rencontrés chez les parkinsoniens non dépressifs: il en est ainsi apparu que “l’impression que la vie ne vaut pas la peine d’être vécue”, “la perte d’espoir pour l’avenir”, “l’impression de ne pas être à la hauteur, de ne rien faire de bien”, “la baisse d’énergie”, “la tristesse matinale” caractérisent la dépression parkinsonienne. La dépression parkinsonienne revêt deux grandes formes cliniques. La première est la plus riche en manifestations somatiques: troubles du sommeil, fatigue matinale; elle correspond aux dépressions les plus sévères avec une absence d’espoir pour l’avenir , une perte de confiance en soi. La seconde est pauvre en manifestations somatiques alors que l’apathie y est très fréquente ainsi que le ralentissement.Conclusions:Cette étude permet ainsi de préciser les symptômes de la dépression parkinsonienne qui doit être mieux reconnue pour être plus souvent traitée. Les liens entre la dépression et les signes axiaux de la maladie expliquent sans doute pourquoi la L-dopa et les agonistes dopaminergiques améliorent les signes moteurs de la dépression sans agir le plus souvent sur les manifestations dépressives.
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Lopez FV, Ferencz B, Rohl BY, Trifilio E, Scott B, Okun MS, Marsiske M, Bowers D. Everyday functioning in Parkinson's disease: Evidence from the Revised-Observed Tasks of Daily Living (OTDL-R). Parkinsonism Relat Disord 2018; 60:167-170. [PMID: 30190102 DOI: 10.1016/j.parkreldis.2018.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/26/2018] [Accepted: 08/31/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Performance tasks are presumed to have greater validity than rating scales in assessing day-to-day behaviors in Parkinson's disease (PD). One such task is the revised Observed Tasks of Daily Living (OTDL-R), which has been used extensively in healthy older adults, and but not yet empirically examined in PD. Thus, the aims of the current study were to examine and determine the impact of cognitive, motor, and mood symptoms on OTDL-R performance in PD. METHOD Nineteen non-demented PD patients and 18 healthy older adults (HC) were administered measures of mood and cognitive functioning, and the OTDL-R (subtests include medication and telephone use, and medication management). Clinical severity of PD was assessed using the H&Y stage, UPDRS, and Schwab and England functional disability scores. RESULTS Mann Whitney U tests indicated the PD patients were significantly slower to complete the OTDL-R and performed worse on only the telephone use subtest, relative to the HC group. In the PD group, hierarchical regression analyses revealed memory, attention, and initiative/perseveration were uniquely associated with the financial management subtest, after controlling for motor severity (ps < .05). No other significant relationships were found. CONCLUSIONS PD patients were slower to complete the OTDL-R, but only less accurate on the telephone use subtest. Poor performance on the telephone use subtest may be related to motor severity, while poor performance on the financial management subtest was related to attention and working memory. Overall, the findings warrant future investigation to determine the validity and reliability of the OTDL-R in PD.
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Affiliation(s)
- Francesca V Lopez
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Beata Ferencz
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Brittany Y Rohl
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Erin Trifilio
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Bonnie Scott
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; Department of Neurology and Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; Department of Neurology and Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, USA.
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Dobkin RD, Interian A, Durland JL, Gara MA, Menza MA. Personalized Telemedicine for Depression in Parkinson's Disease: A Pilot Trial. J Geriatr Psychiatry Neurol 2018; 31:171-176. [PMID: 29945467 DOI: 10.1177/0891988718783274] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
High rates of depression are observed in Parkinson's disease, and limited access to care complicates management. The purpose of this pilot project was to evaluate the feasibility and impact of a personalized cognitive-behavioral telemedicine program for depression in Parkinson's disease (dPD). Thirty-four individuals with dPD and their carepartners participated in this pilot study. A 10-module self-help workbook, tailored to the unique needs of the dPD population, was created to be used as either a stand-alone intervention, with minimal therapist support, or a supplement to formal telephone-administered cognitive-behavioral therapy sessions. Improvements in depression, anxiety, quality of life, sleep, negative thoughts, and caregiver burden were observed over the course of the 4-month study, independent of treatment modality (guided self-help vs formal telephone-based psychotherapy). Future research will utilize randomized controlled designs and continue to focus on delivery models that can improve access to this and other evidence-based mental health interventions for dPD.
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Affiliation(s)
- Roseanne D Dobkin
- 1 Department of Psychiatry, RUTGERS, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Alejandro Interian
- 2 VA NJ Healthcare System-Lyons Campus, Mental Health and Behavioral Sciences, Lyons, NJ, USA
| | - John Logan Durland
- 1 Department of Psychiatry, RUTGERS, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Michael A Gara
- 1 Department of Psychiatry, RUTGERS, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Matthew A Menza
- 1 Department of Psychiatry, RUTGERS, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Mills KA, Greene MC, Dezube R, Goodson C, Karmarkar T, Pontone GM. Efficacy and tolerability of antidepressants in Parkinson's disease: A systematic review and network meta-analysis. Int J Geriatr Psychiatry 2018; 33:642-651. [PMID: 29235150 PMCID: PMC5992618 DOI: 10.1002/gps.4834] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 11/09/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To systematically review and analyze the efficacy and tolerability of different antidepressant pharmacologic treatments for depressive symptoms in Parkinson's disease (PD) METHODS: We searched PubMed, EMBASE, Cochrane database (CENTRAL), clinicaltrials.gov, and bibliographies for randomized controlled trials investigating the efficacy of antidepressant medications versus a non-treatment, placebo, or active treatment groups for depressive symptoms in PD. Twenty of 3191 retrieved studies (1893 patients) were included, but not all could be meta-analyzed. We used a random-effects model meta-analysis to compare depression scores between an active drug and placebo or control group then used a network meta-analysis to compare the effectiveness of different antidepressant classes. The primary outcome was the efficacy of different classes of antidepressant medications in PD patients with depressive symptoms, measured by standardized mean difference (SMD) in depression score from baseline compared with control. RESULTS Pairwise meta-analysis suggested that type B-selective monoamine oxidase inhibitors (SMD = -1.28, CI = -1.68, -0.88), selective serotonin reuptake inhibitors (SMD = -0.49, CI = -0.93, -0.05), and tricyclics (SMD = -0.83, CI = -1.53, -0.13) are effective antidepressants in PD. Network meta-analysis showed that monoamine oxidase inhibitors had the largest effect on depression in PD (SMD (vs selective serotonin reuptake inhibitors) = -0.78, CI = -1.55, -0.01), but these might not be considered traditional antidepressants given their type B selectivity. CONCLUSIONS Although limited by few data, this review suggests that multiple antidepressant classes are potentially efficacious in the treatment of depression in PD, but that further comparative efficacy and tolerability research is needed.
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Affiliation(s)
- Kelly A Mills
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M Claire Greene
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca Dezube
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carrie Goodson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taruja Karmarkar
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Ye BS, Jeon S, Yoon S, Kang SW, Baik K, Lee Y, Chung SJ, Oh JS, Moon H, Kim JS, Lee PH, Sohn YH. Effects of dopaminergic depletion and brain atrophy on neuropsychiatric symptoms in de novo Parkinson's disease. J Neurol Neurosurg Psychiatry 2018; 89:197-204. [PMID: 28951497 DOI: 10.1136/jnnp-2017-316075] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 09/03/2017] [Accepted: 09/11/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms impact the patients' quality of life and caregivers' burdens in Parkinson's disease (PD). We aimed to investigate the effects of striatal dopaminergic depletion and brain atrophy on the neuropsychiatric symptoms of patients with PD. METHODS Two hundred and seven patients with de novo drug-naïve PD underwent dopamine transporter (DAT) positron emission tomography and brain MRI scanning. In addition, the patients were assessed with caregiver-administered neuropsychiatric inventory (NPI) questionnaires. To evaluate the effects of DAT uptake, subcortical volume and cortical thinning on the patients' neuropsychiatric symptoms, we performed logistic regression and negative binomial regression analyses on the NPI data after controlling for possible confounders. RESULTS Frontal cortical thinning was associated with the presence of nighttime behaviour and irritability, and the thinning correlated with the severity of the nighttime behaviour. Temporal cortical thinning was associated with the presence of aggression/agitation, and it correlated with the severity of the aggression/agitation. Subcortical atrophy in the accumbens was associated with the presence of disinhibition and correlated with the severity of the disinhibition. Putamen atrophy and insular thinning were independently associated with the presence of apathy, but only insular thinning correlated with the severity of the apathy. Of the predictors, only frontal cortical thinning correlated with the total NPI score. CONCLUSIONS The results of this study suggested that accumbens atrophy and frontotemporal cortical thinning, especially frontal cortical thinning, independently contributed to neuropsychiatric symptoms in patients with PD, while DAT uptake did not affect the neuropsychiatric symptoms.
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Affiliation(s)
- Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seun Jeon
- McGill Center for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Sohoon Yoon
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Woo Kang
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - KyoungWon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoonju Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jungsu S Oh
- Department of Nuclear Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hyojeong Moon
- Department of Nuclear Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Ho Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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Seubert-Ravelo AN, Yáñez-Téllez MG, Salgado-Ceballos H, Escartín-Pérez RE, Neri-Nani GA, Velázquez-Osuna S. Mild Cognitive Impairment in Patients with Early-Onset Parkinson's Disease. Dement Geriatr Cogn Disord 2018; 42:17-30. [PMID: 27467581 DOI: 10.1159/000447533] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Few studies have described mild cognitive impairment (MCI) and cognitive characteristics in early-onset Parkinson's disease (EOPD). This study describes attention/working memory, language, memory, visuospatial abilities, executive function, and frequency of MCI and dementia in EOPD. METHODS Eighty-one EOPD patients were administered neuropsychological tests and the Beck Depression Inventory. Scores were compared with age/education-appropriate norms and were correlated to years of disease progression and severity of motor symptoms. The frequency of MCI and dementia was determined by the Movement Disorder Society criteria. RESULTS Thirty-one percent of patients met the MCI criteria, but none had dementia. Commonly affected domains were memory, visuospatial, and executive function. Cognitive dysfunction was not explained by depression or severity of motor symptoms. CONCLUSION One third of EOPD patients presented with MCI, which was not associated with the same risk factors as reported in late-onset Parkinson's disease. MCI could have a different prognostic value in EOPD.
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Affiliation(s)
- Ana Natalia Seubert-Ravelo
- Interdisciplinary Investigation Unit in Health and Education Sciences, Master in Psychology, Clinical Neuropsychology Residency Program, FES Iztacala, Universidad Nacional Autónoma de México, Mexico City, Mexico
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The interplay between inflammation, oxidative stress, DNA damage, DNA repair and mitochondrial dysfunction in depression. Prog Neuropsychopharmacol Biol Psychiatry 2018; 80:309-321. [PMID: 28669580 DOI: 10.1016/j.pnpbp.2017.06.036] [Citation(s) in RCA: 188] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/05/2017] [Accepted: 06/29/2017] [Indexed: 12/13/2022]
Abstract
A growing body of evidence suggests that inflammation, mitochondrial dysfunction and oxidant-antioxidant imbalance may play a significant role in the development and progression of depression. Elevated levels of reactive oxygen and nitrogen species - a result of oxidant-antioxidant imbalance - may lead to increased damage of biomolecules, including DNA. This was confirmed in depressed patients in a research study conducted by our team and other scientists. 8-oxoguanine - a marker of oxidative DNA damage - was found in the patients' lymphocytes, urine and serum. These results were confirmed using a comet assay on lymphocytes. Furthermore, it was shown that the patients' cells repaired peroxide-induced DNA damage less efficiently than controls' cells and that some single nucleotide polymorphisms (SNP) of the genes involved in oxidative DNA damage repair may modulate the risk of depression. Lastly, less efficient DNA damage repair observed in the patients can be, at least partly, attributed to the presence of specific SNP variants, as it was revealed through a genotype-phenotype analysis. In conclusion, the available literature shows that both oxidative stress and less efficient DNA damage repair may lead to increased DNA damage in depressed patients. A similar mechanism may result in mitochondrial dysfunction, which is observed in depression.
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Fields JA. Cognitive and Neuropsychiatric Features in Parkinson's and Lewy Body Dementias. Arch Clin Neuropsychol 2017; 32:786-801. [DOI: 10.1093/arclin/acx085] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/30/2017] [Indexed: 01/11/2023] Open
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Rutten S, Vriend C, van der Werf YD, Berendse HW, Weintraub D, van den Heuvel OA. The bidirectional longitudinal relationship between insomnia, depression and anxiety in patients with early-stage, medication-naïve Parkinson's disease. Parkinsonism Relat Disord 2017; 39:31-36. [PMID: 28365203 PMCID: PMC5441947 DOI: 10.1016/j.parkreldis.2017.01.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 12/24/2016] [Accepted: 01/29/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION While anxiety, depression and insomnia frequently (co-)occur in Parkinson's disease (PD) patients, little is known about their temporal relationship. In this study, we tested two hypotheses: i) insomnia predicts an increase in symptoms of depression or anxiety and ii) anxiety or depression at baseline predicts insomnia in PD patients six months later. METHODS We used longitudinal data from a prospective cohort study of early-stage, medication-naïve PD patients. Primary outcome measures were: anxiety symptoms, measured with the State-Trait Anxiety Inventory (STAI); depressive symptoms, measured with the 15-item Geriatric Depression Scale (GDS-15); and insomnia, defined as a score ≥ 2 on item 1.7 of the Movement Disorder Society - Unified Parkinson's Disease Rating Scale. We performed linear and logistic regression analyses, correcting for baseline value of the respective outcome variable. RESULTS Baseline insomnia was not associated with GDS-15 or STAI total score at follow-up. In a post hoc analysis, we found that insomnia predicted a higher STAI State score (B(SE) = 2.50 (1.07), p < 0.05), while the association with the STAI Trait score was not significant. Baseline STAI scores (B(SE) = 0.02 (0.01), p = 0.001) and GDS-15 score (B(SE) = 0.15 (0.05), p < 0.001) were significantly associated with insomnia at follow-up. CONCLUSION Symptoms of anxiety and depression may constitute a risk factor for insomnia in PD. The relationship between insomnia and anxiety is bidirectional, which suggests that both anxiety and sleep disorders can start a negative spiral in PD patients, where one enhances the other. Independent clinical attention for these symptoms in PD patients is therefore warranted.
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Affiliation(s)
- Sonja Rutten
- Department of Psychiatry, VU University Medical Center (VUmc), The Netherlands; Department of Anatomy & Neurosciences, VUmc, The Netherlands.
| | - Chris Vriend
- Department of Psychiatry, VU University Medical Center (VUmc), The Netherlands; Department of Anatomy & Neurosciences, VUmc, The Netherlands; Amsterdam Neuroscience, Amsterdam, The Netherlands; Department of Neurology, VUmc, The Netherlands
| | - Ysbrand D van der Werf
- Department of Anatomy & Neurosciences, VUmc, The Netherlands; Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Henk W Berendse
- Amsterdam Neuroscience, Amsterdam, The Netherlands; Department of Neurology, VUmc, The Netherlands
| | - Daniel Weintraub
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, United States
| | - Odile A van den Heuvel
- Department of Psychiatry, VU University Medical Center (VUmc), The Netherlands; Department of Anatomy & Neurosciences, VUmc, The Netherlands; Amsterdam Neuroscience, Amsterdam, The Netherlands
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Starkstein SE, Brockman S. Management of Depression in Parkinson's Disease: A Systematic Review. Mov Disord Clin Pract 2017; 4:470-477. [PMID: 30363415 DOI: 10.1002/mdc3.12507] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/18/2017] [Accepted: 04/22/2017] [Indexed: 12/19/2022] Open
Abstract
Background Depression is a frequent psychiatric condition in Parkinson's disease (PD). The treatment of depression has been examined in several randomized controlled trials and meta-analyses, but no clear guidelines are available. Methods We carried out a systematic review of pharmacological and non-pharmacological treatments for depression in patients with PD using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched main medical databases up to December 12, 2016, and included randomized controlled trials, patient-control studies, and case series with data on treatment modality, outcome measures, and side effects. Results Selective serotonergic reuptake inhibitors and tricyclic antidepressants may have efficacy for the treatment of depression in patients with PD, although the evidence is not strong. The antidepressant efficacy of dopamine agonists is still controversial, and initial results were positive for pramipexole but not for rotigotine. Cognitive-behavioral therapy showed promising results in two recent randomized controlled trials, but further evidence is required. Studies using repetitive transcranial magnetic stimulation produced conflicting results, and the efficacy results for this treatment have been inconsistent. On the other hand, electroconclusive therapy produced strong positive results in patients with severe depression, but no randomized controlled trials are available. Conclusion Selective serotonergic reuptake inhibitors and cognitive-behavioral therapy are currently first-line treatments for depression in patients with PD, although the evidence is still weak. The heterogeneity among contributory factors for depression in PD should be considered for the most effective treatment of depression in this condition.
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Affiliation(s)
- Sergio E Starkstein
- Department of Psychiatry University of Western Australia Fremantle Hospital Perth Western Australia Australia
| | - Simone Brockman
- Department of Psychiatry University of Western Australia Fremantle Hospital Perth Western Australia Australia
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Reynolds GO, Hanna KK, Neargarder S, Cronin-Golomb A. The relation of anxiety and cognition in Parkinson's disease. Neuropsychology 2017; 31:596-604. [PMID: 28425730 DOI: 10.1037/neu0000353] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Parkinson's disease (PD) has long been conceptualized as a motor disorder, but nonmotor symptoms also manifest in the disease and significantly reduce quality of life. Anxiety and cognitive dysfunction are prevalent nonmotor symptoms, even in early disease stages, but the relation between these symptoms remains poorly understood. We examined self-reported anxiety and neurocognitive function, indexed by measures of executive function (set-shifting and phonemic fluency), categorical fluency, and attention/working memory. We hypothesized that anxiety would correlate with cognitive performance. METHOD The Beck Anxiety Inventory and cognitive tests (Trail Making, Verbal Fluency, Digit Span) were administered to 77 nondemented adults with mild to moderate idiopathic PD (39 men, 38 women; Mage = 62.9 years). RESULTS Higher anxiety was associated with more advanced disease stage and severity and with poorer set-shifting when using a derived metric to account for motoric slowing. Depression correlated with greater anxiety and disease severity, but not with cognitive performance. CONCLUSIONS Our findings support the association of anxiety with a specific domain of executive function, set-shifting, in nondemented individuals with mild to moderate PD, raising the possibility that treatment of anxiety may alleviate aspects of executive dysfunction in this population. (PsycINFO Database Record
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Affiliation(s)
| | - Kristine K Hanna
- Department of Psychological and Brain Sciences, Boston University
| | - Sandy Neargarder
- Department of Psychological and Brain Sciences, Boston University
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Schrag A, Taddei RN. Depression and Anxiety in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:623-655. [DOI: 10.1016/bs.irn.2017.05.024] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Szatmari S, Illigens BMW, Siepmann T, Pinter A, Takats A, Bereczki D. Neuropsychiatric symptoms in untreated Parkinson's disease. Neuropsychiatr Dis Treat 2017; 13:815-826. [PMID: 28352181 PMCID: PMC5360401 DOI: 10.2147/ndt.s130997] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Neuropsychiatric and cognitive symptoms are common in Parkinson's disease (PD) and may precede and exceed motor symptoms as major factors impacting disease course and quality of life. Neuropsychiatric symptoms (NPS) in PD are various and are attributed to pathologic changes within multiple brain regions, to psychological stress, and to adverse effects of dopamine replacement therapy. Sleep disorders and mood symptoms such as apathy, depression, and anxiety may antedate the development of motor symptoms by years, while other NPS such as impulse control disorders, psychosis, and cognitive impairment are more common in later stages of the disease. Few studies report on NPS in the early, untreated phase of PD. We reviewed the current literature on NPS in PD with a focus on the early, drug-naive stages of PD. Among these early disease stages, premotor and early motor phases were separately addressed in our review, highlighting the underlying pathophysiological mechanisms as well as epidemiological characteristics, clinical features, risk factors, and available techniques of clinical assessment.
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Affiliation(s)
- Szabolcs Szatmari
- Department of Neurology, Sibiu County Emergency Hospital, Sibiu; 2nd Department of Neurology, Targu Mures Emergency Clinical County Hospital, Targu Mures, Romania; János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
| | - Ben Min-Woo Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Timo Siepmann
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University; Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Alexandra Pinter
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University; Department of Family Medicine
| | - Annamaria Takats
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
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Mendes A, Gonçalves A, Vila-Chã N, Calejo M, Moreira I, Fernandes J, Damásio J, Teixeira-Pinto A, Krack P, Lima AB, Cavaco S. Statistical Models of Parkinson’s Disease Progression: Predictive Validity in a 3-Year Follow-up. JOURNAL OF PARKINSONS DISEASE 2016; 6:793-804. [DOI: 10.3233/jpd-160877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Alexandre Mendes
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Alexandra Gonçalves
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Nuno Vila-Chã
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Margarida Calejo
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Inês Moreira
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Joana Fernandes
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Joana Damásio
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Armando Teixeira-Pinto
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- CINTESIS, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Paul Krack
- Department of Clinical Neurosciences, Clinic of Neurology, Geneva University Hospital, Geneva, Switzerland
- Department of Basic Neurosciences, Medical Faculty, University of Geneva, Geneva, Switzerland
| | | | - Sara Cavaco
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Bega D, Kim S, Zhang Y, Elm J, Schneider J, Hauser R, Fraser A, Simuni T. Predictors of Functional Decline in Early Parkinson's Disease: NET-PD LS1 Cohort. JOURNAL OF PARKINSONS DISEASE 2016; 5:773-82. [PMID: 26639661 DOI: 10.3233/jpd-150668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Data on predictors of decline in PD are largely based on de-novo populations and limited to the use of motor outcomes that fail to capture the full scope of disease. OBJECTIVE Determine the clinical predictors of decline in early treated PD using a novel multi-domain measure. METHODS Data from NINDS Exploratory Trials in PD Long-Term Study 1 (NET-PD LS1), a multicenter Phase 3 study of creatine in early treated PD, were analyzed. Functional decline was defined by a global outcome metric (GO) that consisted of: Schwab and England ADL scale, PD 39-item Questionnaire, Unified PD Rating Scale, Ambulatory Capacity Score, Symbol Digit Modalities Test, and Modified Rankin Scale. Univariate and multivariate models were used to test the association of predictors of interest with a standardized rank-sum of the GO. RESULTS 765 of 1741 participants completed five-year assessments and were included. Older age at disease onset (p < 0.0001), higher baseline levodopa equivalent dose (p = 0.01), and worse Scales for Outcomes of Parkinson's Disease Cognition score (p = 0.001) at baseline were the strongest predictors of functional decline in multivariate analysis. PD symptom subtype was not a significant predictor of outcome (p = 0.42). The full model was only a modest predictor of change in GO (R2 = 0.186). CONCLUSIONS This is the largest study to systematically assess predictors of functional decline in early treated PD over several years, and the first to use a multi-domain outcome measure of decline. Older age at disease onset and worse cognition, and not PD subtype, were predictors of decline.
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Affiliation(s)
- Danny Bega
- Northwestern University, Chicago, IL, USA
| | - Soeun Kim
- University of Texas Health Science Center, Houston, TX, USA
| | - Yunxi Zhang
- University of Texas Health Science Center, Houston, TX, USA
| | - Jordan Elm
- Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Andy Fraser
- Oregon Health Sciences University, Portland, OR, USA
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Egan SJ, Laidlaw K, Starkstein S. Cognitive Behaviour Therapy for Depression and Anxiety in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2016; 5:443-51. [PMID: 26406124 PMCID: PMC4923758 DOI: 10.3233/jpd-150542] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Evidence is reviewed demonstrating that cognitive behavior therapy (CBT) is effective in the treatment of depression and anxiety in Parkinson’s disease. The aims were to review the extant literature, specify a model of cognitive and behavioral maintenance factors in depression and anxiety in Parkinson’s disease and provide a guide to treatment. It is argued that treatment should take into account specific cognitive and behavioral maintaining factors. Symptoms of depression and anxiety are highly prevalent in Parkinson’s disease and therapists should consider how to augment the efficacy of CBT for patients with Parkinson’s disease. Cognitive and behavioral interventions can help people overcome some of the challenges in living with PD by maximizing wellbeing and overall quality of life.
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Affiliation(s)
- Sarah J Egan
- School of Psychology and Speech Pathology, Curtin University, WA, Australia
| | - Ken Laidlaw
- Department of Clinical Psychology, The University of East Anglia, Norfolk, UK
| | - Sergio Starkstein
- School of Psychiatry, University of Western Australia, Crawley WA, Australia
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Pontone GM, Bakker CC, Chen S, Mari Z, Marsh L, Rabins PV, Williams JR, Bassett SS. The longitudinal impact of depression on disability in Parkinson disease. Int J Geriatr Psychiatry 2016; 31:458-65. [PMID: 26284815 PMCID: PMC6445642 DOI: 10.1002/gps.4350] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Depression in Parkinson disease (PD) is a common problem that worsens quality of life and causes disability. However, little is known about the longitudinal impact of depression on disability in PD. This study examined the association between disability and DSM-IV-TR depression status across six years. METHODS Longitudinal cohort study with assessments at study entry, year two, four, and six conducted in the Morris K. Udall Parkinson Disease Research Center. Recruitment totaled 137 adult men and women with idiopathic PD in which up to six years of data on demographic, motor, and non-motor variables was collected. Movement disorder specialists used the structured interview for DSM-IV-TR depressive disorders and the Northwestern Disability Scale to assess depression and disability. A generalized linear mixed model was fitted with Northwestern Disability Scale score as the dependent variable to determine the effect of baseline depression status on disability. RESULTS A total of 43 participants were depressed at baseline compared to 94 without depression. Depressed participants were more likely to be female, were less educated, were less likely to take dopamine agonists, and more likely to have motor fluctuations. Controlling for these variables, symptomatic depression predicted greater disability compared to both never depressed (p = 0.0133) and remitted depression (p = 0.0009). Disability associated with symptomatic depression at baseline was greater over the entire six-year period compared to participants with remitted depressive episodes or who were never depressed. CONCLUSIONS Persisting depression is associated with a long-term adverse impact on daily functioning in PD. Adequate treatment or spontaneous remission of depression improves ADL function.
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Affiliation(s)
- Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA,The Morris K. Udall Parkinson’s Disease Research Center of Excellence, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Catherine C Bakker
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA,The Morris K. Udall Parkinson’s Disease Research Center of Excellence, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shaojie Chen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Zoltan Mari
- The Morris K. Udall Parkinson’s Disease Research Center of Excellence, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura Marsh
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA,The Morris K. Udall Parkinson’s Disease Research Center of Excellence, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Departments of Psychiatry and Neurology, Baylor College of Medicine, Houston, TX, USA (current affiliation),Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA (current affiliation)
| | - Peter V Rabins
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James R Williams
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Biogen Idec. (current affiliation)
| | - Susan S Bassett
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA,The Morris K. Udall Parkinson’s Disease Research Center of Excellence, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Pineau F, Roze E, Lacomblez L, Bonnet AM, Vidailhet M, Czernecki V, Corvol JC. Executive functioning and risk-taking behavior in Parkinson's disease patients with impulse control disorders. J Neural Transm (Vienna) 2016; 123:573-81. [PMID: 27085342 DOI: 10.1007/s00702-016-1549-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 04/04/2016] [Indexed: 12/19/2022]
Abstract
Impulse control disorders (ICD) are common in Parkinson's disease (PD) and are associated with dopaminergic medication. The purpose of this study was to investigate executive function and risk-taking behavior in PD patients with ICD. 17 PD patients with ICD (ICD-PD) were compared to 20 PD patients without ICD (CTRL-PD) using neuropsychological and experimental tasks. Executive functions were assessed using standard executive testing (Conner's Performance Test, Modified Wisconsin Card Sorting Test, Trail Making Test and phonological verbal fluency). Subjects were also submitted to an experimental gambling task consisted of three decks of money cards: neutral deck (equal opportunity for gains as losses), winning deck (small amount of money with a positive balance) and loser deck (high amount of money with a negative balance), evaluating risk-taking behavior (number of cards picked in each deck) and valuation of the reward (subjective appreciation of the value of each deck). There was no significant difference in executive functioning between groups. Both groups selected more cards in the losing deck (high amount of money) as compared to the neutral deck (Mann-Whitney test, ICD-PD, p = 0.02; CTRL-PD, p = 0.003) and to the winning deck (Mann-Whitney test, ICD-PD p = 0.0001; CTRL-PD p = 0.003), suggesting an increased risk-taking behavior. Interestingly, we found that ICD-PD patients estimated the value of decks differently from CTRL-PD patients, taking into account mainly the positive reinforced value of the decks (Mann-Whitney test, p = 0.04). This study showed that executive pattern and risk-taking behavior are similar between ICD-PD and CTRL-PD patients. However, ICD-PD patients showed a specific deficit of the subjective estimation of the reward. Links between this deficit and metacognitive skills are discussed.
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Affiliation(s)
- Fanny Pineau
- Département des Maladies du Système Nerveux, Sorbonne Universités, UPMC Univ Paris 06, and INSERM UMRS_1127 and CIC_1422, and CNRS UMR_7225, and AP-HP, and ICM, Hôpital Pitié-Salpêtrière, 75013, Paris, France.
- Service de Neurologie, Hôpitaux Civils de Colmar, Bâtiment 59, 39 Avenue de la Liberté, 68000, Colmar, France.
| | - Emmanuel Roze
- Département des Maladies du Système Nerveux, Sorbonne Universités, UPMC Univ Paris 06, and INSERM UMRS_1127 and CIC_1422, and CNRS UMR_7225, and AP-HP, and ICM, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Lucette Lacomblez
- Département des Maladies du Système Nerveux, Sorbonne Universités, UPMC Univ Paris 06, and INSERM UMRS_1146 and CIC_1422, and AP-HP, and ICM, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Anne-Marie Bonnet
- Département des Maladies du Système Nerveux, Sorbonne Universités, UPMC Univ Paris 06, and INSERM UMRS_1127 and CIC_1422, and CNRS UMR_7225, and AP-HP, and ICM, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Marie Vidailhet
- Département des Maladies du Système Nerveux, Sorbonne Universités, UPMC Univ Paris 06, and INSERM UMRS_1127 and CIC_1422, and CNRS UMR_7225, and AP-HP, and ICM, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Virginie Czernecki
- Département des Maladies du Système Nerveux, Sorbonne Universités, UPMC Univ Paris 06, INSERM UMRS_975, and AP-HP, and ICM, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Jean-Christophe Corvol
- Département des Maladies du Système Nerveux, Sorbonne Universités, UPMC Univ Paris 06, and INSERM UMRS_1127 and CIC_1422, and CNRS UMR_7225, and AP-HP, and ICM, Hôpital Pitié-Salpêtrière, 75013, Paris, France
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Landau S, Harris V, Burn DJ, Hindle JV, Hurt CS, Samuel M, Wilson KC, Brown RG. Anxiety and anxious-depression in Parkinson's disease over a 4-year period: a latent transition analysis. Psychol Med 2016; 46:657-667. [PMID: 26492977 PMCID: PMC4697304 DOI: 10.1017/s0033291715002196] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 08/27/2015] [Accepted: 09/21/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Depression and anxiety in Parkinson's disease are common and frequently co-morbid, with significant impact on health outcome. Nevertheless, management is complex and often suboptimal. The existence of clinical subtypes would support stratified approaches in both research and treatment. METHOD Five hundred and thirteen patients with Parkinson's disease were assessed annually for up to 4 years. Latent transition analysis (LTA) was used to identify classes that may conform to clinically meaningful subgroups, transitions between those classes over time, and baseline clinical and demographic features that predict common trajectories. RESULTS In total, 64.1% of the sample remained in the study at year 4. LTA identified four classes, a 'Psychologically healthy' class (approximately 50%), and three classes associated with psychological distress: one with moderate anxiety alone (approximately 20%), and two with moderate levels of depression plus moderate or severe anxiety. Class membership tended to be stable across years, with only about 15% of individuals transitioning between the healthy class and one of the distress classes. Stable distress was predicted by higher baseline depression and psychiatric history and younger age of onset of Parkinson's disease. Those with younger age of onset were also more likely to become distressed over the course of the study. CONCLUSIONS Psychopathology was characterized by relatively stable anxiety or anxious-depression over the 4-year period. Anxiety, with or without depression, appears to be the prominent psychopathological phenotype in Parkinson's disease suggesting a pressing need to understanding its mechanisms and improve management.
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Affiliation(s)
- S. Landau
- Department of Biostatistics,
Institute of Psychiatry, Psychology and
Neuroscience, King's College London,
UK
| | - V. Harris
- Department of Biostatistics,
Institute of Psychiatry, Psychology and
Neuroscience, King's College London,
UK
| | - D. J. Burn
- Institute of Neuroscience,
Newcastle University, Newcastle upon
Tyne, UK
| | - J. V. Hindle
- Betsi Cadwaladr University Health
Board, Department of Care of the Elderly,
Llandudno, UK
- University of Bangor,
North Wales Organisation for Randomised Trials in Health (NWORTH),
UK
| | - C. S. Hurt
- School of Health Sciences,
City University London, London,
UK
| | - M. Samuel
- Department of Neurology,
King's College Hospital, King's Health
Partners, London, UK
- East Kent Hospitals NHS University Foundation
Trust, Ashford, Kent,
UK
| | - K. C. Wilson
- EMI Academic Unit,
University of Liverpool, St Catherine's
Hospital, Wirral, UK
| | - R. G. Brown
- Department of Psychology,
Institute of Psychiatry, Psychology and
Neuroscience, King's College London,
UK
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70
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Gene expression profiling predicts pathways and genes associated with Parkinson’s disease. Neurol Sci 2015; 37:73-79. [DOI: 10.1007/s10072-015-2360-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 08/04/2015] [Indexed: 12/25/2022]
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71
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Bega D, Luo S, Fernandez H, Chou K, Aminoff M, Parashos S, Walker H, Russell DS, Christine CW, Dhall R, Singer C, Bodis-Wollner I, Hamill R, Truong D, Mari Z, Glazmann S, Huang M, Houston E, Simuni T. Impact of Depression on Progression of Impairment and Disability in Early Parkinson's Disease. Mov Disord Clin Pract 2015; 2:371-378. [PMID: 28393083 DOI: 10.1002/mdc3.12205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Depression is one of the most common nonmotor symptoms associated with Parkinson's disease (PD), yet the impact of depression on progression of disease is unclear. OBJECTIVE The aim of this study was to prospectively characterize the relationship between depressive symptoms and measures of disease progression in a large sample of patients with early, medically treated PD. METHODS Baseline and longitudinal Beck Depression Inventory (BDI) scores from participants in the NINDS Exploratory Trials in PD Long Term Study 1 were correlated with changes in multiple measures of disease severity over 5 years. Multivariate analysis of predictors of change in BDI was performed. RESULTS Of 1,741 participants, 746 completed 5-year assessments and were included. Mean age was 62.00 years (standard deviation [SD]: 9.22) and mean disease duration was 1.69 years (SD, 1.16). Mean BDI score was 6.24 (SD, 5.02) at baseline and 8.57 (SD, 6.60) at 5 years. Baseline BDI score was strongly associated with rate of change in all examined measures of disease severity. In multivariate analysis, BDI 5-year change was associated with change in UPDRS Part I (excluding depression item; P < 0.01), 33-item Parkinson's Disease Questionnaire (P < 0.01), EuroQOL Five Dimensional Questionnaire (P = 0.02), and Total Functional Capacity (P < 0.01), but was not associated with motor or cognitive measures. This model explained 68.8% of the variance 5-year change of the BDI score. CONCLUSIONS Worse baseline BDI scores are associated with a decline in multiple measures of disease severity in PD. Worsening of BDI at 5 years was associated with worsening in UPDRS Part I and quality-of-life measures, but not with motor or cognitive measures.
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Affiliation(s)
- Danny Bega
- Northwestern University, Chicago, Illinois, USA
| | - Sheng Luo
- University of Texas Health Science Center, Houston, Texas, USA
| | | | - Kelvin Chou
- University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Aminoff
- University of California San Francisco, San Francisco, California, USA
| | | | - Harrison Walker
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David S Russell
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | | | - Rohit Dhall
- Muhammad Ali Parkinson Center, Phoenix, Arizona, USA
| | | | | | | | - Daniel Truong
- Parkinson and Movement Disorders Institute, Fountain Valley, California, USA
| | - Zoltan Mari
- Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Meilin Huang
- University of Texas Health Science Center, Houston, Texas, USA
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The Natural History of Depression in Parkinson's Disease within 30-Month Follow-Up. PARKINSONS DISEASE 2015; 2015:362892. [PMID: 25722914 PMCID: PMC4333563 DOI: 10.1155/2015/362892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 01/16/2015] [Accepted: 01/16/2015] [Indexed: 11/18/2022]
Abstract
Depression is one of the most common and persistent nonmotor syndromes occurring in 35% of patients diagnosed with PD. However, little information is known about the longitudinal study of its natural history of depression in PD. In this study, we identified 110 patients who are diagnosed with idiopathic PD and recruited them for assessing information about their PD related motor and nonmotor symptoms and rating scales. A follow-up evaluation was performed in 103 patients 30 months later. About 66.7% depressed patients at baseline were still depressed at follow-up, and 24.4% had incident depression among subjects without depression at baseline. Greater decline on MMSE (P = 0.029), higher baseline UPDRS-II (P < 0.001) score, change of UPDRS-II (P = 0.026), and female (P < 0.001) were associated with the worsening of HDRS scores. Higher baseline HDRS score (P < 0.001) and greater decline on MMSE (P = 0.001) were related to the occurrence of depression. In conclusion, cognitive decline is a disease related factor of worsening and the occurrence of depression. Activities of Daily Living (ADL) symptoms in PD and female gender may be crucial factors of increasing depressive symptoms.
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Grover S, Somaiya M, Kumar S, Avasthi A. Psychiatric aspects of Parkinson's disease. J Neurosci Rural Pract 2015; 6:65-76. [PMID: 25552854 PMCID: PMC4244792 DOI: 10.4103/0976-3147.143197] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Parkinson's disease (PD) is essentially characterized by the motor symptoms in the form of resting tremor, rigidity and bradykinesia. However, over the years it has been recognized that motor symptoms are just the "tip of the iceberg" of clinical manifestations of PD. Besides motor symptoms, PD characterized by many non-motor symptoms, which include cognitive decline, psychiatric disturbances (depression, psychosis and impulse control), sleep difficulties, autonomic failures (gastrointestinal, cardiovascular, urinary, thermoregulation) and pain syndrome. This review evaluates the various aspects of psychiatric disorders including cognitive decline and sleep disturbances in patients with PD. The prevalence rate of various psychiatric disorders is high in patients with PD. In terms of risk factors, various demographic, clinical and treatment-related variables have been shown to be associated with higher risk of development of psychiatric morbidity. Evidence also suggests that the presence of psychiatric morbidity is associated with poorer outcome. Randomized controlled trials, evaluating the various pharmacological and non-pharmacological treatments for management of psychiatric morbidity in patients with PD are meager. Available evidence suggests that tricyclic antidepressants like desipramine and nortriptyline are efficacious for management of depression. Among the antipsychotics, clozapine is considered to be the best choice for management of psychosis in patients with PD. Among the various cognitive enhancers, evidence suggest efficacy of rivastigmine in management of dementia in patients with PD. To conclude, this review suggests that psychiatric morbidity is highly prevalent in patients with PD. Hence, a multidisciplinary approach must be followed to improve the overall outcome of PD. Further studies are required to evaluate the efficacy of various other measures for management of psychiatric morbidity in patients with PD.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mansi Somaiya
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Santhosh Kumar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Aarsland D, Taylor JP, Weintraub D. Psychiatric issues in cognitive impairment. Mov Disord 2014; 29:651-62. [PMID: 24757113 DOI: 10.1002/mds.25873] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/20/2014] [Accepted: 03/03/2013] [Indexed: 01/08/2023] Open
Abstract
Neuropsychiatric symptoms (NPS) such as depression, hallucinations and apathy commonly occur in Parkinson's disease (PD) and have major clinical consequences including a negative impact on quality of life. This review discusses the epidemiology, clinical features, diagnostic procedures and treatment issues of NPS in PD and related disorders in the perspective of cognitive impairment, focusing on depression, anxiety, visual hallucinations, apathy, sleep disturbances, impulse control disorder and non-motor fluctuations. The majority of NPS are more common in PD patients with dementia, possibly related to shared underlying pathologies. Recent studies also suggest that NPS are associated with mild cognitive impairment in PD, in particular with the amnestic type. Accurate diagnosis of NPS is important but can be difficult, due to overlapping symptoms and similar appearance of symptoms of motor symptoms of parkinsonism, cognitive impairment, mood disorders and apathy. There are few systematic studies focusing on the management of NPS in PD with cognitive impairment.
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Affiliation(s)
- Dag Aarsland
- Alzheimer's Disease Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; Department of Geriatric Psychiatry, Akershus University Hospital, Oslo, Norway
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Worku DK, Yifru YM, Postels DG, Gashe FE. Prevalence of depression in Parkinson's disease patients in Ethiopia. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2014; 1:10. [PMID: 26788336 PMCID: PMC4711030 DOI: 10.1186/s40734-014-0010-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/05/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is associated with cognitive and psychiatric disturbances including depression, anxiety, psychotic symptoms and sleep disturbances. These psychiatric manifestations have a negative impact on disease course and the medical management of PD patients. Major depression has a greater negative impact on patients' quality of life than abnormal motor function, and is associated with faster cognitive decline and progression of motor deficits. Thus, the objective of this study was to determine the prevalence and pattern of depression in PD outpatients in Ethiopia. We determined the age range in which depression in PD patients is most common, the most common symptoms of depression, and the epidemiologic confounders associated with depression in PD patients. METHODS We conducted a cross-sectional point prevalence study of all PD patients attending the follow-up clinics of the departments of neurology at Black Lion Teaching and Zewuditu Memorial Hospitals in Addis Ababa, Ethiopia, from May 2013 to August 2013. We collected information using a structured questionnaire which assessed demographic information, clinical history, and neurologic function. RESULT Of the 101 patients surveyed, the prevalence of depression was 58/101(57.4%). Of these patients, 1 of 58(1.7%) was on antidepressant medications. These low proportions likely indicate a low index of suspicion and under treatment of depression in PD outpatients. CONCLUSION In Ethiopian PD outpatients, depression is under recognized and undertreated. We recommend routine use of screening tools. In those who screen positive for depression, treatment is warranted. Further studies are needed to confirm these findings, and to increase our understanding of specific signs and symptoms of depression in the context of PD.
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Affiliation(s)
| | | | - Douglas G Postels
- International Neurologic and Psychiatric Epidemiology Program, Michigan State University, Michigan, USA
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Abstract
Objective:To examine predictive factors associated with onset of depression among individuals diagnosed with Parkinson's disease (PD).Background:Depression may precede or follow symptomatic parkinsonism in PD. It is frequently treatable but often overlooked.Methods:The clinical series comprised 685 individuals who were diagnosed with PD and followed by one neurologist (RJU) from 1994 to 2007. The primary outcome was time to depression following the onset of PD. Diagnosis of depression was based on clinical assessment of depressive symptoms from patients (and spouse/family/caregiver) and antidepressant usage. A number of demographic, historical and clinical predictive factors were examined, including gender, age at symptomatic onset, disease duration, onset characteristics, clinical ratings, antiparkinsonian medications, cognitive status, depression history, and familial history of PD and other neurodegenerative disorders.Results:Seventy-two percent of patients developed depression within ten years of symptomatic PD onset, and the mean time to depression was 7.9 years (median: 5.7 years). Factors associated with depression included longer PD duration, greater impairment in activities of daily living, and positive family history of motor neuron disease (MND).Conclusions:A high rate of individuals with PD develop depressive symptoms during the course of the disease. Based on first clinic visit characteristics, most factors examined were not helpful in identifying individuals with an increased risk of depression. However, disease duration, functional limitations and family history of MND should lead clinicians to an increased vigilance for identifying depression.
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Abstract
Depressive disturbances are common in patients with Parkinson's disease (PD) and influence many other clinical aspects of the disease. In addition to causing inherent emotional distress, depressive disorders negatively impact quality of life, motor and cognitive deficits, functional disability, and other psychiatric comorbidities in patients with PD. Knowledge of the pathophysiology of PD depression remains limited. However, clinical studies demonstrate the efficacy of medications and psychotherapies for PD depression, underscoring the importance of their timely detection and concerted management.
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The tools of the trade: A state of the art “How to Assess Cognition” in the patient with Parkinson's disease. Mov Disord 2014; 29:584-96. [DOI: 10.1002/mds.25874] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/07/2014] [Accepted: 02/27/2014] [Indexed: 01/08/2023] Open
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Lewis C, Annett LE, Davenport S, Hall AA, Lovatt P. Mood changes following social dance sessions in people with Parkinson's disease. J Health Psychol 2014; 21:483-92. [PMID: 24752558 DOI: 10.1177/1359105314529681] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Dance interventions have physical benefits for the elderly, especially those with Parkinson's disease. This study assessed the psychological benefits of dance. A total of 37 participants, with either Parkinson's disease (n= 22) or age-matched controls (n= 15) completed mood questionnaires before and after a 10-week dance intervention. An overall reduction in total mood disturbance and a specific reduction in anger were observed. In addition, less fatigue was found for those initially scoring higher in depression. This suggests that dance can provide psychological benefits for both people with Parkinson's disease and the elderly, with findings suggesting that this is an avenue to be explored further.
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80
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Goldman JG, Williams-Gray C, Barker RA, Duda JE, Galvin JE. The spectrum of cognitive impairment in Lewy body diseases. Mov Disord 2014; 29:608-21. [PMID: 24757110 PMCID: PMC4126402 DOI: 10.1002/mds.25866] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/15/2014] [Accepted: 02/20/2014] [Indexed: 12/17/2022] Open
Abstract
Cognitive impairment represents an important and often defining component of the clinical syndromes of Lewy body disorders: Parkinson's disease and dementia with Lewy bodies. The spectrum of cognitive deficits in these Lewy body diseases encompasses a broad range of clinical features, severity of impairment, and timing of presentation. It is now recognized that cognitive dysfunction occurs not only in more advanced Parkinson's disease but also in early, untreated patients and even in those patients with pre-motor syndromes, such as rapid eye movement behavior disorder and hyposmia. In recent years, the concept of mild cognitive impairment as a transitional or pre-dementia state in Parkinson's disease has emerged. This has led to much research regarding the diagnosis, prognosis, and underlying neurobiology of mild cognitive impairment in Parkinson's disease, but has also raised questions regarding the usefulness of this concept and its application in clinical and research settings. In addition, the conundrum of whether Parkinson's disease dementia and dementia with Lewy bodies represent the same or different entities remains unresolved. Although these disorders overlap in many aspects of their presentations and pathophysiology, they differ in other elements, such as timing of cognitive, behavioral, and motor symptoms; medication responses; and neuropathological contributions. This article examines the spectrum and evolution of cognitive impairment in Lewy body disorders and debates these controversial issues in the field using point-counterpoint approaches.
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Affiliation(s)
| | - Caroline Williams-Gray
- John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Roger A. Barker
- John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - John E. Duda
- Department of Neurology, University of Pennsylvania Perelman School of Medicine and the Parkinson’s Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - James E. Galvin
- Departments of Neurology, Psychiatry and Population Health, New York University School of Medicine, New York, NY
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81
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Baillon S, Dennis M, Lo N, Lindesay J. Screening for depression in Parkinson's disease: the performance of two screening questions. Age Ageing 2014; 43:200-5. [PMID: 24132854 DOI: 10.1093/ageing/aft152] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND the study objective was to evaluate the validity of the two questions recommended by the UK. National Institute for Health and Clinical Excellence for depression screening in Parkinson's disease (PD). METHODS one hundred and twenty patients attending a PD out-patient clinic were interviewed in a standardised manner using relevant sections of the Present State Examination- Schedules for Clinical Assessment in Neuropsychiatry to identify depression according to Diagnostic and Statistical Manual (4th edition) criteria. Participants then completed the two depression screening questions and the 15-item Geriatric Depression Scale (GDS-15). RESULTS sensitivity, specificity, positive and negative predictive values of the two questions and GDS-15 for major and minor depression combined were calculated for different cut-off scores and a receiver operating characteristics (ROC) analysis was conducted. A threshold of one or more positive responses to the two screening questions gave a sensitivity of 100% and specificity of 84% (positive predictive value 54%, negative predictive value 100%). The area under the ROC curve was 0.95. The optimal cut-off for the GDS-15 was 5/6, which gave a sensitivity of 84% and specificity of 89% (positive predictive value 59%, negative predictive value 97%), and the area under the curve was 0.92. CONCLUSION this study shows that the two depression screening questions can be used as an initial screen for depression in patients with PD who have no significant cognitive impairment. A positive response to either of the questions would indicate that further diagnostic assessment may be warranted.
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Affiliation(s)
- Sarah Baillon
- Department of Health Sciences, University of Leicester, Leicester, Leics, UK
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Abstract
OPINION STATEMENT Anxiety and depression, while very common problems in Parkinson's disease (PD), have not been subject to adequate treatment trials. While a handful of double blind placebo-controlled trials of depression have been published, only a small number of subjects have been enrolled in most of these. There have been no adequate treatment trials of anxiety. Thus, most practitioners base their treatments on what has been published in the general population and their own personal experience. The data suggest that depression is probably treatable in some cases, but there are no data to support any drug treatment of anxiety. Much of the rationale for treating these disorders is based primarily on side effect profiles rather than efficacy and is almost entirely based on anecdotal experience. Although we lack convincing data, we do believe in the pharmacologic treatment of depression and anxiety and choose medications based on side effect profiles, some of which may be useful. We favor the selective serotonin reuptake inhibitors (SSRIs) in general for both depression and anxiety because of their relative freedom from side effects but will often choose mirtazapine if insomnia or weight loss is a problem, clonazepam for anxiety without depression if an SSRI is insufficient or if REM sleep behavior disorder is a problem, or a tricyclic antidepressant if drooling is troubling and the patient is not demented. Alternatively, we use the serotonin and noradrenaline reuptake inhibitor venlafaxine in those who do not tolerate an SSRI. SSRIs cannot be used for anxiety on an as needed basis, whereas short-acting benzodiazepines may be useful for this purpose. Psychosocial treatments of both depression and anxiety have also been under-studied, with probable benefits and a benign adverse effect profile.
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Affiliation(s)
- Atbin Djamshidian
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, 1 Wakefield Street, WC1N1PJ, London, UK,
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Lagopoulos J, Malhi GS, Ivanovski B, Cahill CM, Morris JGL. A matter of motion or an emotional matter? Management of depression in Parkinson’s disease. Expert Rev Neurother 2014; 5:803-10. [PMID: 16274337 DOI: 10.1586/14737175.5.6.803] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Depression is one of the most frequent comorbidities occurring in Parkinson's disease, affecting up to 50% of patients. Depression is associated with severe negative symptoms and has been shown to contribute to an increased rate of decline of both cognitive and motor function, profoundly impacting on the patient's quality of life. The symptoms of depression overlap with the motor features of Parkinson's disease, making detection difficult. Moreover, the lack of specialized screening tools means that depression remains undiagnosed and untreated in a high percentage of patients. However, depression in Parkinson's disease, when identified early, can be effectively treated with a variety of antidepressant medications, improving quality of life and preserving daily function. The focus of this review is to provide an overview of current knowledge regarding depression in Parkinson's disease, followed by a practical discussion addressing the issues of the detection, diagnosis and treatment.
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Affiliation(s)
- Jim Lagopoulos
- School of Psychiatry, The University of New South Wales, Australia
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84
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Dobkin RD, Tröster AI, Rubino JT, Allen LA, Gara MA, Mark MH, Menza M. Neuropsychological outcomes after psychosocial intervention for depression in Parkinson's disease. J Neuropsychiatry Clin Neurosci 2014; 26:57-63. [PMID: 24275895 PMCID: PMC4144827 DOI: 10.1176/appi.neuropsych.12120381] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The authors describe neuropsychological outcomes in people with Parkinson's disease (PD) after their participation in an NIH-sponsored, randomized, controlled trial of cognitive-behavioral treatment for depression. Improvements in mood were associated with modest gains in verbal memory and executive functioning over the 10-week treatment period and accounted for greater variance in neuropsychological outcomes at the end of treatment than other known correlates of cognitive functioning in PD, such as disease severity, age, and education. Baseline working memory and executive skills were also associated with depression improvement over time.
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Affiliation(s)
| | | | - Jade Tiu Rubino
- Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School
| | - Lesley A. Allen
- Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School
| | - Michael A. Gara
- Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School
| | - Margery H. Mark
- Departments of Psychiatry and Neurology, UMDNJ-Robert Wood Johnson Medical School
| | - Matthew Menza
- Departments of Psychiatry and Neurology, UMDNJ-Robert Wood Johnson Medical School
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85
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Effectiveness of multidisciplinary interventions to improve the quality of life for people with Parkinson's disease: A systematic review. Int J Nurs Stud 2014; 51:166-74. [DOI: 10.1016/j.ijnurstu.2013.03.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 03/07/2013] [Accepted: 03/16/2013] [Indexed: 12/18/2022]
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86
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Liepelt-Scarfone I, Fruhmann Berger M, Prakash D, Csoti I, Gräber S, Maetzler W, Berg D. Clinical characteristics with an impact on ADL functions of PD patients with cognitive impairment indicative of dementia. PLoS One 2013; 8:e82902. [PMID: 24349393 PMCID: PMC3857297 DOI: 10.1371/journal.pone.0082902] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 11/07/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Dementia in Parkinson's disease (PD) is defined as cognitive decline severe enough to affect activities of daily living function (ADL). The aim of our exploratory study was to compare two groups of PD patients. Both groups had cognitive deficits severe enough to justify diagnosis of dementia, but they differed according to caregivers' rating on ADL dysfunction. Parameters which differed between the two groups were interpreted to affect the caregivers' perception of ADL dysfunction in PD patients with cognitive impairment indicative of Parkinson's disease dementia. METHODOLOGY/PRINCIPAL FINDINGS Thirty of 131 Parkinson's disease patients fulfilled the Movement Disorders Society Task Force - recommended, cognitive Level-I-criteria for dementia. According to standardized caregiver ratings, volunteers were grouped into 18 patients with (ADL-) and 12 without instrumental activities of daily living dysfunction (ADL+). Caregiver activities of daily living function ratings closely correlated with self-estimates of patients and those of physician (p<0.001). ADL- patients performed worse on tests assessing visual-construction (p<0.05) and attention (p=0.03) than ADL+ patients. Moreover, the postural instability and gait disorder subtype was more frequent in ADL- patients (p=0.009). ADL- patients tended to have more communication problems (p=0.05), more anxiety (p=0.05) and showed a tendency to be treated more often with neuroleptics (p=0.049) than ADL+. CONCLUSIONS/SIGNIFICANCE Results indicate that worse attention, visual-construction abilities, the postural instability and gait disorder subtype, communication problems, medication and presence of anxiety are related to activities of daily living dysfunctions in Parkinson's disease patients with cognitive decline indicative of dementia. Our data suggests that not only cognitive factors but also non-cognitive factors seem to be linked to the diagnosis of Parkinson's disease dementia associated with significant impact on instrumental activities of daily living function. Further studies with larger sample sizes are needed to verify our results.
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Affiliation(s)
- Inga Liepelt-Scarfone
- German Center of Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Monika Fruhmann Berger
- German Center of Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Deborah Prakash
- German Center of Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Ilona Csoti
- Department of Neurology, Gertrudis Hospital, Leun-Biskirchen, Germany
| | - Susanne Gräber
- German Center of Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Walter Maetzler
- German Center of Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Daniela Berg
- German Center of Neurodegenerative Diseases (DZNE), Tuebingen, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
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87
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Xu MK, Jones PB, Barnett JH, Gaysina D, Kuh D, Croudace TJ, Richards M. Adolescent self-organization predicts midlife memory in a prospective birth cohort study. Psychol Aging 2013; 28:958-68. [PMID: 24364401 PMCID: PMC3906799 DOI: 10.1037/a0033787] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 04/19/2013] [Accepted: 05/15/2013] [Indexed: 11/18/2022]
Abstract
Childhood and adolescent mental health have a lasting impact on adult life chances, with strong implications for subsequent health, including cognitive aging. Using the British 1946 birth cohort, the authors tested associations between adolescent conduct problems, emotional problems and aspects of self-organization, and verbal memory at 43 years and rate of decline in verbal memory from 43 to 60-64 years. After controlling for childhood intelligence, adolescent self-organization was positively associated with verbal memory at 43 years, mainly through educational attainment, although not with rate of memory decline. Associations between adolescent conduct and emotional problems and future memory were of negligible magnitude. It has been suggested that interventions to improve self-organization may save a wide range of societal costs; this study also suggests that this might also benefit cognitive function in later life.
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Affiliation(s)
- Man K Xu
- Department of Psychiatry, University of Cambridge
| | | | | | | | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing
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88
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Williams-Gray CH, Mason SL, Evans JR, Foltynie T, Brayne C, Robbins TW, Barker RA. The CamPaIGN study of Parkinson's disease: 10-year outlook in an incident population-based cohort. J Neurol Neurosurg Psychiatry 2013; 84:1258-64. [PMID: 23781007 DOI: 10.1136/jnnp-2013-305277] [Citation(s) in RCA: 422] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Prognosis in Parkinson's disease (PD) remains poorly understood due to a lack of unbiased data on the natural history of treated PD. The CamPaIGN study has been the first to prospectively track disease evolution from diagnosis in an unselected population-representative incident cohort. We now report the 10-year follow-up data, focusing on three key irreversible milestones: postural instability (Hoehn and Yahr 3), dementia and death. METHODS The cohort was collected between December 2000 and 2002. Those meeting diagnostic criteria (n=142) were followed-up until 1 January 2012. Clinical, neuropsychological and genetic testing were performed. Progression to key milestones was evaluated using Kaplan-Meier and Cox regression survival analyses. RESULTS At 10 years, 55% had died, 68% had postural instability and 46% dementia. 23% had a good outcome at 10 years (surviving free of dementia/postural instability). Death rate was comparable with the UK population (standardised mortality ratio 1.29 (0.97-1.61)). Death certificates indicated PD was a substantial contributor in only 20%, with pneumonia being the commonest cause of death. Age, non-tremor-dominant motor phenotype and comorbidity predicted earlier postural instability. Baseline predictors of dementia were age, motor impairment, 'posterior-cortical' cognitive deficits and MAPT genotype. CONCLUSIONS (1) outlook in PD is heterogeneous, with most dying or developing dementia or postural instability by 10 years from diagnosis, but a quarter still doing well, with preserved mobility and intact cognition; (2) death is not directly related to PD in the majority; (3) baseline clinical and genetic variables are predictive of outcome and may be helpful in selecting patients for clinical trials.
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Affiliation(s)
- Caroline H Williams-Gray
- John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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89
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Pirogovsky E, Martinez-Hannon M, Schiehser DM, Lessig SL, Song DD, Litvan I, Filoteo JV. Predictors of performance-based measures of instrumental activities of daily living in nondemented patients with Parkinson’s disease. J Clin Exp Neuropsychol 2013; 35:926-33. [DOI: 10.1080/13803395.2013.838940] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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90
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Bee TS, Allison W. The Effects of Parkinson's Disease on Caregivers and People with Parkinson's Disease: A Literature Review. PROCEEDINGS OF SINGAPORE HEALTHCARE 2013. [DOI: 10.1177/201010581302200306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Parkinson's disease (PD) is a complex, slowly progressive, neurodegenerative, neurological condition characterised by a wide range of motor problems such as movement disorders, issues with gait and balance, and difficulty with swallowing and speech. In addition, sufferers also experience non-motor symptoms such as disorder of sleep, postural hypotension, mood alterations, lethargy, and cognitive dysfunction. As PD progresses to an advanced stage, people experience periods of debilitating physical and neurological problems and their caregivers face increasing complexity of care. Many people with PD require the support of a caregiver to attend to activities of daily living. This paper will review the literature on the effects of Parkinson's disease on both the patient and caregiver. Findings highlight the progressive nature of the disease affecting both functional and affective domains, and the need for caregiver support to enable the delivery of quality of care to this group throughout the disease trajectory.
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Affiliation(s)
- Tan Siok Bee
- Nursing Division, Singapore General Hospital, Singapore
| | - Williams Allison
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
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91
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Harris E, McNamara P, Durso R. Apathy in patients with Parkinson disease as a function of side of onset. J Geriatr Psychiatry Neurol 2013; 26:95-104. [PMID: 23584852 DOI: 10.1177/0891988713481267] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In previous studies among patients with Parkinson disease (PD) who were administered the Apathy Evaluation Scale (AES), between 12% and 51% evidenced clinically significant apathy. Although apathy is a risk factor for dementia, its causes and clinical correlates have not been adequately studied. In particular, side of onset of disease, though a likely predictor of apathy and dementia, has not been thoroughly investigated. METHODS A total of 30 mid-stage patients with PD and 35 community-dwelling elderly control patients (CPs) were administered the AES (self version) along with a battery of cognitive and neuropsychiatric assessments. Persons close to patients with PD and CPs completed the AES--other (informant) version about the patient or CP. Multiple linear regression analysis examined predictors of apathy severity after controlling for mood, levodopa dosage equivalents (LDEs), gender, age, and disease severity (Hoehn--Yahr [H-Y] stage). RESULTS Patients with right-onset disease more frequently exhibited apathy and evidenced significantly higher total AES scores than left-onset patients with PD or CPs (P < .03). Of all the patients, 42% with right-onset PD versus 11.1% of the patients with left-onset PD exhibited clinically significant levels of apathy. There were no differences for self versus informant scores for right-onset patients with PD. The AES scores were not correlated with depression, stress, anxiety, LDEs, gender, age, and H-Y stage. There were no gender differences for any AES variables. CONCLUSION Clinically significant levels of apathy are much more likely to occur in patients with right-onset disease. These patients may be at greater risk of PD-related dementia.
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Affiliation(s)
- Erica Harris
- Department of Behavioral Sciences and Epidemiology, Naval Health Research Center, San Diego, CA 92106, USA.
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Dobkin RD, Rubino JT, Friedman J, Allen LA, Gara MA, Menza M. Barriers to mental health care utilization in Parkinson's disease. J Geriatr Psychiatry Neurol 2013; 26:105-16. [PMID: 23589410 PMCID: PMC3644337 DOI: 10.1177/0891988713481269] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is frequently complicated by co-occurring psychiatric problems such as depression and anxiety that negatively affect the course and management of the illness. Yet, in most cases, these psychiatric comorbidities are neither recognized nor treated to remission. The primary purpose of this study was to identify and describe barriers to mental health care utilization for people with PD. Secondary objectives included the assessment of attitudes and preferences regarding the need for mental health services in the PD community and the acceptability of telehealth interventions as a method for improving access and quality of care. METHODS A total of 769 people with PD completed an anonymous cross-sectional questionnaire assessing barriers to mental health care utilization in this medical population. Respondents were drawn from a national sample. RESULTS Commonly endorsed barriers to mental health care utilization in PD reflect the patients' incomplete understanding of mental health problems, access issues, and illness-specific concerns, as well as the inadequate screening and detection of psychiatric complications by medical providers and the need for more effective treatments in this medical population. Several demographic, medical, and psychiatric variables also influenced the likelihood of accessing mental health care. Interest in telehealth approaches to mental health treatment was high and, in several instances, correlated with perceived barriers to mental health care utilization. CONCLUSIONS People with PD may encounter a multitude of barriers that impede their pursuit of mental health care. Clinical implications are discussed and further research is needed to replicate and extend these findings.
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Affiliation(s)
- Roseanne D. Dobkin
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, NJ
| | - Jade Tiu Rubino
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, NJ
| | - Jill Friedman
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, NJ
| | - Lesley A. Allen
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, NJ
| | - Michael A. Gara
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, NJ
| | - Matthew Menza
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, NJ,Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, NJ
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Combined beneficial effect of rasagiline on motor function and depression in de novo PD. Clin Neuropharmacol 2013; 35:121-4. [PMID: 22561875 DOI: 10.1097/wnf.0b013e31823b1da8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate prokinetic and antidepressive effects of rasagiline in de novo Parkinson disease (PD). MATERIALS AND METHODS Patients with newly diagnosed PD with comorbid untreated depression were randomly assigned to rasagiline monotherapy 1 or 2 mg/d. Unified Parkinson's Disease Rating Scale Part 2 (Activity of Daily Living) and Part 3 (Motor Function), and Hamilton Depression Rating Scale (HDRS) assessments were carried out by a blinded investigator in each patient at baseline and after 8 weeks of rasagiline treatment. RESULTS Both groups showed equal motor improvement at the end point. The improvements of HDRS score and activity of daily living were significantly more pronounced with rasagiline, 2 mg/d, than rasagiline, 1 mg/d (P = 0.0002). The treatment with rasagiline, 2 mg/d, improved symptoms in all HDRS core depression symptoms and specifically those not considered to be influenced by motor function: mood, guilt, psychic anxiety, and hypochondria. CONCLUSION Our results suggest that antidepressive effect seen in higher dosage of rasagiline may be not related to the motor improvement.
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Fabbrini G, Latorre A, Suppa A, Bloise M, Frontoni M, Berardelli A. Fatigue in Parkinson's disease: Motor or non-motor symptom? Parkinsonism Relat Disord 2013; 19:148-52. [DOI: 10.1016/j.parkreldis.2012.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 10/02/2012] [Accepted: 10/05/2012] [Indexed: 01/18/2023]
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Assogna F, Fagioli S, Cravello L, Meco G, Pierantozzi M, Stefani A, Imperiale F, Caltagirone C, Pontieri FE, Spalletta G. Depressive symptoms in Parkinson's disease and in non-neurological medical illnesses. Neuropsychiatr Dis Treat 2013; 9:389-96. [PMID: 23569379 PMCID: PMC3615851 DOI: 10.2147/ndt.s40013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with neurological and non-neurological medical illnesses very often complain of depressive symptoms that are associated with cognitive and functional impairments. We compared the profile of depressive symptoms in Parkinson's disease (PD) patients with that of control subjects (CS) suffering from non-neurological medical illnesses. METHODS One-hundred PD patients and 100 CS were submitted to a structured clinical interview for identification of major depressive disorder (MDD) and minor depressive disorder (MIND), according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR), criteria. The Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory (BDI) were also administered to measure depression severity. RESULTS When considering the whole groups, there were no differences in depressive symptom frequency between PD and CS apart from worthlessness/guilt, and changes in appetite reduced rates in PD. Further, total scores and psychic and somatic subscores of HDRS and BDI did not differ between PD and CS. After we separated PD and CS in those with MDD, MIND, and no depression (NODEP), comparing total scores and psychic/somatic subscores of HDRS and BDI, we found increased total depression severity in NODEP PD and reduced severity of the psychic symptoms of depression in MDD PD, with no differences in MIND. However, the severity of individual symptom frequency of depression was not different between PD and CS in MDD, MIND, and NODEP groups. CONCLUSION Although MDD and MIND phenomenology in PD may be very similar to that of CS with non-neurological medical illnesses, neurological symptoms of PD may worsen (or confound) depression severity in patients with no formal/structured DSM-IV-TR, diagnosis of depressive mood disorders. Thus, a thorough assessment of depression in PD should take into consideration the different impacts of neurological manifestations on MDD, MIND, and NODEP.
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Starkstein SE, Tranel D. Neurological and psychiatric aspects of emotion. HANDBOOK OF CLINICAL NEUROLOGY 2012; 106:53-74. [PMID: 22608615 DOI: 10.1016/b978-0-444-52002-9.00004-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Neurological and psychiatric aspects of emotions have been the focus of intense research for the past 30 years. Studies in both acute (e.g., stroke, traumatic brain injury (TBI)) and chronic (e.g., dementia, Parkinson's disease) neurological disorders demonstrated a high frequency of both depression and apathy. Studies in stroke and TBI reported a significant association between lesion location and depression. Both depression and apathy are significant predictors of poor recovery among patients with brain injuries, and of steeper cognitive and functional decline among patients with neurodegenerative disorders. Poor insight and judgment are frequently found among patients with brain injury or degeneration. There is increasing evidence that damage to specific brain regions, such as the ventromedial prefrontal cortex, is associated with inappropriate emotional reactions in social contexts and diminished anxiety and concern for the future. In severe cases, behavioural changes may also include poor decision-making in the social realm, deficits in goal-directed behavior, and lack of insight into these changes. Future studies will validate specific diagnostic criteria for the various cognitive, emotional, and behavioral problems reported among patients with neurological disorders, which may result in more specific and effective treatments.
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Affiliation(s)
- Sergio E Starkstein
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia.
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97
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Abstract
PURPOSE OF REVIEW To examine progress about relevant behavioural and psychiatric disorders in Parkinson's disease, such as depression, apathy, psychosis, and impulse control disorder. RECENT FINDINGS Several recent studies have characterized the phenomenology of depression in Parkinson's disease, and randomized controlled trials have demonstrated the efficacy of tricyclics, selective serotonin reuptake inhibitors and psychotherapy for depression in Parkinson's disease. Apathy is a valid behavioural syndrome in Parkinson's disease and is associated with depression and cognitive deficits. Psychosis is highly prevalent in the late stages of the disease, but there are few effective therapeutic modalities for this psychiatric condition. Impulse control disorders are also relatively frequent in Parkinson's disease, and are associated with comorbid psychiatric disorders. SUMMARY Standardized criteria should be used to diagnose depression and apathy in Parkinson's disease. Psychotherapy and pharmacotherapy are useful treatment modalities for affective disorders in Parkinson's disease. Clozapine is still the most effective, albeit rarely used, treatment for psychosis in Parkinson's disease. Impulse control disorders are relatively frequent in Parkinson's disease and all patients should be screened for this complex disorder.
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Pirogovsky E, Woods SP, Vincent Filoteo J, Gilbert PE. Prospective memory deficits are associated with poorer everyday functioning in Parkinson's disease. J Int Neuropsychol Soc 2012; 18:986-95. [PMID: 22846463 PMCID: PMC3698041 DOI: 10.1017/s1355617712000781] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although individuals with Parkinson's disease (PD) evidence moderate deficits in prospective memory (PM), it is not known whether PM deficits confer an increased risk of poorer everyday functioning. In the current study, 33 individuals with PD and 26 demographically similar normal controls (NC) were administered performance-based and self-report measures of PM and everyday functioning, including medication and financial management. As compared to NC, PD participants demonstrated significantly lower scores on performance-based measures of PM and financial capacity, worse performance at a trend level on performance-based medication management and endorsed significantly greater self-reported declines in PM and instrumental activities of daily living (iADLs). In the PD sample, the laboratory measure of PM significantly correlated with performance-based measures of financial capacity and medication management and a self-report measure of medication management. Self-reported PM failures significantly correlated with perceived declines in iADLs, worse medication management, and poorer health-related quality of life. Although future studies are needed to examine the incremental ecological validity of PM in PD, findings from this study extend prior research by providing preliminary evidence that PM impairment may play a significant role in a range of critical everyday functions in PD.
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Affiliation(s)
- Eva Pirogovsky
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California 92120, USA
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99
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Piccinni A, Marazziti D, Veltri A, Ceravolo R, Ramacciotti C, Carlini M, Del Debbio A, Schiavi E, Bonuccelli U, Dell'Osso L. Depressive symptoms in Parkinson's disease. Compr Psychiatry 2012; 53:727-31. [PMID: 22209634 DOI: 10.1016/j.comppsych.2011.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 11/02/2011] [Accepted: 11/08/2011] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE We aimed to investigate the relationship between the presence and severity of depression and the degree of motor and functional disability in Parkinson's disease (PD). METHODS One hundred twenty-two outpatients with PD were enrolled in a neurology department: 65 satisfied the Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition criteria for major depression, and 57 did not (PD-C). Depressive symptoms were assessed by means of the Hamilton Rating Scale for Depression (HRSD), and the PD severity was assessed according to the Hoehn and Yahr System. Activities of daily living and motor symptoms were measured by the Unified PD Rating Scale (UPDRS), parts II and III. RESULTS Twenty-nine patients had a mild depression (HRSD total score ranging between 8 and 17), 30 had a moderate depression (HRSD total score ranging between 18 and 24), and 6 had a severe depression (HRSD total score, ≥25). By comparing the 3 groups of patients, it emerged that those with a severe depression showed significantly higher scores at the UPDRS II, UPDRS III, and HY scales than did PD-C or patients with a mild depression. Moreover, patients with a moderate depression scored significantly higher on the UPDRS II, UPDRS III, and HY scales than did PD-C or those with a mild depression. CONCLUSIONS Our findings suggest that depression and motor symptoms/well-being are highly intertwined in patients with PD.
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Affiliation(s)
- Armando Piccinni
- Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnologies, University of Pisa, Via Roma 67, 56126 Pisa, Italy.
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100
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Smith MM, Mills JA, Epping EA, Westervelt HJ, Paulsen JS. Depressive symptom severity is related to poorer cognitive performance in prodromal Huntington disease. Neuropsychology 2012; 26:664-9. [PMID: 22846033 DOI: 10.1037/a0029218] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Depression is associated with more severe cognitive deficits in many neurological disorders, though the investigation of this relationship in Huntington disease (HD) has been limited. This study examined the relationship between depressive symptom severity and measures of executive functioning, learning/memory, and attention in prodromal HD. METHOD Participants (814 prodromal HD, 230 gene-negative) completed a neuropsychological test battery and the Beck Depression Inventory-II (BDI-II). Based on the BDI-II, there were 637 participants with minimal depression, 89 with mild depression, 61 with moderate depression, and 27 with severe depression in the prodromal HD group. RESULTS ANCOVA (controlling for age, sex, and education) revealed that performance on SDMT, Trails B, Hopkins Verbal Learning Test--Revised (HVLT-R) Immediate Recall, and Stroop interference was significantly different between the BDI-II severity groups, with the moderate and severe groups performing worse than the minimal and mild groups. There were no significant differences between the BDI-II severity groups for Trails A or HVLT-R Delayed Recall. Linear regression revealed that both gene status and depression severity were significant predictors of performance on all cognitive tests examined, with contributions of BDI-II and gene status comparable for Trails A, SDMT, and Stroop interference. Gene status had a higher contribution for HVLT-R Immediate and Delayed Recall and Trails B. CONCLUSIONS Our results suggest that depressive symptom severity is related to poorer cognitive performance in individuals with prodromal HD. Though there are currently no approved therapies for cognitive impairment in HD, our findings suggest that depression may be a treatable contributor to cognitive impairment in this population.
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Affiliation(s)
- Megan M Smith
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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