Quality of life and depression in Parkinson's disease

Transcranial sonography findings related to depression in parkinsonian disorders: cross-sectional study in 126 patients

Background. Transcranial sonography (TCS) has emerged as a potential diagnostic tool for Parkinson’s disease. Recent research has suggested that abnormal echogenicity of substantia nigra, raphe nuclei and third ventricle is associated with increased risk of depression among these patients. We sought to reproduce these findings in an ongoing larger study of patients with parkinsonian syndromes.

Methods. A total of 126 patients with parkinsonian symptoms underwent the Hamilton Depression Scale, and TCS of the substantia nigra (SN) (n = 126), the raphe nuclei (RN) (n = 80) and the third ventricle (n = 57). We then calculated the correlation between depression and hyper-echogenic SN, hypo-echogenic RN and a wider third ventricle.

Results. In patients with PD we found no significant difference of the SN between non-depressed and depressed patients (46% vs. 22%; p = 0.18). Non-depressed patients with other parkinsonisms more often had hyperechogenicity of the SN than depressed patients (51% vs. 0%; p = 0.01). We found no relation between depression and the echogenicity of the RN or the width of the third ventricle.

Conclusions. In patients with parkinsonian syndromes, we found no association between depression and hyper-echogenic SN, hypo-echogenic RN or a wider third ventricle, as determined by transcranial sonography.

Assessing health-related quality of life with the SCOPA-PS in French individuals with Parkinson's disease having undergone DBS-STN: A validation study

INTRODUCTION

The aims of this study were to validate the French version of the SCales for Outcomes in Parkinson's Disease-PsychoSocial (SCOPA-PS) in individuals with Parkinson's disease (PD) who underwent deep brain stimulation of the subthalamic nucleus (DBS-STN), to confirm the unifactorial structure of this questionnaire, and to establish its psychometric properties.

METHODS

Routinely used psychological questionnaires (BDI-II, STAI-Y, PDQ-39, UPDRS III) and the SCOPA-PS were used for a cross-sectional observational study of 154 PD patients. SCOPA-PS acceptability, scaling assumption, reliability, ordinal confirmatory factor analysis and validity were assessed.

RESULTS

The ICC for two-week test-retest reliability was 0.88. SEM was 8.42. In confirmatory factor analysis, the one-factor model showed an acceptable fit to the data (Chi(2)/df=2.130; CFI=0.976; RMSEA=0.086). No floor or ceiling effects were observed. Skewness was 0.33. Item-total correlation coefficients ranged from 0.47 to 0.71. Cronbach's alpha was 0.86. SCOPA-PS SI correlated with PDQ-39 SI (rs=0.83) and with state-anxiety and depression (rs=0.56 and 0.69 respectively). The SCOPA-PS SI was higher in more depressed patients and in those with the most severe PD motor symptoms.

CONCLUSION AND DISCUSSION

SCOPA-PS French version is a one-factor scale with satisfactory psychometric properties consistent with other language versions. This short scale can be used to evaluate the psychosocial component of QoL in PD patients treated with DBS-STN.

How close are we to individualized medicine for Parkinson's disease?

INTRODUCTION

There is a considerable inter-individual heterogeneity in clinical features, disease course, and treatment response in Parkinson's disease (PD), which can be explained not only by disease process and clinical variables, but also by an impact from genetic factors. Evidence-based medicine relies on large randomized control trials and meta-analysis-average medicine, which ignores individual differences. However, we are now in the early phases of a paradigm shift in medicine relating to individuality and variability. The purpose of individualized medicine is to predict patients' responses to targeted therapy using diagnostic tests based on genetics or other molecular mechanisms, thus providing the right drug at the right dose at the right time.

AREAS COVERED

In this article, we outline current state of individualized medicine for PD. Expert Commentary: Pharmacogenomics, an important element of individualized medicine, is just beginning to be considered in PD. To advance the clinical use of pharmacogenomics, big data cohort for genomic research and multidisciplinary team approaches are necessary.

Perceptions of people living with Parkinson's disease: a qualitative study in Iran

AIM

This study explores the primary concerns and perceptions of patients living with Parkinson's disease (PD).

METHOD

This was an exploratory qualitative study. A purposive sample of 17 patients with PD who were attending a hospital outpatients' neurology clinic in Iran were recruited. Study data were collected through semi-structured interviews and analysed using the conventional qualitative content analysis approach.

FINDINGS

We identified the 'fear of becoming disabled' as a primary concern in these patients. This concern affected the physical, emotional, mental, and social aspects of their lives. The 'fear of becoming disabled' fell into four categories, including progressive physical disability, mental alteration, decreasing social connectedness, and self-change.

CONCLUSION

The study results showed that older adults with PD face a number of challenges in self-care. In addition, the 'fear of becoming disabled' was the main concern of patients with PD, particularly in late stages of the disease.

Research in Parkinson's disease in India: A review

Parkinson's disease (PD) is a common neurodegenerative disorder affecting patients in large numbers throughout the world. In this article, we review all the published data on PD based on studies in Indian population. We have tried to consolidate the contribution of Indian studies in PD research. We found 95 articles, of which 92 were original research papers. This is a relatively less number, but in the last decade, there has been an increase in research on PD from this country. But most of them seem to be restricted to only a few research institutes. The nonmotor symptoms and genetics are the most commonly studied aspects. The systematic review of the articles reveals that the epidemiology in India may be different with relatively lesser incidence here. Most of the genetic mutations found to cause PD in other population are not found in India, revealing that other genetic factors may be involved. Further research needs to be encouraged to understand the disease in Indian patients better, as all the results cannot be extrapolated from the Western literature to this heterogeneous Indian population. There need to be more studies on therapeutic aspects of the disease.

Postoperative apathy can neutralise benefits in quality of life after subthalamic stimulation for Parkinson's disease

BACKGROUND

Subthalamic nucleus deep brain stimulation (STN-DBS) improves motor symptoms of Parkinson's disease, leading to improvement in health-related quality of life (HRQoL). However, an excessive decrease in dopaminergic medication can lead to a withdrawal syndrome with apathy as the predominant feature. The present study aims to assess the impact of postoperative apathy on HRQoL.

METHODS

A cohort of 88 patients who underwent STN-DBS was divided into two groups, those who were apathetic at 1 year and those who were not, as measured by the Starkstein scale. HRQoL was assessed using the Parkinson's disease questionnaire 39 (PDQ-39) and was compared between the two groups. We also compared activities of daily living, motor improvement and motor complications (Unified Parkinson's Disease Rating Scale, UPDRS), depression and anxiety, as well as cognition and drug dosages. Baseline characteristics and postoperative complications were recorded.

RESULTS

One year after surgery, 27.1% of patients suffered from apathy. While motor improvement was significant and equivalent in both the apathy (-40.4% of UPDRS motor score) and non-apathy groups (-48.6%), the PDQ-39 score did not improve in the apathy group (-5.5%; p=0.464), whereas it improved significantly (-36.7%; p≤0.001) in the non-apathy group. Change in apathy scores correlated significantly with change in HRQoL scores (r=0.278, p=0.009). Depression and anxiety scores remained unchanged from baseline in the apathy group (p=0.409, p=0.075), while they improved significantly in patients without apathy (p=0.006, p≤0.001). A significant correlation was found between changes in apathy and depression (r=0.594, p≤0.001).

CONCLUSIONS

The development of apathy after STN-DBS can cancel out the benefits of motor improvement in terms of HRQoL. Systematic evaluation and management of apathy occurring after subthalamic stimulation appears mandatory.

Cortical activation changes and sub-threshold affective symptoms are associated with social functioning in a non-clinical population: A multi-channel near-infrared spectroscopy study

Few studies have examined the relationship between social function and brain activation in non-clinical populations. The aim of the present study was to assess this relationship and examine the underlying cortical mechanisms in a non-clinical population. Eighty healthy volunteers performed a serial arithmetic task according to the Uchida-Kraepelin performance test while hemoglobin concentration changes were assessed on the surface of the prefrontal cortex (PFC) using 32-channel near-infrared spectroscopy. Participants were also assessed for quality of life (QOL) using the Short-Form 36-item Questionnaire (SF-36), for affective symptoms using the Zung Self-rating Depression Scale (SDS), for apathy using the Apathy Scale, for feelings of stress using the Stress Arousal Checklist (SACL), and for task performance using the number of answers in a serial arithmetic task. Activity in the frontopolar PFC displayed a significant positive correlation with social functioning on the SF-36. SDS and SACL scores correlated negatively with social functioning. Furthermore, in multiple regression analysis, social functioning was predicted by activity of the frontopolar PFC and SDS scores. These results suggest that the association between changes in cortical activation and sub-threshold affective symptoms may objectively identify individuals with QOL on social functioning.

Transcranial Sonography Findings in Depression in Association With Psychiatric and Neurologic Diseases: A Review

The transcranial sonography (TCS) finding of reduced echogenicity of brainstem raphe (hypoechogenic BR) has been associated with depressive states. Here, we review the TCS studies in subjects with depressive disorders and with depression related to degenerative brain diseases, and compare the frequency and clinical correlates of hypoechogenic BR in these reports. Summarizing the data published so far, hypoechogenic BR is present in 67% (range, 37-95%) of depressed but only in 15% (5-36%) of nondepressed subjects without history of neurodegenerative disease. The finding of hypoechogenic BR in these subjects is associated with a relative risk of 3.03 (95% CI, 2.44-3.75; P < .001) of being diagnosed with depression. In patients with Parkinson's disease, hypoechogenic BR is present in 63% (35-92%) of depressed but only in 27% (10-62%) of nondepressed patients, resulting in a relative risk of 2.18 (95% CI, 1.80-2.66; P < .001) of being diagnosed with depression. Hypoechogenic BR is associated with depression in a number of neurological disorders such Huntington's disease, idiopathic Rapid Eye Movement (REM) sleep behavior disorder, myotonic dystrophies, and cerebral small vessel disease. Although some studies did not show any relationship between BR echogenicity and severity of depression, others suggest an association with higher severity of depression, or even with suicidal ideation. In one study BR hypoechogenicity was found to be associated with better responsivity to serotonin reuptake inhibitors. Further studies are warranted to compare the TCS findings of BR alteration with post-mortem histopathological findings, and with genetic variants related to cerebral serotonin metabolism.

Influences of Chronic Mild Stress Exposure on Motor, Non-Motor Impairments and Neurochemical Variables in Specific Brain Areas of MPTP/Probenecid Induced Neurotoxicity in Mice

Parkinson's disease (PD) is regarded as a movement disorder mainly affecting the elderly population and occurs due to progressive loss of dopaminergic (DAergic) neurons in nigrostriatal pathway. Patients suffer from non-motor symptoms (NMS) such as depression, anxiety, fatigue and sleep disorders, which are not well focussed in PD research. Depression in PD is a predominant /complex symptom and its pathology lies exterior to the nigrostriatal system. The main aim of this study is to explore the causative or progressive effect of chronic mild stress (CMS), a paradigm developed as an animal model of depression in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (25 mg/kg. body wt.) with probenecid (250 mg/kg, s.c.) (MPTP/p) induced mice model of PD. After ten i.p. injections (once in 3.5 days for 5 weeks) of MPTP/p or exposure to CMS for 4 weeks, the behavioural (motor and non-motor) impairments, levels and expressions of dopamine (DA), serotonin (5-HT), DAergic markers such as tyrosine hydroxylase (TH), dopamine transporter (DAT), vesicular monoamine transporters-2 (VMAT 2) and α-synuclein in nigrostriatal (striatum (ST) and substantia nigra (SN)) and extra-nigrostriatal (hippocampus, cortex and cerebellum) tissues were analysed. Significantly decreased DA and 5-HT levels, TH, DAT and VMAT 2 expressions and increased motor deficits, anhedonia-like behaviour and α-synuclein expression were found in MPTP/p treated mice. Pre and/or post exposure of CMS to MPTP/p mice further enhanced the MPTP/p induced DA and 5-HT depletion, behaviour abnormalities and protein expressions. Our results could strongly confirm that the exposure of stress after MPTP/p injections worsens the symptoms and neurochemicals status of PD.

Trait Impulsivity and Anhedonia: Two Gateways for the Development of Impulse Control Disorders in Parkinson's Disease?

Apathy and impulsivity are two major comorbid syndromes of Parkinson's disease (PD) that may represent two extremes of a behavioral spectrum modulated by dopamine-dependent processes. PD is characterized by a progressive loss of dopaminergic neurons in the substantia nigra pars compacta to which are attributed the cardinal motor symptoms of the disorder. Dopamine replacement therapy (DRT), used widely to treat these motor symptoms, is often associated with deficits in hedonic processing and motivation, including apathy and depression, as well as impulse control disorders (ICDs). ICDs comprise pathological gambling, hypersexuality, compulsive shopping, binge eating, compulsive overuse of dopaminergic medication, and punding. More frequently observed in males with early onset PD, ICDs are associated not only with comorbid affective symptoms, such as depression and anxiety, but also with behavioral traits, such as novelty seeking and impulsivity, as well as with personal or familial history of alcohol use. This constellation of associated risk factors highlights the importance of inter-individual differences in the vulnerability to develop comorbid psychiatric disorders in PD patients. Additionally, withdrawal from DRT in patients with ICDs frequently unmasks a severe apathetic state, suggesting that apathy and ICDs may be caused by overlapping neurobiological mechanisms within the cortico-striato-thalamo-cortical networks. We suggest that altered hedonic and impulse control processes represent distinct prodromal substrates for the development of these psychiatric symptoms, the etiopathogenic mechanisms of which remain unknown. Specifically, we argue that deficits in hedonic and motivational states and impulse control are mediated by overlapping, yet dissociable, neural mechanisms that differentially interact with DRT to promote the emergence of ICDs in vulnerable individuals. Thus, we provide a novel heuristic framework for basic and clinical research to better define and treat comorbid ICDs in PD.

Accuracy of screening instruments for detection of neuropsychiatric syndromes in Parkinson's disease

Parkinson's disease includes neuropsychiatric manifestations, such as depression, anxiety, apathy, psychosis, and impulse control disorders, which often are unreported by patients and caregivers or undetected by doctors. Given their substantial impact on patients and caregivers as well as the existence of effective therapies for some of these disorders, screening for neuropsychiatric symptoms is important. Instruments for screening have a particular methodology for validation, and their performance is expressed in terms of accuracy compared with formal diagnostic criteria. The present study reviews the attributes of the screening instruments applied for detection of the aforementioned major neuropsychiatric symptoms in Parkinson's disease. A quasi-systematic review (including predefined selection criteria, but not evaluating the quality of the reviewed studies) was carried out on the basis of previous systematic reviews (commissioned by the American Academy of Neurology and the Movement Disorder Society) and made current by conducting a literature search (2005-2014). For depression, 11 scales and questionnaires were shown to be valid for Parkinson's disease screening. The recently developed Parkinson Anxiety Scale and the Geriatric Anxiety Inventory demonstrate satisfactory properties as screening instruments for anxiety, and the Lille Apathy Rating Scale for detection of apathy. No scale adequately screens for psychosis, so a specific psychosis instrument should be developed. The Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (Questionnaire and Rating Scale) are valid for comprehensive screening of impulse control disorders, and the Parkinson's Disease-Sexual Addiction Screening Test for hypersexuality specifically.

Machine learning classification of medication adherence in patients with movement disorders using non-wearable sensors

Medication non-adherence is a major concern in the healthcare industry and has led to increases in health risks and medical costs. For many neurological diseases, adherence to medication regimens can be assessed by observing movement patterns. However, physician observations are typically assessed based on visual inspection of movement and are limited to clinical testing procedures. Consequently, medication adherence is difficult to measure when patients are away from the clinical setting. The authors propose a data mining driven methodology that uses low cost, non-wearable multimodal sensors to model and predict patients' adherence to medication protocols, based on variations in their gait. The authors conduct a study involving Parkinson's disease patients that are "on" and "off" their medication in order to determine the statistical validity of the methodology. The data acquired can then be used to quantify patients' adherence while away from the clinic. Accordingly, this data-driven system may allow for early warnings regarding patient safety. Using whole-body movement data readings from the patients, the authors were able to discriminate between PD patients on and off medication, with accuracies greater than 97% for some patients using an individually customized model and accuracies of 78% for a generalized model containing multiple patient gait data. The proposed methodology and study demonstrate the potential and effectiveness of using low cost, non-wearable hardware and data mining models to monitor medication adherence outside of the traditional healthcare facility. These innovations may allow for cost effective, remote monitoring of treatment of neurological diseases.

Meanings of feeling well among women with Parkinson's disease

We conducted a qualitative inquiry to describe the meanings of feeling well as experienced by women with Parkinson's disease. Nine women were interviewed and we analysed the interviews using a reflective lifeworld approach based on phenomenological epistemology. We present the analysis as five constituents: the body as unnoticed; being able to move on; feeling joy by being connected; finding peace and harmony; and being the director of one's own life. Our findings can be used to understand and promote well-being among women with Parkinson's disease. In care meetings, knowledge about the lived and experienced health processes supports the women's striving to not let illness dominate their experience of daily life.

Evaluation of quality of life and psychological aspects of Parkinson's disease patients who participate in a support group

Parkinson's disease (PD) is a neurodegenerative disorder that can dramatically impair patient quality of life (QoL).

Depressive symptoms in neurodegenerative diseases

Depressive symptoms are very common in chronic conditions. This is true so for neurodegenerative diseases. A number of patients with cognitive decline and dementia due to Alzheimer’s disease and related conditions like Parkinson’s disease, Lewy body disease, vascular dementia, frontotemporal degeneration amongst other entities, experience depressive symptoms in greater or lesser grade at some point during the course of the illness. Depressive symptoms have a particular significance in neurological disorders, specially in neurodegenerative diseases, because brain, mind, behavior and mood relationship. A number of patients may develop depressive symptoms in early stages of the neurologic disease, occurring without clear presence of cognitive decline with only mild cognitive deterioration. Classically, depression constitutes a reliable diagnostic challenge in this setting. However, actually we can recognize and evaluate depressive, cognitive or motor symptoms of neurodegenerative disease in order to establish their clinical significance and to plan some therapeutic strategies. Depressive symptoms can appear also lately, when the neurodegenerative disease is fully developed. The presence of depression and other neuropsychiatric symptoms have a negative impact on the quality-of-life of patients and caregivers. Besides, patients with depressive symptoms also tend to further decrease function and reduce cognitive abilities and also uses to present more affected clinical status, compared with patients without depression. Depressive symptoms are treatable. Early detection of depressive symptoms is very important in patients with neurodegenerative disorders, in order to initiate the most adequate treatment. We review in this paper the main neurodegenerative diseases, focusing in depressive symptoms of each other entities and current recommendations of management and treatment.

Turkish Version Study of "Parkinson's Disease Quality of Life Questionnaire" (PDQL)

INTRODUCTION

This study aimed to evaluate Turkish transcultural adaptation, reliability, and validity of "Parkinson's Disease Quality of Life Questionnaire" (PDQL), which has been developed to assess the quality of life of patients with Parkinson's disease.

METHODS

Eighty-nine patients who were included in the study were diagnosed with Parkinson's disease. They were presented to the outpatient clinic of the Istanbul Faculty of Medicine, Physical Medicine and Rehabilitation department between July 2005 and April 2008. The Turkish translated version of PDQL (PDQL-TR), "Unified Parkinson's Disease Rating Scale" (UPDRS), and Hoehn & Yahr (HY) were used as the main outcome measures.

RESULTS

The calculated Pearson correlation coefficient for PDQL, H&Y, and UPDRS ranged between -0.36 and -0.80. Cronbach's alpha coefficients of the PDQL-TR complete questionnaire and subdomains were higher than 0.80. The absolute value of item-total score correlation coefficients by Pearson fluctuated between 0.40 (question 4-total score) and 0.88 (question 26-total score), whereas the subdomain-total score correlation coefficients ranged between 0.81 and 0.96. PDQL-TR showed high stability according to the ICC results, ranging between 0.75 (Emotional Function) and 0.88 (Parkinsonian Symptoms).

CONCLUSION

The psychometric features of PDQL-TR are satisfactory, and our results are consistent with the previous literature findings. PDQL-TR is a valid and reliable tool to measure health-related quality of life in patients with Parkinson's disease.

Quality of life in primary headache disorders: A review

BACKGROUND

Health-related quality of life (HRQoL) is emerging as an important element of clinical research in primary headache disorders, allowing a measure of the impact of headache on patients' well-being and daily life. A better understanding of this may contribute to improved resource allocations and treatment approaches.

OBJECTIVE

The objective of this study is to review available data on HRQoL in primary headache disorders and identify any influencing factors.

METHODS

Database searches including MEDLINE, PsycINFO and EMBASE were performed. Studies that investigated HRQoL in patients with primary headache disorders were included and reviewed. Trials that evaluated the efficacy of medications or interventions were excluded.

RESULTS

A total of 80 articles were included in the review. Both physical and emotional/mental aspects of HRQoL were impaired across headache subtypes, although the extent varied depending on headache type. A number of factors influencing HRQoL were also identified.

CONCLUSION

This narrative review suggests that headache, particularly in its chronic form, has a great impact on HRQoL. Clinical practice should not solely focus on pain alleviation but rather adopt routine assessment of HRQoL. Furthermore, identification and management of associated psychological comorbidities, which can significantly influence HRQoL in headache sufferers, are essential for optimal clinical management.

Non-motor signs in Parkinson's disease: a review

During the past decade the view of Parkinson's disease (PD) as a motor disorder has changed significantly and currently it is recognized as a multisystem process with diverse non-motor signs (NMS). In addition to been extremely common, these NMS play a major role in undermining functionality and quality of life. On the other hand, NMS are under recognized by physicians and neglected by patients. Here, we review the most common NMS in PD, including cognitive, psychiatric, sleep, metabolic, and sensory disturbances, discuss the current knowledge from biological, epidemiological, clinical, and prognostic standpoints, highlighting the need for early recognition and management.

Parkinson's Disease, Depression, and Quality-of-Life

BACKGROUND

Depression is the most common psychiatric disorder associated with Parkinson's disease (PD) but is often under diagnosed and under treated leading to worsening of symptoms and deterioration of the quality-of-life of the people suffering from this disease.

AIMS

The current study aims to determine the correlation between depression and health-related quality-of-life (HRQOL) domains in patients with PD.

MATERIALS AND METHODS

A sample of 65 consecutive patients attending the specialty Parkinson's clinic was assessed by a psychiatrist as part of the treatment protocol. Diagnosis of depression was done using the International Classification of Diseases-10 by a psychiatrist and depression was scored using the Geriatric Depression Scale (GDS). QOL-BREF Malayalam version was used to assess quality-of-life in the patients.

STATISTICAL ANALYSIS

One-way ANOVA was used to find the difference in the quality-of-life experienced by different age categories, duration of the disease, psychiatric co-morbidity. Independent sample t-test was used to find the difference in the quality-of-life experienced by genders, co morbid conditions and to find the difference in the scores on GDS and domains of WHO QOL BREF. Association of H and Y staging and duration of Parkinsonism with GDS Scores were computed using Pearson's Chi-square test.

RESULTS AND CONCLUSIONS

There was a significant association of female gender and depression with the physical and psychological domains of QOL while the duration and staging of PD did not have any association with QOL Domains. Depression thus emerges as one of the main predictors of poor quality-of-life in PD.

L-Dopa and Brain Serotonin System Dysfunction

L-dopa is used to treat the motor symptoms associated with Parkinson's disease, a neurodegenerative movement disorder characterized by a loss of dopamine neurons. L-dopa is the precursor to dopamine and crosses the blood-brain barrier to increase dopamine neurotransmission. This review will focus on the findings that dopamine produced from L-dopa is mediated in part by serotonin neurons. Direct evidence will be provided that increases in dopamine cause oxidative stress and damage serotonin neurons. Similarly, chronic L-dopa produces deficits in serotonin neurotransmission, including decreases in both serotonin cell bodies within the dorsal raphe and serotonin neurotransmitter concentrations in several forebrain regions. Since serotonin is involved in many important physiological processes including mood and cognition, L-dopa induced serotonin deficits may play a role in the side-effect symptoms observed in Parkinson's disease patients treated with L-dopa.

A randomized controlled pilot study of the therapeutic effects of yoga in people with Parkinson's disease

Background:

Exercise can be beneficial for cardiopulmonary, musculoskeletal or neurological systems, and other factors including mood, and may be beneficial in reducing fall risks, dementia and variables associated with quality of life (QOL). Parkinson's disease (PD) produces progressive motor and cognitive deterioration that may leave those inflicted unable to participate in standard exercise programs. Alternative forms of exercise such as yoga may be successful in improving physical function, QOL and physiological variables for overall well-being.

Aim:

This randomized controlled pilot study investigated the effectiveness of yoga intervention on physiological and health-related QOL measures in people with PD.

Methods and Materials:

Thirteen people with stage 1-2 PD were randomized to either a yoga (n = 8) or a control group (n = 5). The yoga group participated in twice-weekly yoga sessions for 12 weeks. Participants were tested at baseline, and at 6 and 12 weeks using the Unified Parkinson's Disease Rating Scale (UPDRS), clinical measures of health-related QOL and physiological measures.

Results:

Significant improvement in UPDRS scores (P = .006), diastolic blood pressure (P = 0.036) and average forced vital capacity (P = 0.03) was noted in the yoga group over time. Changes between groups were also noted in two SF-36 subscales. Positive trends of improvement were noted in depression scores (P = 0.056), body weight (P = 0.056) and forced expiratory volume (P = 0.059). Yoga participants reported more positive symptom changes including immediate tremor reduction.

Conclusions:

The results suggest that yoga may improve aspects of QOL and physiological functions in stages 1-2 PD. Future larger studies are needed to confirm and extend our findings of the effects of yoga in PD.

Anxiety and Depression Are Better Correlates of Parkinson's Disease Quality of Life Than Apathy

Due to controversy regarding the influence of apathy on quality of life (QoL), the authors examined the independent influence of apathy, depression, and trait anxiety in a nondemented sample of patients with Parkinson disease (PD). Participants (N=107) completed standard self-report measures of QoL and mood/motivation. Analyses investigated the contribution of these measures and empirically derived factor scores on QoL. QoL was predicted by trait anxiety, dysphoria, and decreased interest, with no independent contribution of apathy. Different patterns emerged with respect to domain-specific QoL, with trait anxiety being the strongest predictor across most domains. Anxiety was most widely related to QoL in PD, with minimal contribution of apathy. Future studies should examine different roles of PD mood/motivation symptoms on caregiver QoL.

Abnormal functional connectivity of the amygdala is associated with depression in Parkinson's disease

Depressive symptoms are common in Parkinson's disease (PD), but the pathophysiology and neural basis underlying depression in PD is not well understood. Abnormal functional connectivity of the amygdala with various cortical and subcortical areas has been observed in major depressive disorder, indicating that dysfunction of the corticolimbic network may be involved in the pathogenesis of major depressive disorder. However, little is known about alterations of amygdala functional connectivity in depressed PD patients. In the present study, 20 depressed PD patients, 40 nondepressed PD patients, and 43 matched healthy controls underwent neuropsychological tests and resting-state functional MRI scanning. Between-group differences in amygdala functional connectivity network were examined using t tests. Compared to the nondepressed PD patients, depressed PD patients showed increased left amygdala functional connectivity with the bilateral mediodorsal thalamus, right amygdala functional connectivity with the left superior temporal gyrus, and left calcarine gyrus. Compared to the healthy controls, the depressed PD group also showed increased left amygdala functional connectivity with the bilateral mediodorsal thalamus, but decreased left amygdala functional connectivity with the left putamen, left inferior frontal gyrus, and the right cerebellum, as well as decreased right amygdala functional connectivity with the left inferior orbitofrontal gyrus, the left gyrus rectus, and the right putamen. The increased connectivity between limbic regions and decreased connectivity between the corticolimbic networks may reflect impaired high-order cortical regulatory effects on the emotion-related limbic areas, which may lead to mood dysregulation. Our study should advance the understanding of neural mechanisms underlying depression in PD.

Is the kidney disease quality of life-36 (KDQOL-36) a valid instrument for Chinese dialysis patients?

Background

The aim of this study is to determine the validity and reliability of the Cantonese Chinese version of the Kidney Disease Quality of Life-36 (KDQOL-36™) questionnaire. The scale has been translated into Cantonese Chinese, but has not been tested among the Cantonese-speaking populations.

Methods

A total of 110 dialysis patients and 122 renal transplant patients were recruited. The data for the KDQOL-36™ were extracted from the KDQOL-Short Form. The criterion validity and scale equivalence were examined using the KDQOL-Short Form scores as the gold standard. The Hospital Anxiety and Depression scale was used to identify the correlations between depression, anxiety, and quality of life to establish the convergent validity. Discriminant validity was examined using the transplant patients to compare the quality of life of dialysis patients. The Cronbach’s alpha coefficient and test-retest were used for estimating reliability.

Results

There were very strong positive correlations for the physical and mental component summary between the KDQOL-36™ and KDQOL-Short Form. Despite the strong correlations, the effect size was 0.6 and 0.13 for the physical composite summary and mental composite summary score, respectively. Most of the subscales demonstrated significant moderate correlations with the Hospital Anxiety and Depression Scale, from -0.265 to -0.516. The discriminant validity was confirmed with a significant difference between the dialysis and transplant group patients. A high intraclass correlation of >0.98 was demonstrated in the test-retest.

Conclusion

The Cantonese Chinese KDQOL-36™ was reliable. Further testing will be required to determine its validity for the physical health summary scale.

Spontaneous locomotor activity and L-DOPA-induced dyskinesia are not linked in 6-OHDA parkinsonian rats

Bradykinesia (slowness of movement) and other characteristic motor manifestations of Parkinson's disease (PD) are alleviated by treatment with L-dihydroxyphenylalanine (L-DOPA). Long-term L-DOPA treatment, however, is associated with complications such as motor fluctuations and dyskinesia that severely impair the quality of life. It is unclear whether the effect of L-DOPA on spontaneous motor activity and its dyskinesia-inducing effect share a common mechanism. To investigate the possible connection between these two effects, we analyzed the spontaneous locomotor activity of parkinsonian rats before surgery (unilateral injection of 6-OHDA in the right medial forebrain bundle), before treatment with L-DOPA, during L-DOPA treatment (the "ON" phase), and after the end of L-DOPA treatment (the "OFF" phase). We correlated the severity of dyskinesia (AIM scores) with locomotor responses in the ON/OFF phases of chronic L-DOPA treatment at two different doses. We treated three groups of parkinsonian animals with chronic injections of 8 mg/kg L-DOPA, 6 mg/kg L-DOPA, and saline solution and one group of non-lesioned animals with 8 mg/kg L-DOPA. At the end of the experiment, tyrosine hydroxylase (TH) immunoreactivity was analyzed in the striatum of all parkinsonian rats. We found no correlation between the severity of dyskinesia and spontaneous locomotor activity in the ON or OFF phase of L-DOPA treatment. The only observed correlation was between the pathological rotation induced by L-DOPA at the highest dose and locomotor activity in the ON phase of L-DOPA treatment. In addition, a L-DOPA withdrawal effect was observed, with worse motor performance in the OFF phase than before the start of L-DOPA treatment. These findings suggest that different neural mechanisms underlie the effect of L-DOPA on spontaneous motor activity and its dyskinesia-inducing effect, with a different dose-response relationship for each of these two effects.

Influence of depressive symptoms on dopaminergic treatment of Parkinson's disease

Introduction: Depressive symptoms are very common in patients with Parkinson’s disease (PD) and have a significant impact on the quality of life. Dopaminergic medication has been shown to have an influence on the development of depressive symptoms.

Materials and methods: The present study analyzed two groups of non-demented patients with PD, with and without depressive symptoms, and reported the correlations between antiparkinsonian medication [specifically levodopa (l-DOPA) and dopaminergic agonists] with depressive symptoms.

Results: A strong statistically significant positive correlation between l-DOPA dosages and the level of depressive symptoms has been revealed, suggesting that higher l-DOPA dosages correlate with a worsening of depressive status. No significant correlation was found with dopamine agonists.

Discussion: The results of this study show that in patients with PD, higher l-DOPA dosages correlate with worse depressive symptoms. From this point of view, PD patients need to be better diagnosed with respect to depressive symptoms and need additional treatment adjustment when clinical manifestations of depression are present. Clinicians must be aware that dopaminergic drugs are not sufficient to alleviate depressive symptoms.

Systematic Review of Traditional Chinese Medicine for Depression in Parkinson's Disease

Depression is the most common non-motor symptom of Parkinson's disease (PD). Recent clinical trials have evaluated the effectiveness of traditional Chinese medicine (TCM) in the treatment of depression in PD (dPD). However, the results are conflicting rather than conclusive. To investigate the effectiveness of TCM for the treatment of dPD, a systematic review was conducted. Literature searches and collections were performed to identify studies addressing the treatment of TCM for dPD. The methodological quality and risk of bias in all studies included were evaluated. Weighted mean difference (WMD) with 95% confidence interval (CI) was used as the effect measure. Finally, a total of 10 studies involving 582 patients were identified. The pooled results revealed that TCM combined with conventional drugs significantly improved the total scores of the unified Parkinson's disease rating scale (WMD = -7.35, 95% CI: -11.24 to -3.47) and the score of the Hamilton rating scale for depression (HAM-D) (WMD = -4.19, 95% CI: -5.14 to -3.24) compared with conventional drug, respectively. Conclusively, there is evidence that TCM may be beneficial to the treatment of dPD in spite of the methodological weakness of the included studies.

The cognition and emotional well-being indices of the Parkinson's disease questionnaire-39: what do they really measure?

INTRODUCTION

The Parkinson's disease questionnaire-39 (PDQ-39) is a common measure of health related quality of life (HRQoL) that is widely used with Parkinson disease (PD) patients. Previous evidence suggests that the PDQ-39 reflects at least 8 dimensions (i.e., Emotion, Cognitions, Mobility, etc). To date, little research has examined the external/convergent validity of the Cognitions and Emotional Well-being domains of the PDQ-39.

METHODS

A convenience sample of 303 PD patients underwent a comprehensive multi-domain neuropsychological evaluation, including tests of execution function, episodic verbal memory, processing speed, language and working memory, as well as completing measures of depression, apathy, state and trait anxiety and HRQoL (PDQ-39). Hierarchical regressions were conducted in order to examine the relationship between scores on neuropsychological tests and the Cognitions index, as well as mood measures and the Emotional Well-being index of the PDQ-39.

RESULTS

Neuropsychological test performance did not account for a significant amount of variance in the PDQ-39 Cognitions index scores. Instead, it was depression that significantly contributed to the Cognitions index, above and beyond neuropsychological performance. The PDQ-39 Emotional Well-being index was also related to mood measures, primarily depression and trait anxiety.

CONCLUSIONS

The PDQ-39 Cognition index may be more related to mood functioning, as opposed to cognitive functioning, and should not be considered a "proxy" for cognitive functioning. Future studies are needed to better explain the construct of this index.

Granulocyte-colony stimulating factor improves Parkinson's disease associated with co-morbid depression: an experimental exploratory study

Introduction:

The present study was designed to evaluate the effect of granulocyte-colony stimulating factor (G-CSF) in the treatment of Parkinson's disease (PD), the second most common neurodegenerative disease characterized by muscle and movement disorder, often associated with depression. PD is very difficult to treat. Hence, the present study was aimed to evaluate the effect of G-CSF in PD associated with depression.

Materials and Methods:

Adult Wistar male rats weighing about 180-250 g were selected and divided into five groups in parallel designed method namely; control group (n = 5); sham operated group (n = 5); Vehicle group (n = 5); G-CSF group (70 μg/kg, s.c.) (n = 5) and L-DOPA group (n = 5). The rats were treated with 6-hydroxydopamine (6-OHDA) on day 0 and then treatment was continued for 14 day of L-DOPA/carbidopa, whereas G-CSF (70 μg/kg, s.c.) was given from day 1 to 6. Thereafter, adhesive removal and forced swim tests were conducted to evaluate the behavioral outcome of G-CSF treatment. The finding was correlated and analyzed with Nissl staining findings for the final conclusion.

Results:

The behavioral parameters were assessed and found to be ameliorate the symptoms of Parkinson's and reduced the depression like behavior in PD. The histological findings were supported the behavioral findings and showed pathological improvement.

Conclusion:

As a preliminary work, the present study first time suggested that G-CSF have a potential role in PD and associated depression.

Depression and voice handicap in Parkinson disease

BACKGROUND

Dysphonia is common in Parkinson's disease (PD), but the mechanism underlying the development remains unclear. This study investigated possible clinical factors related to PD dysphonia.

METHODS

Dysphonia severity was assessed in 147 non-demented patients with PD and 30 non-PD controls using the Voice Handicap Index (VHI)-10. A threshold of 12 VHI-10 score was used to define the presence of dysphonia. The severity of PD and depression was measured using the Unified Parkinson's Disease Rating Scale (UPDRS)-motor and the Geriatric Depression Scale (GDS).

RESULTS

Dysphonia was observed in 52 patients (35.4%). Patients with dysphonia scored higher on the UPDRS and GDS scores compared with patients without dysphonia. Multivariate logistic regression analysis revealed that GDS was the only factor significantly associated with the presence of dysphonia. Non-PD controls did not show this association.

CONCLUSIONS

The results support a high prevalence of dysphonia in patients with PD, and suggest that the presence of dysphonia is more closely related to depression than to the severity of PD.

Dopaminergic modulation of emotional conflict in Parkinson's disease

Neuropsychiatric fluctuations in Parkinson's disease (PD) are frequent and disabling. One way to investigate them is to assess the ability to inhibit distractive emotional information by a modified emotional Stroop (ES) task. We compared non-depressed, non-demented PD patients with healthy controls. During an acute levodopa challenge, patients performed a modified ES task during functional MRI and a neuropsychological assessment including Visual Analog Mood (VAMS) and Apathy scales. Ten patients and 12 controls completed the study. The VAMS scores were significantly improved by the acute intake of levodopa (p = 0.02), as was the apathy score (p = 0.03). Negative ES task (i.e. fearful facial expressions with the words "happy" or "fear" written across them), induced a lengthening of the mean reaction time during the incongruent trials compared with the congruent trials in controls (relative difference = 2.7%, p < 0.001) and in ON patients (relative difference = 5.9%, p < 0.001), but not in OFF patients (relative difference = 1.7%, p = 0.28). Controls and ON patients displayed greater activation than OFF patients within the right pregenual anterior cingulate cortex (pACC), an area specifically involved in emotional conflict resolution (p < 0.001 and p < 0.008 respectively, k > 5 uncorrected). No difference in the activation of the pACC was found between controls and ON patients, suggesting a normalization of the activation following levodopa administration. These results suggest that emotional conflict processes could be dopamine-dependent. Pregenual ACC hypoactivation could be directly due to the degeneration of dopaminergic mesocorticolimbic pathway. Our results propose that neuropsychiatric fluctuations in PD patients could be partially explained by pACC hypoactivation and that adjustments of dopaminergic medication might be helpful for their treatment.

Activities of daily living, depression, and quality of life in Parkinson's disease

This study examined whether activities of daily living (ADL) mediate the relationship between depression and health-related quality of life (HR-QOL) in people with Parkinson's disease (PD). A cross-sectional, correlational research design examined data from 174 participants who completed the Geriatric Depression Scale (GDS-15), Parkinson's Disease Questionnaire-39 (PDQ-39), and Unified Parkinson's Disease Rating Scale-section 2 (UPDRS-section 2 [ADL]). Multiple Regression Analysis (MRA) was used to examine the mediator model. Depression and ADL significantly (p<.001) predicted HR-QOL, and depression significantly (p<.001) predicted ADL. Whilst ADL did not impact on the relationship between depression and HR-QOL, there was a significant (p<.001) indirect effect of depression on HR-QOL via ADL, suggesting both direct and indirect (via ADL) effects of depression on HR-QOL. The magnitude of this effect was moderate (R² = .13). People with PD who report depression also experience greater difficulty completing ADL, which impacts upon their HR-QOL. It is recommended that clinicians adopt a multidisciplinary approach to care by combining pharmacological treatments with psycho/occupational therapy, thereby alleviating the heterogeneous impact of motor and non-motor symptoms on HR-QOL in people with PD.

Disrupted social connectedness in people with Parkinson's disease

A study was conducted to explore the effects of Parkinson's disease on people's social interactions. An exploratory qualitative design was used. Participants were a purposive sample of 10 people with Parkinson's disease who were attending a hospital outpatients' neurology clinic. Data were collected by semi-structured in-depth interviews. All interviews were transcribed and analysed by using conventional content analysis to explore the participants' experiences and perceptions on social interactions, using the central question 'what effect does Parkinson's disease have on people's social interactions?' Analysis revealed that Parkinson's disease affected social interactions by disrupting social connectedness. Social connectedness was disrupted by a number of factors, including 'progressive physical disability, mood disturbances, shrinking of social activities and secluding oneself. Older adults with Parkinson's disease therefore face a number of challenges to remaining socially connected. It appears that disrupted social connectedness is one of the negative consequences of living with Parkinson's.

PREDICTING THE EQ-5D FROM THE PARKINSON'S DISEASE QUESTIONNAIRE PDQ-8 USING MULTI-DIMENSIONAL BAYESIAN NETWORK CLASSIFIERS

The impact of the Parkinson's disease and its treatment on the patients' health-related quality of life can be estimated either by means of generic measures such as the european quality of Life-5 Dimensions (EQ-5D) or specific measures such as the 8-item Parkinson's disease questionnaire (PDQ-8). In clinical studies, PDQ-8 could be used in detriment of EQ-5D due to the lack of resources, time or clinical interest in generic measures. Nevertheless, PDQ-8 cannot be applied in cost-effectiveness analyses which require generic measures and quantitative utility scores, such as EQ-5D. To deal with this problem, a commonly used solution is the prediction of EQ-5D from PDQ-8. In this paper, we propose a new probabilistic method to predict EQ-5D from PDQ-8 using multi-dimensional Bayesian network classifiers. Our approach is evaluated using five-fold cross-validation experiments carried out on a Parkinson's data set containing 488 patients, and is compared with two additional Bayesian network-based approaches, two commonly used mapping methods namely, ordinary least squares and censored least absolute deviations, and a deterministic model. Experimental results are promising in terms of predictive performance as well as the identification of dependence relationships among EQ-5D and PDQ-8 items that the mapping approaches are unable to detect.

Timed up and go, cognitive, and quality-of-life correlates in Parkinson's disease

OBJECTIVE

To examine the relationship between Timed Up and Go (TUG) performance, verbal executive function (EF) performance, and quality-of-life (QOL) measures in Parkinson's disease (PD).

DESIGN

Cross-sectional.

SETTING

Sixteen movement disorder centers from across the United States.

PARTICIPANTS

Patients with PD (N=1964).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

TUG test, immediate and delayed 5-word recall, verbal fluency, PD QOL Questionnaire.

RESULTS

TUG performance and verbal EF performance were significantly associated with, and predictors of, QOL measures, having the greatest association and predictability with the mobility domain of the QOL measures.

CONCLUSIONS

The TUG test and verbal EF tests have QOL correlates, making the combined evaluation of mobility, cognitive, and QOL decline a potential examination tool to evaluate the sequelae of PD.

Patients' expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson's disease: a mixed-method approach

OBJECTIVE

To study patients' expectations of subthalamic deep brain stimulation (STN-DBS) and their subjective perceived outcome, by using qualitative and quantitative methods in Parkinson's disease (PD).

METHODS

PD patients were prospectively examined before and 3 months after surgery. Semistructured interviews regarding preoperative expectations and postsurgical subjective perceived outcome were conducted. These were analysed using content analysis. For statistical analyses, patients were classified according to their subjective perceived outcome, resulting in three different subjective outcome groups (negative, mixed, positive outcome). The groups were used for multiple comparisons between and within each group regarding motor impairment, quality of life (QoL), neuropsychiatric status and cognitive functioning, using standard instruments. A logistic regression analysis was conducted to find predictors of subjective negative outcome. Receiver operating characteristic curves were used to analyse cut-off scores for predictive tests.

RESULTS

Of the 30 PD patients participating, 8 had a subjective negative outcome, 8 a mixed and 14 a positive outcome. All groups significantly improved in motor functioning. Patients with subjective negative outcome were characterised by preoperative unrealistic expectations, no postsurgical improvement in QoL, and significantly higher presurgical and postsurgical apathy and depression scores. Higher preoperative apathy and depression scores were significant predictors of negative subjective outcome. Cut-off scores for apathy and depression were identified.

CONCLUSIONS

The mixed-method approach proved useful in examining a patient's subjective perception of STN-DBS outcome. Our results show that significant motor improvement does not necessarily lead to a positive subjective outcome. Moreover, PD patients should be screened carefully before surgery regarding apathy and depression. (DRKS-ID: DRKS00003221).

Clinical issues in the treatment of anxiety and depression in older adults with Parkinson's disease

A significant proportion of persons affected by Parkinson's disease (PD) are over age 65 years. Mental health issues are often less a focus of treatment in this population than physical manifestations of the illness. Anxiety or depression alone, as well as comorbid depression and anxiety, are underrecognized in patients with PD and are associated with deleterious effects on physical and interpersonal functioning, negatively impacting quality of life and well-being. We offer a brief overview of salient clinical points with respect to assessment and treatment approaches to enhance efficacy of the treatment of mental health symptoms in older adults with PD. Cognitive behavior therapy involves the patient learning to overcome behavioral avoidance associated with anxiety and challenge unhelpful negative cognitions. It is suggested that cognitive behavior therapy is an effective approach to treatment of anxiety and depression in PD and should be offered as a treatment to patients.

Effect of impulse control disorders on disability and quality of life in Parkinson's disease patients

Impulse control and related disorders (ICRD) are not uncommon in patients with idiopathic Parkinson's disease (PD). The present study aimed to investigate the effects of ICRD on quality of life (QoL) and disability in PD. From two movement disorder clinics in Sydney, Australia, 100 consecutive patients with PD were included in the trial. The Unified Parkinson's Disease Rating Scale (UPDRS), Mini Mental State Examination and the Parkinson's Disease Questionnaire-39 were used to measure disease severity, cognition and disease-specific QoL. The diagnosis of ICRD was based on face-to-face structured clinical interviews by three psychiatrists with experience in ICRD using the Expanded Structured Clinical Interview for the Diagnostic and Statistical Manual IV for Obsessive-Compulsive Disorder Related/Spectrum Disorders. ICRD were present in 15% of our patient population, and had a negative impact on QoL and Activity of Daily Living (ADL) scores. After adjusting for the presence of major depressive disorders and PD duration, the effect on emotional wellbeing remained statistically significant (p<0.004). Disease duration also correlated with worse QoL and ADL scores. Major depression disorders reduced QoL but not ADL. Patients with ICRD tended to suffer more from depression than those without ICRD. There were no statistically significant differences in age, sex, major depressive disorders, PD duration, total levodopa equivalent daily dose, use of dopamine agonists, or UPDRS motor score between patients with and without ICDR.

Negative correlation between affective symptoms and prefrontal activation during a verbal fluency task: a near-infrared spectroscopy study

Only a few studies have examined the relationships between affective symptoms, cognitive function (e.g. verbal fluency), quality of life (QOL), and brain activation in a nonclinical population. The aim of the present study was to assess these relationships and examine the underlying cortical mechanisms in a nonclinical population. Fifty-two healthy male volunteers were assessed for depressive symptoms using the Zung Self-Rating Depression Scale (SDS), for apathy using the Apathy Scale, and QOL using the Medical Outcomes Study short-form 36-item questionnaire (SF36). The volunteers also performed a verbal fluency test (VFT) while hemoglobin concentration changes were assessed on the surface of the frontal cortex using 24-channel near-infrared spectroscopy (NIRS). The SDS and Apathy Scale scores showed significant negative correlations with the scores of most of the SF36 subscales. Frontal activation had a significant negative correlation with the SDS scores and the Apathy Scale. These results suggest that the degree of affective symptoms is associated with a lower QOL in a nonclinical population, and that cortical hypoactivation during a VFT measured by NIRS may objectively identify individuals with a high degree of affective symptoms.