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Even C, Weintraub D. Is depression in Parkinson's disease (PD) a specific entity? J Affect Disord 2012; 139:103-12. [PMID: 21794923 DOI: 10.1016/j.jad.2011.07.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 07/04/2011] [Accepted: 07/04/2011] [Indexed: 12/29/2022]
Abstract
BACKGROUND Clinical lore and research have suggested for a long time that depression and PD are closely related. We examined the validity of depression associated with PD (dPD) as a specific subtype of depression according to face validity, descriptive validity, construct validity and predictive validity. METHODS The English literature was reviewed after searching the MEDLINE database up to June 2010. RESULTS There appears to be three possible subtypes of comorbid depression: 1) patients who would have been depressed even if they had no PD (nonspecific-casual comorbid dPD), 2) patients who would have been depressed if they had had another disabling medical illness (nonspecific-reactive comorbid dPD) 3) those for which depression is directly related to the underlying pathophysiology of PD (specific comorbid dPD). These latter patients may more often present with particular clinical characteristics (descriptive validity): absence of history of depression or only within 5 years prior to onset of PD, absence of guilty thoughts and self-blame, absence of suicidal behavior, right-sided onset. However, dPD is only partly responsive to dopamine replacement and cannot be solely explained by dopamine deficiency. Other neurotransmitter systems are affected in PD and are involved in the pathophysiology of dPD. Their relative involvement however may differ from that in idiopathic depression (i.e.: lesser involvement of serotonergic systems). LIMITATIONS Therapeutic data are limited to few controlled trials. CONCLUSIONS Further research may allow differential diagnosis between dPD subtypes (i.e.: those who do and do not result from the underlying pathophysiological process of PD) and help inform treatment choice.
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Affiliation(s)
- Christian Even
- Clinique des Maladies Mentales et de l'Encéphale, Centre Hospitalier Sainte-Anne, Paris, France.
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102
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Yang S, Sajatovic M, Walter BL. Psychosocial interventions for depression and anxiety in Parkinson's disease. J Geriatr Psychiatry Neurol 2012; 25:113-21. [PMID: 22689704 DOI: 10.1177/0891988712445096] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Depression has been estimated to affect 1 in 3 individuals with Parkinson's disease (PD) and can lead to worse health outcomes and decreased quality of life. Anxiety further complicates PD outcomes. Pharmacologic treatments of depression and anxiety can have negative side effects in patients with PD, including exacerbation of PD symptoms. There is a critical need for alternative treatment approaches that address depression and anxiety among patients with PD. Psychosocial or behavioral approaches are known to be effective for depression generally, but only a handful of studies have examined the role of psychosocial treatments of patients with depression in PD. OBJECTIVE The aim of this article was to review published psychosocial treatment studies of depression and anxiety in patients with PD. METHODS The PubMed database was searched for articles published in English before April 2011 using the terms Parkinson's disease, depression, anxiety, psychotherapy, cognitive therapy, behavioral treatment, behavioral therapy, nonpharmacologic treatment, psychoeducation, education, psychosocial treatment, and stress management. Articles included were prospective clinical trials utilizing specific depression or anxiety assessments as primary or secondary outcomes in patients with PD. RESULTS Nine reports derived from 8 separate studies fit the inclusion criteria and were included in this review. All studies were published between 1997 and 2011, and all but 3 had small sample sizes (<40 patients). Interventions included cognitive behavioral therapy (CBT), psychodrama, education, and behavior therapy as well as multidisciplinary rehabilitation. Cognitive behavioral therapy was the most studied and was shown to decrease depressive and anxiety symptoms in patients with PD. Other individual and group therapies may improve depression and anxiety in patients with PD, but the general paucity of studies and study methods limit the interpretation of these results. CONCLUSIONS There have been few studies on psychosocial treatments that specifically assess change in depression and anxiety among patients with PD. While results for CBT and other modes of therapy are promising for acute management of depression and anxiety, longer term effects after treatment have been variable. There is a need for additional studies on psychosocial interventions in people with PD.
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Affiliation(s)
- Sarah Yang
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
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103
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Dobkin RD, Rubino JT, Allen LA, Friedman J, Gara MA, Mark MH, Menza M. Predictors of treatment response to cognitive-behavioral therapy for depression in Parkinson's disease. J Consult Clin Psychol 2012; 80:694-9. [PMID: 22409644 DOI: 10.1037/a0027695] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of this study was to examine predictors of treatment response to cognitive-behavioral therapy (CBT) for depression in Parkinson's disease (PD). METHOD The sample comprised 80 depressed (DSM-IV criteria) adults with PD (60% male) and their caregivers who participated in an National Institutes of Health-sponsored randomized-controlled trial of CBT vs. clinical monitoring from April 2007 until July 2010. Individually administered CBT was provided to people with PD for 10 weeks, modified to address the unique needs of the medical population, and supplemented with up to 4 separate caregiver educational sessions. Treatment response was defined a priori as a rating of depression much improved or very much improved on the Clinical Global Impression-Improvement Scale or ≥ 50% reduction in the baseline Hamilton Depression Rating Scale score. It was hypothesized (a priori) that caregiver participation in treatment, motor disability, psychiatric comorbidity, and executive functioning would be significant predictors of response to CBT at end-of-treatment (Week 10) and short-term follow-up (Week 14). RESULTS At Week 10, caregiver participation was the only significant predictor of treatment response in the CBT group. At Week 14, both caregiver participation and executive functioning predicted response to CBT. Treatment group, baseline depression severity, executive functioning, motor disability, psychiatric comorbidity, marital status, and caregiver burden were also related to change in depression scores, for all participants, in secondary and exploratory models. CONCLUSIONS Caregiver participation may enhance acute treatment response to psychosocial interventions for depression in PD. Further research is needed to extend and replicate 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 08854, USA.
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104
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Lomax C, Brown RG, Chaudhuri KR, Howard RJ. Behavioural and Psychiatric Symptoms in Patients With Neurodegenerative Diseases. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.2005.6.3.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractNeuropsychiatric symptoms are common features in patients with neurodegenerative diseases, and have important clinical implications for both patients and caregivers. This study used the Neuropsychiatric Inventory (NPI) to measure symptomatology in 120 patients drawn from five disease groups: Parkinson's disease (PD), Alzheimer's disease (AD), dementia associated with Lewy bodies (DLB), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). Ninety per cent of the patient group reported experiencing at least one symptom, with the most prevalent symptoms being depression and apathy. However, a differential pattern of symptomatology was reported across the disease groups, a finding which has diagnostic and treatment implications. Furthermore, this provides additional evidence that a broad cortical–subcortical distinction cannot be supported.
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105
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Zahodne LB, Marsiske M, Okun MS, Rodriguez RL, Malaty I, Bowers D. Mood and motor trajectories in Parkinson's disease: multivariate latent growth curve modeling. Neuropsychology 2012; 26:71-80. [PMID: 22142359 PMCID: PMC3296901 DOI: 10.1037/a0025119] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Apathy is a common feature of Parkinson's disease (PD) that can manifest independently of depression, but little is known about its natural progression in medically managed patients. The present study sought to characterize and compare trajectories of apathy, depression, and motor symptoms in PD over 18 months. METHOD Data from a sample of 186 PD patients (mean disease duration of 8.2 years) followed by the University of Florida Movement Disorders Center were obtained from a clinical research database. Scores on the Unified Parkinson's disease Rating Scale (motor portion), Apathy Scale, and Beck Depression Inventory at three time-points (baseline, 6 months, 18 months) were analyzed in a structural equation modeling framework. RESULTS A multivariate growth model controlling for age, sex, education, and disease duration identified linear worsening of both apathy (slope estimate = 0.73; p < .001) and motor symptoms (slope estimate = 1.51; p < .001), and quadratic changes in depression (slope estimate = 1.18; p = .07). All symptoms were positively correlated. Higher education was associated with lower apathy, depression, and motor severity. Advanced age was associated with greater motor and apathy severity. Female sex and longer disease duration were associated with attenuated motor worsening. Antidepressant use was associated only with depression scores. CONCLUSIONS These longitudinal results support the differentiation of apathy and depression in PD. Like motor progression, apathy progression may be linked at least partially to dopaminergic neurodegeneration. Empirically supported treatments for apathy in PD are needed.
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Affiliation(s)
- Laura B Zahodne
- Department of Clinical and Health Psychology, University of Florida, P. O. Box 100165, Gainesville, FL 32610-0165, USA.
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Abstract
Depression occurs in around 35% of patients with Parkinson disease (PD) and is often persistent. Symptoms of depression can be evident in individuals at the time of diagnosis and might develop in the premotor stage of the disease. The underlying mechanisms of depression in PD are not known in detail, but changes in brain structure, signaling by neurotransmitters, and levels of inflammatory and neurotrophic factors are all suggested to contribute to its development. Psychosocial factors and pain could also have roles in depression. Changes in dopaminergic, noradrenergic and serotonergic systems in patients with PD might help to explain the incidence of depression in these individuals. Antidepressants that have dual serotonergic and noradrenergic effects are the drugs of choice for treating depression in PD. However, antiparkinsonian drugs might have beneficial effects not only on the motor symptoms of disease, but also on a patient's mood. Deep brain stimulation can worsen depression in some patients, but a preliminary study has suggested that transcranial magnetic stimulation could improve symptoms of depression. This Review describes the frequency and course of depression in patients with PD. The mechanisms that underlie depression in this disease are also discussed, and the management strategies for these patients are highlighted.
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107
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Dobkin RD, Menza M, Allen LA, Tiu J, Friedman J, Bienfait KL, Gara MA, Mark MH. Telephone-based cognitive-behavioral therapy for depression in Parkinson disease. J Geriatr Psychiatry Neurol 2011; 24:206-14. [PMID: 22228827 PMCID: PMC3571630 DOI: 10.1177/0891988711422529] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although face-to-face cognitive-behavioral therapy (CBT) was found to be beneficial for the treatment of depression in Parkinson disease (dPD) in a recent randomized-controlled trial, access to care was identified as a critical issue that needs to be addressed in order to improve the management of this nonmotor complication in PD. The purpose of this study was to examine the feasibility and effect of telephone-based CBT for dPD. METHODS Twenty-one depressed people with PD participated in a National Institutes of Health-sponsored uncontrolled pilot trial of telephone-based CBT in an academic medical center from October 2009 to February 2011. The Hamilton Depression Rating Scale was the primary outcome. Treatment was provided to people with PD for 10 weeks, modified for delivery over the phone, and supplemented with 4 separate phone-based caregiver educational sessions. Assessments were completed at baseline and 5 (midpoint), 10 (end-of-treatment), and 14 weeks (follow-up) post-enrollment. RESULTS Twenty (95%) people with PD completed the study treatment. Phone-based CBT was associated with significant improvements in depression, anxiety, negative thoughts, and coping. Mean Hamilton Depression Rating Scale change from baseline to week 10 was 7.91 points (P < .001, Cohen d = 1.21). CONCLUSIONS Telephone-based CBT may be a feasible and helpful approach for treating dPD and warrants further exploration in randomized-controlled trials. Results were comparable to those observed in the few in-person cognitive-behavioral treatment studies for dPD conducted to date.
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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
| | - 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
| | - Lesley A. Allen
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey- Robert Wood Johnson Medical School, Piscataway, NJ
| | - Jade Tiu
- 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
| | - Karina L. Bienfait
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey- Robert Wood Johnson Medical School, Piscataway, NJ,Merck and Co, Whitehouse Station, NJ
| | - Michael A. Gara
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey- Robert Wood Johnson Medical School, Piscataway, NJ
| | - Margery H. Mark
- 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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108
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Dobkin RD, Menza M, Allen LA, Gara MA, Mark MH, Tiu J, Bienfait KL, Friedman J. Cognitive-behavioral therapy for depression in Parkinson's disease: a randomized, controlled trial. Am J Psychiatry 2011; 168:1066-74. [PMID: 21676990 PMCID: PMC3186855 DOI: 10.1176/appi.ajp.2011.10111669] [Citation(s) in RCA: 189] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Despite the negative effects of depression in Parkinson's disease, there is currently no evidence-based standard of care. The purpose of this study was to examine the efficacy of individually administered cognitive-behavioral therapy (CBT), relative to clinical monitoring (with no new treatment), for depression in this medical population. METHOD Eighty depressed (based on DSM-IV criteria) patients with Parkinson's disease participated in a randomized, controlled trial of CBT relative to clinical monitoring (1:1 ratio) in an academic medical center from April 2007 to July 2010. All patients continued to maintain stable medication regimens under the care of their personal physicians. The 17-item Hamilton Depression Rating Scale (HAM-D) total score was the primary outcome. CBT was modified to meet the unique needs of the Parkinson's disease population and provided for 10 weeks. Assessments were completed by blind raters at baseline and 5 (midpoint), 10 (end of treatment), and 14 weeks (follow-up evaluation) postrandomization. RESULTS The CBT group reported greater reductions in depression (change in HAM-D score) than the clinical monitoring group. At week 10, the mean HAM-D score change was 7.35 for CBT relative to 0.05 for clinical monitoring. CBT was also superior to clinical monitoring on several secondary outcomes (i.e., Beck Depression Inventory scores, anxiety, quality of life, coping, Parkinson's disease symptom ratings). There were more treatment responders in the CBT group than the clinical monitoring group (56% versus 8%, respectively). CONCLUSIONS CBT may be a viable approach for the treatment of depression in Parkinson's disease. 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
| | - 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
| | - 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
| | - Margery H. Mark
- 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
| | - Jade Tiu
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey- Robert Wood Johnson Medical School, Piscataway, NJ
| | - Karina L. Bienfait
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey- Robert Wood Johnson Medical School, Piscataway, NJ, Merck and Co, Whitehouse Station, NJ
| | - Jill Friedman
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey- Robert Wood Johnson Medical School, Piscataway, NJ
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109
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Lee HW, Choi J, Suk K. Increases of pentraxin 3 plasma levels in patients with Parkinson's disease. Mov Disord 2011; 26:2364-70. [DOI: 10.1002/mds.23871] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 06/06/2011] [Accepted: 06/15/2011] [Indexed: 01/09/2023] Open
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Tan SKH, Hartung H, Sharp T, Temel Y. Serotonin-dependent depression in Parkinson's disease: a role for the subthalamic nucleus? Neuropharmacology 2011; 61:387-99. [PMID: 21251918 DOI: 10.1016/j.neuropharm.2011.01.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 12/23/2010] [Accepted: 01/05/2011] [Indexed: 12/17/2022]
Abstract
Depression is the most common neuropsychiatric co-morbidity in Parkinson's disease (PD). The underlying mechanism of depression in PD is complex and likely involves biological, psychosocial and therapeutic factors. The biological mechanism may involve changes in monoamine systems, in particular the serotonergic (5-hydroxytryptamine, 5-HT) system. It is well established that the 5-HT system is markedly affected in the Parkinsonian brain, with evidence including pathological loss of markers of 5-HT axons as well as cell bodies in the dorsal and median raphe nuclei of the midbrain. However, it remains unresolved whether alterations to the 5-HT system alone are sufficient to confer vulnerability to depression. Here we propose low 5-HT combined with altered network activity within the basal ganglia as critically involved in depression in PD. The latter hypothesis is derived from a number of recent findings that highlight the close interaction between the basal ganglia and the 5-HT system, not only in motor but also limbic functions. These findings include evidence that clinical depression is a side effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN), a treatment option in advanced PD. Further, it has recently been demonstrated that STN DBS in animal models inhibits 5-HT neurotransmission, and that this change may underpin depressive-like side effects. This review provides an overview of 5-HT alterations in PD and a discussion of how these changes might combine with altered basal ganglia network activity to increase depression vulnerability.
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Affiliation(s)
- Sonny K H Tan
- Department of Neuroscience, Maastricht University, Maastricht, The Netherlands.
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111
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Barone P, Aarsland D, Burn D, Emre M, Kulisevsky J, Weintraub D. Cognitive impairment in nondemented Parkinson's disease. Mov Disord 2011; 26:2483-95. [PMID: 22170275 DOI: 10.1002/mds.23919] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 07/06/2011] [Accepted: 07/21/2011] [Indexed: 11/06/2022] Open
Abstract
A substantial percentage of patients with newly diagnosed Parkinson's disease without dementia are reported to be affected by cognitive impairment (CI). In practice, however, CI is underrecognized, as the signs may not be apparent in early-stage disease and many routine assessment tools lack the sensitivity to detect subtle cognitive dysfunction. Patients with PD and mild CI (MCI) may have a higher risk of developing dementia than cognitively intact PD patients; however, it is not currently known which patients with CI are at increased risk of developing dementia. This review summarizes current knowledge about CI in nondemented PD; it discusses the structural and functional changes associated with CI and addresses areas of unmet needs. We focus on questions that should be addressed in future studies to achieve consensus on its characteristics and definition, pathophysiology, epidemiology, diagnosis and assessment, and treatment and management.
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Affiliation(s)
- Paolo Barone
- Department of Neurological Sciences, University Federico II-ICD Hermitage, Capodimonte, Naples, Italy.
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112
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Starkstein S, Dragovic M, Jorge R, Brockman S, Merello M, Robinson RG, Bruce D, Wilson M. Diagnostic criteria for depression in Parkinson's disease: a study of symptom patterns using latent class analysis. Mov Disord 2011; 26:2239-45. [PMID: 21739470 DOI: 10.1002/mds.23836] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 05/15/2011] [Accepted: 05/19/2011] [Indexed: 02/02/2023] Open
Abstract
Although major depression is one of the most frequent psychiatric disorders among patients with Parkinson's disease, diagnostic criteria have yet to be validated. The main aim of our study was to validate depressive symptoms using latent class analysis for use as diagnostic criteria for major depression in Parkinson's disease. We examined a consecutive series of 259 patients with Parkinson's disease admitted to 2 movement disorders clinics for regular follow-ups. All patients were assessed with a comprehensive psychiatric interview that included structured assessments for depression, anxiety, and apathy. The main finding was that all 9 Diagnostic and Statistical Manual (4th edition) diagnostic criteria for major depression (ie, depressed mood, diminished interest or pleasure, weight or appetite changes, sleep changes, psychomotor changes, loss of energy, feelings of worthlessness or inappropriate guilt, poor concentration, and suicidal ideation) identified a patient class (severe depression group) with high statistical significance. Latent class analysis also demonstrated a patient class with minimal depressive symptoms (no-depression group), and a third patient class with intermediate depressive symptoms (moderate depression). Anxiety and apathy were both significant comorbid conditions of moderate and severe depression. Taken together, our findings support the use of the full Diagnostic and Statistical Manual (4th edition) criteria for major depression for use in clinical practice and research in Parkinson's disease and suggest that anxiety may be included as an additional diagnostic criterion.
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Affiliation(s)
- Sergio Starkstein
- School of Psychiatry and Clinical Neurosciences, University of Western Australia and Fremantle Hospital, Fremantle, Western Australia, Australia.
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113
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Bolbecker AR, Hong SL, Kent JS, Klaunig MJ, O'Donnell BF, Hetrick WP. Postural control in bipolar disorder: increased sway area and decreased dynamical complexity. PLoS One 2011; 6:e19824. [PMID: 21611126 PMCID: PMC3097205 DOI: 10.1371/journal.pone.0019824] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 04/17/2011] [Indexed: 12/20/2022] Open
Abstract
Structural, neurochemical, and functional abnormalities have been identified in
the brains of individuals with bipolar disorder, including in key brain
structures implicated in postural control, i.e. the cerebellum, brainstem, and
basal ganglia. Given these findings, we tested the hypothesis that postural
control deficits are present in individuals with bipolar disorder. Sixteen
participants with bipolar disorder (BD) and 16 age-matched non-psychiatric
healthy controls were asked to stand as still as possible on a force platform
for 2 minutes under 4 conditions: (1) eyes open-open base; (2) eyes closed-open
base; (3) eyes open-closed base; and (4) eyes closed-closed base. Postural sway
data were submitted to conventional quantitative analyses of the magnitude of
sway area using the center of pressure measurement. In addition, data were
submitted to detrended fluctuation analysis, a nonlinear dynamical systems
analytic technique that measures complexity of a time-series, on both the
anterior-posterior and medio-lateral directions. The bipolar disorder group had
increased sway area, indicative of reduced postural control. Decreased
complexity in the medio-lateral direction was also observed for the bipolar
disorder group, suggesting both a reduction in dynamic range available to them
for postural control, and that their postural corrections were primarily
dominated by longer time-scales. On both of these measures, significant
interactions between diagnostic group and visual condition were also observed,
suggesting that the BD participants were impaired in their ability to make
corrections to their sway pattern when no visual information was available.
Greater sway magnitude and reduced complexity suggest that individuals with
bipolar disorder have deficits in sensorimotor integration and a reduced range
of timescales available on which to make postural corrections.
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Affiliation(s)
- Amanda R. Bolbecker
- Department of Psychological and Brain
Sciences, Indiana University, Bloomington, Indiana, United States of
America
- Larue D. Carter Memorial Hospital,
Indianapolis, Indiana, United States of America
| | - S. Lee Hong
- Department of Kinesiology, Indiana University,
Bloomington, Indiana, United States of America
| | - Jerillyn S. Kent
- Department of Psychological and Brain
Sciences, Indiana University, Bloomington, Indiana, United States of
America
| | - Mallory J. Klaunig
- Larue D. Carter Memorial Hospital,
Indianapolis, Indiana, United States of America
| | - Brian F. O'Donnell
- Department of Psychological and Brain
Sciences, Indiana University, Bloomington, Indiana, United States of
America
- Larue D. Carter Memorial Hospital,
Indianapolis, Indiana, United States of America
- Department of Psychiatry, Indiana University
School of Medicine, Indianapolis, Indiana, United States of America
| | - William P. Hetrick
- Department of Psychological and Brain
Sciences, Indiana University, Bloomington, Indiana, United States of
America
- Larue D. Carter Memorial Hospital,
Indianapolis, Indiana, United States of America
- Department of Psychiatry, Indiana University
School of Medicine, Indianapolis, Indiana, United States of America
- * E-mail:
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Rouse AG, Stanslaski SR, Cong P, Jensen RM, Afshar P, Ullestad D, Gupta R, Molnar GF, Moran DW, Denison TJ. A chronic generalized bi-directional brain-machine interface. J Neural Eng 2011; 8:036018. [PMID: 21543839 DOI: 10.1088/1741-2560/8/3/036018] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A bi-directional neural interface (NI) system was designed and prototyped by incorporating a novel neural recording and processing subsystem into a commercial neural stimulator architecture. The NI system prototype leverages the system infrastructure from an existing neurostimulator to ensure reliable operation in a chronic implantation environment. In addition to providing predicate therapy capabilities, the device adds key elements to facilitate chronic research, such as four channels of electrocortigram/local field potential amplification and spectral analysis, a three-axis accelerometer, algorithm processing, event-based data logging, and wireless telemetry for data uploads and algorithm/configuration updates. The custom-integrated micropower sensor and interface circuits facilitate extended operation in a power-limited device. The prototype underwent significant verification testing to ensure reliability, and meets the requirements for a class CF instrument per IEC-60601 protocols. The ability of the device system to process and aid in classifying brain states was preclinically validated using an in vivo non-human primate model for brain control of a computer cursor (i.e. brain-machine interface or BMI). The primate BMI model was chosen for its ability to quantitatively measure signal decoding performance from brain activity that is similar in both amplitude and spectral content to other biomarkers used to detect disease states (e.g. Parkinson's disease). A key goal of this research prototype is to help broaden the clinical scope and acceptance of NI techniques, particularly real-time brain state detection. These techniques have the potential to be generalized beyond motor prosthesis, and are being explored for unmet needs in other neurological conditions such as movement disorders, stroke and epilepsy.
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Affiliation(s)
- A G Rouse
- Department of Biomedical Engineering, Washington University, St Louis, MO, USA
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115
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Abstract
Although diagnosed by characteristic motor features, Parkinson's disease may be preceded, and is frequently accompanied by, a wide range of cognitive and neuropsychiatric features. In addition to the most commonly studied disorders of dementia, depression, and psychosis, other relatively common and clinically significant psychiatric complications include impulse control disorders, anxiety symptoms, disorders of sleep and wakefulness, and apathy. These problems may be underrecognized and are frequently undertreated. The emergent focus on nonmotor aspects of Parkinson's disease over the past quarter of a century is highlighted by a nonlinear increase in the number of articles published devoted to this topic. Although the development of newer antidepressants, atypical antipsychotics, and cholinesterase inhibitors in recent years has had a positive benefit on the management of these troublesome and distressing symptoms, responses are frequently suboptimal, and this remains an area of major unmet therapeutic need.
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Affiliation(s)
- Daniel Weintraub
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Depression in Parkinson's disease: symptom improvement and residual symptoms after acute pharmacologic management. Am J Geriatr Psychiatry 2011; 19:222-9. [PMID: 20808132 PMCID: PMC3010522 DOI: 10.1097/jgp.0b013e3181e448f7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Parkinson's disease (PD) is frequently complicated by depression and there is a paucity of controlled research that can inform the management of this disabling nonmotor complaint. A randomized controlled trial of nortriptyline, paroxetine, and placebo for the treatment of depression in PD (dPD) was recently completed. The purpose of this article is to describe the baseline pattern of depressive symptom presentation in PD, the specific symptoms of dPD that improve with pharmacotherapy, and the residual symptoms that remain in patients who meet a priori criteria for response or remission after acute treatment (8 weeks). SETTING The Departments of Psychiatry and Neurology at Robert Wood Johnson Medical School, New Jersey. PARTICIPANTS : Fifty-two depressed patients (major depression or dysthymia based on Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria) with Parkinson's disease (by research criteria). DESIGN/INTERVENTION A randomized controlled trial of nortriptyline, paroxetine, and placebo. MEASUREMENT The four subscales (core mood, anxiety, insomnia, and somatic) and individual items from the Hamilton Rating Scale for Depression-17 were the focus of this study. These measures were assessed at baseline and Week 8. RESULTS Baseline depressive symptoms were unrelated to motor functioning. Treatment response was associated with significant improvements in the core mood, anxiety, insomnia, and somatic symptoms seen in dPD. Residual symptoms, such as sadness and loss of interest, persisted in treatment responders in a milder form than was initially present. CONCLUSIONS Antidepressants may influence all symptoms of dPD, including those that share great overlap with the physical disease process. Additional research regarding adjunctive interventions is needed to help optimize the management of dPD.
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Davous P, Auquier P, Grignon S, Neukirch H. A prospective study of depression in French patients with Parkinson's disease. The Depar study. Eur J Neurol 2011; 2:455-61. [DOI: 10.1111/j.1468-1331.1995.tb00155.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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118
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Ceravolo R, Rossi C, Kiferle L, Bonuccelli U. Nonmotor symptoms in Parkinson’s disease: the dark side of the moon. FUTURE NEUROLOGY 2010. [DOI: 10.2217/fnl.10.69] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Nonmotor symptoms may appear during the course of Parkinson’s disease, complicating the advanced phase in particular, but are also common in the premotor phase of Parkinson’s disease. The appearance of nonmotor manifestations represents a milestone, determining a worse prognosis and lower quality of life; however, they are often misdiagnosed and untreated. The spectrum of nonmotor symptoms encompasses mood disorders, psychosis, dementia, sleep disorders, impulse-control disorders and autonomic dysfunctions. This article describes these nonmotor symptoms and their management.
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Affiliation(s)
- Roberto Ceravolo
- Department of Neurosciences, Section of Neurology, University of Pisa, via Roma 67, 56126 Pisa, Italy
| | - Carlo Rossi
- Department of Neurosciences, Section of Neurology, University of Pisa, via Roma 67, 56126 Pisa, Italy
| | - Lorenzo Kiferle
- Department of Neurosciences, Section of Neurology, University of Pisa, via Roma 67, 56126 Pisa, Italy
| | - Ubaldo Bonuccelli
- Department of Neurosciences, Section of Neurology, University of Pisa, via Roma 67, 56126 Pisa, Italy
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119
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Weintraub D, Mavandadi S, Mamikonyan E, Siderowf AD, Duda JE, Hurtig HI, Colcher A, Horn SS, Nazem S, Ten Have TR, Stern MB. Atomoxetine for depression and other neuropsychiatric symptoms in Parkinson disease. Neurology 2010; 75:448-55. [PMID: 20679638 DOI: 10.1212/wnl.0b013e3181ebdd79] [Citation(s) in RCA: 170] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Depression and antidepressant use, especially selective serotonin reuptake inhibitors (SSRIs), are common in Parkinson disease (PD). The objective of this clinical trial was to assess the efficacy of atomoxetine, a selective norepinephrine reuptake inhibitor (SNRI), for the treatment of clinically significant depressive symptoms and common comorbid neuropsychiatric symptoms in PD. METHODS A total of 55 subjects with PD and an Inventory of Depressive Symptomatology-Clinician (IDS-C) score > or = 22 were randomized to 8 weeks of atomoxetine or placebo treatment (target dosage = 80 mg/day). Depression response (> 50% decrease in IDS-C score or Clinical Global Impression-Improvement [CGI-I] score of 1 or 2) was assessed using intention-to-treat modeling procedures. Secondary outcomes included global cognition, daytime sleepiness, anxiety, apathy, and motor function. RESULTS There were no between-groups differences in a priori-defined response rates. Using a more liberal response criterion of > 40% decrease in IDS score from baseline, there was a trend (p = 0.08) favoring atomoxetine. Patients receiving atomoxetine experienced significantly greater improvement in global cognition (p = 0.003) and daytime sleepiness (p = 0.001), and atomoxetine was well-tolerated. CONCLUSIONS Atomoxetine treatment was not efficacious for the treatment of clinically significant depressive symptoms in PD, but was associated with improvement in global cognitive performance and daytime sleepiness. Larger studies of SNRIs in PD for disorders of mood, cognition, and wakefulness are appropriate. CLASSIFICATION OF EVIDENCE This interventional study provides Class II evidence that atomoxetine (target dosage = 80 mg/day) is not efficacious in improving clinically significant depression in PD.
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Affiliation(s)
- D Weintraub
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA.
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120
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Evans D, Norman P. Illness representations, coping and psychological adjustment to Parkinson's disease. Psychol Health 2010; 24:1181-96. [PMID: 20204987 DOI: 10.1080/08870440802398188] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The present study reports an application of the common sense model (CSM) of illness representations to the prediction of psychological distress in people with Parkinson's disease (PD). The study sought to (i) examine cross-sectional and prospective associations between illness representations, coping and psychological distress, and (ii) test the hypothesis that coping would mediate any relationships between illness representations and psychological distress. Patients with PD (n = 58) completed the Illness Perception Questionnaire-Revised, the Medical Coping Modes Questionnaire and the Hospital Anxiety and Depression Scale. Patients (n = 57) were followed-up at 6 months. Illness representations explained large amounts of variance in time 1 anxiety (R(2) = 0.42) and depression (R(2) = 0.44) as well as additional variance in time 2 anxiety (DeltaR(2) = 0.12) and depression (DeltaR(2) = 0.09) after controlling for baseline scores. In addition, avoidance mediated the effect of emotional representations on time 1 anxiety, and acceptance-resignation mediated the effects of both consequences and emotional representations on time 1 depression. The present study therefore provides partial support for the mediational model outlined in the CSM, as significant mediation effects were found only in the cross-sectional analyses.
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Affiliation(s)
- Daphne Evans
- School of Education and Social Inclusion, Trinity College, Carmarthen, UK
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121
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Caskie GIL, Sutton MC, Margrett JA. The relation of hypertension to changes in ADL/IADL limitations of Mexican american older adults. J Gerontol B Psychol Sci Soc Sci 2010; 65B:296-305. [PMID: 20110317 PMCID: PMC3107028 DOI: 10.1093/geronb/gbq001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 01/02/2010] [Indexed: 11/13/2022] Open
Abstract
Hypertension, highly prevalent and often undiagnosed among older Mexican Americans, is associated with greater limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) that can lead to greater dependency for older adults. Using data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly study, the rate of increase in ADL/IADL limitations for a 7-year period was examined for 3,046 older Mexican Americans classified either as reporting hypertension at baseline, first reporting hypertension at subsequent waves, or never reporting hypertension. Latent growth models indicated increased ADL/IADL limitations over time; individuals with hypertension evidenced greater increases than those without hypertension. Age, comorbidities, and depression were positively related to greater ADL/IADL limitations at baseline for all groups; only age was consistently related to ADL/IADL change over time. Development of hypertension may increase the risk of ADL/IADL decline, but early diagnosis and treatment may attenuate this effect.
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Affiliation(s)
- Grace I L Caskie
- Department of Education and Human Services, Lehigh University, 111 Research Drive, Bethlehem, PA 18015, USA.
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Klepac N, Hajnsek S, Trkulja V. Cognitive performance in nondemented nonpsychotic Parkinson disease patients with or without a history of depression prior to the onset of motor symptoms. J Geriatr Psychiatry Neurol 2010; 23:15-26. [PMID: 19996416 DOI: 10.1177/0891988709351831] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In Parkinson disease (PD), cognitive impairment is common, occurs mainly in the form of milder deficits (as opposed to dementia), and commonly coincides with depression. In this cross-sectional study, we evaluated whether depression that existed before the onset of typical motor symptoms (pre-PD depression) reflected on the actual cognitive performance. Nondemented nonpsychotic PD patients with (test, n = 27) and without (control, n = 112) a history of pre-PD depression, caliper-matched for age, education, and disease duration were assessed for motor and nonmotor disease characteristics and in a battery of cognitive tests. Test patients had higher actual depression/anxiety levels. Gradual multivariate and mediation analysis indicated unfavorable effects of pre-PD depression on cognition: a direct effect on mental set shifting/response inhibition (independent of actual depression/ anxiety or other factors); and indirect effects on other cognitive domains mediated through the increased depression/anxiety. Data suggest that pre-PD depression favors poorer cognitive abilities in nondemented patients at a given time after PD has been diagnosed.
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Affiliation(s)
- Natasa Klepac
- Department of Neurology, University Hospital Centre Zagreb, Zagreb University School of Medicine, Zagreb, Croatia
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123
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124
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Marder K. Cognitive impairment and dementia in Parkinson's disease. Mov Disord 2010; 25 Suppl 1:S110-6. [DOI: 10.1002/mds.22787] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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125
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Gray WK, Hildreth A, Bilclough JA, Wood BH, Baker K, Walker RW. Physical assessment as a predictor of mortality in people with Parkinson's disease: a study over 7 years. Mov Disord 2010; 24:1934-40. [PMID: 19672988 DOI: 10.1002/mds.22610] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The primary aim of this study was to ascertain whether a battery of physical function measures in a Parkinson's disease (PD) patient cohort predicted mortality status at 7-year follow-up. Secondary aims were establishing which specific tests were the most useful, and whether PD phenotype was a predictor. A retrospective correlation design was used in this study. A cohort of 109 PD patients underwent baseline physiotherapy assessment of gait, balance, posture, muscle strength, and ability to change postural set. We compared mortality status at 7-year follow-up and baseline physical assessment tests. Tinetti gait and balance scores, UPDRS score, 10-m walk test (time, velocity, and number of strides), posture in standing, lying to sitting, sitting to standing, getting up from floor assessments, and time to ascend and descend four steps were found to be statistically significant physical predictors of mortality at 7-year follow-up. In addition, age, sex, and mini-mental state examination were significant nonphysical predictors of mortality. Using Cox regression, a survival model was constructed with age, sex, and Tinetti gait score as independent predictors of mortality. The results of this study suggest that there is a link between reduced physical function and an increased mortality risk in PD populations.
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Affiliation(s)
- William K Gray
- School of Health, Community and Education Studies, University of Northumbria, Coach Lane Campus, Newcastle-upon-Tyne NE29 8NH , United Kingdom
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126
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Dobkin RD, Menza M, Bienfait KL, Gara M, Marin H, Mark MH, Dicke A, Tröster A. The impact of antidepressant treatment on cognitive functioning in depressed patients with Parkinson's disease. J Neuropsychiatry Clin Neurosci 2010; 22:188-95. [PMID: 20463113 PMCID: PMC2872099 DOI: 10.1176/jnp.2010.22.2.188] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Depression is associated with more rapid cognitive decline in Parkinson's disease. The goal of this study was to examine the impact of the acute (8-week) and longer-term (24-week) antidepressant treatment on cognition in Parkinson's disease and to detail cognitive predictors of treatment response. Fifty-two depressed Parkinson's disease patients were enrolled in an NIH-funded randomized, controlled trial of nortriptyline, paroxetine, and placebo. Neuropsychological testing was performed at baseline and weeks 8 and 24. Higher baseline scores on measures of executive functioning, speed of processing, and verbal memory were associated with antidepressant response. Treatment responders did not exhibit larger gains in cognition than nonresponders. Findings warrant replication.
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Affiliation(s)
- Roseanne DeFronzo Dobkin
- Department of Psychiatry, UMDNJ, Robert Wood Johnson Medical School, D317, 675 Hoes Lane, Piscataway, NJ 08854, USA.
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127
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Psychiatric Issues in Parkinson's Disease. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/b978-1-4160-6641-5.00013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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128
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Maetzler W, Liepelt I, Berg D. Progression of Parkinson's disease in the clinical phase: potential markers. Lancet Neurol 2009; 8:1158-71. [PMID: 19909914 DOI: 10.1016/s1474-4422(09)70291-1] [Citation(s) in RCA: 204] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Neuromodulatory or even neuroprotective therapy could soon be available for Parkinson's disease (PD), raising the question of how we should define and measure disease progression. Reported evidence suggests that several symptoms worsen with disease duration. Bradykinesia, rigidity, and activities of daily living deteriorate faster at the beginning of the disease, and this deterioration is paralleled by a decline in functional presynaptic dopaminergic activity, as shown by imaging techniques. Cognitive, speech, sleep, and gait difficulties might progress linearly in proportion to disease duration. Reduced variability in heart rate, orthostatic dysfunction, and visual hallucinations start to develop at mid-stage disease and are more common in late stages than earlier stages. In this Review, we summarise our current understanding of the progression of PD-associated symptoms and markers and conclude that an effective measurement of progression of PD must adapt to the different stages of the disease. In addition to routine clinical rating scales, new quantitative assessments of motor and non-motor symptoms, which should be more broadly available, reasonably priced, and easy-to-use, are needed.
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Affiliation(s)
- Walter Maetzler
- Center of Neurology, Department of Neurodegeneration and Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
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129
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130
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Ravina B, Elm J, Camicioli R, Como PG, Marsh L, Jankovic J, Weintraub D. The course of depressive symptoms in early Parkinson's disease. Mov Disord 2009; 24:1306-11. [PMID: 19412939 DOI: 10.1002/mds.22572] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Little is known about the course of depressive symptoms in Parkinson's disease (PD). We studied the course of clinically significant depressive symptoms using data from two clinical trials that followed 413 early, untreated PD subjects for 12 to 18 months. We measured depressive symptoms with the 15-item geriatric depression scale (GDS-15); a score of > or =5 indicates clinically significant depressive symptoms. We used a time-dependent Cox model to examine the association between demographic variables, PD severity, and medication use on the time to resolution of depressive symptoms. One hundred fourteen of 413 (27.6%) subjects were screened positive for depression during the study, with a median GDS-15 score of 6, indicating mild symptoms. Within 6 months, 47% of subjects experienced remission of clinically significant depressive symptoms. Subjects with mild depressive symptoms were more likely to develop moderate to severe depressive symptoms (GDS > or = 10) than those without prior symptoms (relative risk = 6.16). Increasing severity of depressive symptoms, older age, and longer PD duration predicted a lower likelihood of symptom resolution (hazard ratios 0.83-0.92). Mild depressive symptoms have a variable course, with remission and development of more sustained and severe symptoms occurring over time. More severe depressive symptoms may herald a protracted course.
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Affiliation(s)
- Bernard Ravina
- Department of Neurology, University of Rochester School of Medicine and Dentistry, New York, USA.
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131
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Pankratz N, Nichols WC, Elsaesser VE, Pauciulo MW, Marek DK, Halter CA, Wojcieszek J, Rudolph A, Pfeiffer RF, Foroud T. Alpha-synuclein and familial Parkinson's disease. Mov Disord 2009; 24:1125-31. [PMID: 19412953 DOI: 10.1002/mds.22524] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Whole gene duplications and triplications of alpha-synuclein (SNCA) can cause Parkinson's disease (PD), and variation in the promoter region (Rep1) and 3' region of SNCA has been reported to increase disease susceptibility. Within our cohort, one affected individual from each of 92 multiplex PD families showing the greatest evidence of linkage to the region around SNCA was screened for dosage alterations and sequence changes; no dosage or non-synonymous sequence changes were found. In addition, 737 individuals (from 450 multiplex PD families) that met strict diagnostic criteria for PD and did not harbor a known causative mutation, as well as 359 neurologically normal controls, were genotyped for the Rep1 polymorphism and four SNPs in the 3' region of SNCA. The four SNPs were in high LD (r(2) > 0.95) and were analyzed as a haplotype. The effects of the Rep1 genotype and the 3' haplotype were evaluated using regression models employing only one individual per family. Cases had a 3% higher frequency of the Rep1 263 bp allele compared with controls (OR = 1.54; empirical P-value = 0.02). There was an inverse linear relationship between the number of 263 bp alleles and age of onset (empirical P-value = 0.0004). The 3' haplotype was also associated with disease (OR = 1.29; empirical P-value = 0.01), but not age of onset (P = 0.40). These data suggest that dosage and sequence changes are a rare cause of PD, but variation in the promoter and 3' region of SNCA convey an increased risk for PD.
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Affiliation(s)
- Nathan Pankratz
- Department of Medical and Molecular Genetics, Indiana University Medical Center, Indianapolis, Indiana 46202, USA.
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132
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Holtgraves T, McNamara P, Cappaert K, Durso R. Linguistic correlates of asymmetric motor symptom severity in Parkinson's Disease. Brain Cogn 2009; 72:189-96. [PMID: 19751960 DOI: 10.1016/j.bandc.2009.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 08/07/2009] [Accepted: 08/10/2009] [Indexed: 11/26/2022]
Abstract
Asymmetric motor severity is common in Parkinson's Disease (PD) and provides a method for examining the neurobiologic mechanisms underlying cognitive and linguistic deficits associated with the disorder. In the present research, PD participants (N=31) were assessed in terms of the asymmetry of their motor symptoms. Interviews with the participants were analyzed with the Linguistic Inquiry and Word Count (LIWC) program. Three measures of linguistic complexity - the proportion of verbs, proportion of function words, and sentence length - were found to be affected by symptom asymmetry. Greater left-side motor severity (and hence greater right-hemisphere dysfunction) was associated with the production of significantly fewer verbs, function words, and shorter sentences. Hence, the production of linguistic complexity in a natural language context was associated with relatively greater right hemisphere involvement. The potential neurobiological mechanisms underlying this effect are discussed.
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Affiliation(s)
- Thomas Holtgraves
- Department of Psychological Science, Ball State University, Muncie, IN 47306, USA.
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133
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Depression Impairs Executive Functioning in Parkinson Disease Patients With Low Educational Level. Cogn Behav Neurol 2009; 22:167-72. [DOI: 10.1097/wnn.0b013e3181b278f9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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134
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Affiliation(s)
- Lorraine Savory
- Westminster Primary Care Trust, Soho Centre for Health and Care, 1 Frith Street, London W1D 3HZ
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135
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Pankratz N, Marder KS, Halter CA, Rudolph A, Shults CW, Nichols WC, Foroud T. Clinical correlates of depressive symptoms in familial Parkinson's disease. Mov Disord 2009; 23:2216-23. [PMID: 18785635 DOI: 10.1002/mds.22285] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Depression is one of the most common nonmotor complications of Parkinson's disease (PD) and has a major impact on quality of life. Although several clinical factors have been associated with depression in PD, the relationship between depression and stage of illness as well as between depression and degree of disability remains controversial. We have collected clinical data on 1,378 PD cases from 632 families, using the Unified Parkinson's Disease Rating Scale (UPDRS) Parts II (activities of daily living) & III (motor), the Mini-Mental State Exam, the Geriatric Depression Scale (GDS), and the Blessed Functional Activity Scale (Blessed). Analyses were performed using the 840 individuals with verified PD and without evidence of cognitive decline. Logistic regression was used to identify study variables that individually and collectively best predicted the presence of depressive symptoms (GDS >or= 10). After correcting for multiple tests, depressive symptoms were significantly associated with Hoehn and Yahr stage and other clinical measures but not with any genetic variant (parkin, LRRK2, APOE). The Blessed score, education, presence of a first degree relative with signs of depression, and UPDRS Part II were found to best predict depressive symptomatology (R(2) = 0.33; P = 4 x 10(-48)). Contrary to several reports, the results from this large study indicate that stage of illness, motor impairment, and functional disability are strongly correlated with depressive symptoms.
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Affiliation(s)
- Nathan Pankratz
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, Indiana 46202, USA.
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136
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Kandiah N, Narasimhalu K, Lau PN, Seah SH, Au WL, Tan LC. Cognitive decline in early Parkinson's disease. Mov Disord 2009; 24:605-8. [DOI: 10.1002/mds.22384] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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137
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Shulman LM, Gruber-Baldini AL, Anderson KE, Vaughan CG, Reich SG, Fishman PS, Weiner WJ. The evolution of disability in Parkinson disease. Mov Disord 2008; 23:790-6. [PMID: 18361474 DOI: 10.1002/mds.21879] [Citation(s) in RCA: 194] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The objectives of this study are to assess the level of disease severity associated with disability in Parkinson disease (PD) and the sequence of loss of independence in basic and instrumental activities of daily living (ADLs and IADLs). Six hundred eighteen patients with PD were evaluated for disease severity with the Unified PD Rating Scale (UPDRS) and for disability with the Older Americans Resource and Services Disability Subscale (OARS). The association between patient-reported disability on ADLs and IADLs and level of disease severity on the total UPDRS was examined cross-sectionally. Disability, with loss of independent function is reported between total UPDRS scores 30 to 40, and HY stages II to III. Difficulty with daily activities, without loss of independent function is reported earlier, at UPDRS <20 and HY I to II. Difficulty with walking is initially reported, followed by problems with a number of gait-dependent activities including housework, dressing, transferring in and out of bed, and traveling in the community. The transition from HY stage II to III marks a pivotal milestone in PD, when gait and balance impairment results in disability in many gait-dependent activities. The onset of disability in PD can be identified by asking patients about their walking, housework, dressing, and traveling. While individual patients vary in progression, the benchmarks of disability in this study provide guidance when counseling patients about prognosis. Better understanding of the stages of disability may facilitate the development of novel outcome measures in clinical trials in PD.
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Affiliation(s)
- Lisa M Shulman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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138
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Abstract
Although Parkinson's disease (PD) has been considered to primarily affect motor abilities, increasing emphasis is being placed on cognitive and behavioural impairment in this disorder. Depression, dementia, psychosis and impulse control disorders have a major impact on quality of life for both patients and families. This article reviews cognitive and behavioural disturbances in PD and their relation to affective and motor symptoms, treatment of dementia associated with PD, and treatment approaches to psychosis in PD. We also discuss similarities between the dementia of PD and dementia with Lewy bodies.
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Affiliation(s)
- Doron Merims
- Division of Neurology and Rotman Research Institute, Baycrest, Toronto
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139
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Chen JJ, Trombetta DP, Fernandez HH. Palliative Management of Parkinson Disease: Focus on Nonmotor, Distressing Symptoms. J Pharm Pract 2008. [DOI: 10.1177/0897190008318370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Parkinson disease is a progressive neurodegenerative disease that commonly affects elderly persons. In the absence of neuroprotective or curative therapies, currently available therapies only provide symptomatic benefit. Progression to advanced Parkinson disease is often accompanied by functional dependence with increased risk of admission to a long-term care facility. The prevalence of Parkinson disease in long-term care facilities, within the United States, has been estimated to be between 5.2% and 10%. Patients with advanced Parkinson disease also experience other distressing motor and nonmotor conditions, such as motor complications, dementia, depression, gastrointestinal distress, orthostatic hypotension, pain, and psychosis, which can be a challenge for clinicians to manage. The presence of distressing symptoms along with the fact that Parkinson disease remains incurable necessitate discussion on a palliative care approach to this disorder. This article discusses the symptomatic management of distressing symptoms encountered in the long-term care resident with Parkinson disease, including motor complications and nonmotor features.
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Affiliation(s)
- Jack J. Chen
- Schools of Medicine and Pharmacy, Movement Disorders Center, Loma Linda University, California,
| | - Dominick P. Trombetta
- Geriatrics/Internal Medicine, College of Pharmacy and Nursing, Wilkes University, Wilkes-Barre, Pennsylvania
| | - Hubert H. Fernandez
- Department of Neurology, McKnight Brain Institute/University of Florida, Gainesville, Florida, Movement Disorders Center
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140
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Starkstein SE, Merello M, Jorge R, Brockman S, Bruce D, Petracca G, Robinson RG. A validation study of depressive syndromes in Parkinson's disease. Mov Disord 2008; 23:538-46. [PMID: 18074376 DOI: 10.1002/mds.21866] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The validity, sensitivity, and specificity of depressive symptoms for the diagnosis of major depression, minor depression, dysthymic disorder, and subsyndromal depression in Parkinson's disease (PD) were examined. A consecutive series of 173 patients with PD attending a Movement Disorders Clinic underwent a comprehensive psychiatric and neurological assessment. The symptoms of loss of interest/pleasure, changes in appetite or weight, changes in sleep, low energy, worthlessness or inappropriate guilt, psychomotor retardation/agitation, concentration deficits, and suicide ideation were all significantly associated with the presence of the DSM-IV depressed mood criterion for major depression. The symptoms of changes in appetite, changes in sleep, low energy, low self-esteem, poor concentration, and hopelessness were all significantly associated with the presence of the DSM-IV criterion of sad mood for dysthymic disorder. Thirty percent of our sample met DSM-IV diagnostic criteria for major depression, 20% met diagnostic criteria for dysthymic disorder, 10% met diagnostic criteria for minor depression, and 8% met clinical criteria for subsyndromal depression. Patients with either major or minor depression had significantly more severe deficits in activities of daily living, more severe cognitive impairments, and more severe Parkinsonism than patients with either dysthymic disorder or no depression. This study provides validation to the DSM-IV diagnostic criteria for major depression and dysthymic disorder for use in PD. The categories of minor and subsyndromal depression may need further validation.
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Affiliation(s)
- Sergio E Starkstein
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Western Australia, Australia.
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141
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Abstract
Although still considered a paradigmatic movement disorder, Parkinson's disease (PD) is associated with a broad spectrum of non-motor symptoms. These include disorders of mood and affect with apathy, anhedonia and depression, cognitive dysfunction and hallucinosis, as well as complex behavioural disorders. Sensory dysfunction with hyposmia or pain is almost universal, as are disturbances of sleep-wake cycle regulation. Autonomic dysfunction including orthostatic hypotension, urogenital dysfunction and constipation is also present to some degree in a majority of patients. Whilst overall non-motor symptoms become increasingly prevalent with advancing disease, many of them can also antedate the first occurrence of motor signs - most notably depression, hyposmia or rapid eye movement sleep behaviour disorder (RBD). Although exact clinicopathological correlations for most of these non-motor features are still poorly understood, the occurrence of constipation, RBD or hyposmia prior to the onset of clinically overt motor dysfunction would appear consistent with the ascending hypothesis of PD pathology proposed by Braak and colleagues. Screening these early non-motor features might, therefore, be one approach towards early 'preclinical' diagnosis of PD. This review article provides an overview of the clinical spectrum of non-motor symptoms in PD together with a brief review of treatment options.
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Affiliation(s)
- W Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
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142
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Piovezan MR, Teive HAG, Piovesan EJ, Mader MJ, Werneck LC. Cognitive function assessment in idiopathic Parkinson's disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 65:942-6. [PMID: 18094850 DOI: 10.1590/s0004-282x2007000600003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 08/28/2007] [Indexed: 05/25/2023]
Abstract
Idiopathic Parkinson's disease (PD) is characterized by reduced nigrostriatal and cortical dopaminergic influence, with changes in movement and, subsequently, behavioral and cognitive disturbances. We studied cognitive impairment in Parkinson's disease by assessing a group of 30 idiopathic Parkinson's disease patients with an average age of 64.23 years (PG group) and compared our findings with those for a control group of 30 patients (CG group). All the patients were submitted to the following assessments: motor function, using the UPDRS; staging, using the Hoehn-Yahr scales (PG group only); depression, using the Montgomery-Asberg scale; attention impairment; verbal fluency (FAR and animals); cognitive function, using the Mini Mental State Examination; visuospatial and executive functions; and clock drawing. In addition to altered motor function in PD patients, we found statistically significant differences between PD patients and controls in terms of cognitive function, verbal, executive and visuospatial functions, and attention deficits. Depression was more prevalent in the PG group.
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Affiliation(s)
- Mauro R Piovezan
- Neurology Division, Internal Medicine Department, Hospital de Clinicas, Universidade Federal do Paraná, Rua General Carneiro 181, Curitiba, PR, Brazil
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143
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144
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Reijnders JSAM, Ehrt U, Weber WEJ, Aarsland D, Leentjens AFG. A systematic review of prevalence studies of depression in Parkinson's disease. Mov Disord 2008; 23:183-9; quiz 313. [PMID: 17987654 DOI: 10.1002/mds.21803] [Citation(s) in RCA: 781] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Prevalence rates of depressive disorders in Parkinson's disease (PD) vary widely across studies, ranging from 2.7% to more than 90%. The aim of this systematic review was to calculate average prevalences of depressive disorders taking into account the different settings and different diagnostic approaches of studies. Using Medline on Pubmed, a systematic literature search was carried out for studies of depression in Parkinson's disease. A total of 104 articles were included and assessed for quality; 51 articles fulfilled the quality criteria. Multiple publications from the same database were not included in the meta-analysis. In the remaining 36 articles, the weighted prevalence of major depressive disorder was 17% of PD patients, that of minor depression 22% and dysthymia 13%. Clinically significant depressive symptoms, irrespective of the presence of a DSM defined depressive disorder, were present in 35%. In studies using a (semi) structured interview to establish DSM criteria, the reported prevalence of major depressive disorder was 19%, while in studies using DSM criteria without a structured interview, the reported prevalence of major depressive disorder was 7%. Population studies report lower prevalence rates for both major depressive disorder and the clinically significant depressive symptoms than studies in other settings. This systematic review suggests that the average prevalence of major depressive disorder in PD is substantial, but lower than generally assumed.
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145
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Weintraub D, Saboe K, Stern MB. Effect of age on geriatric depression scale performance in Parkinson's disease. Mov Disord 2008; 22:1331-5. [PMID: 17546674 PMCID: PMC2000798 DOI: 10.1002/mds.21369] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The purpose of this study was to compare the validity of the 15-item Geriatric Depression Scale (GDS-15) in nonelderly (<65 years), young-elderly (age, 65-75), and old-elderly (>75 years) patients with Parkinson's disease (PD). 57 nonelderly, 88 young-elderly, and 81 old-elderly PD patients were administered the GDS-15 and the Structured Clinical Interview for DSM-IV depression module. Receiver-operating characteristic (ROC) curves were plotted for GDS-15 scores against a DSM-IV diagnosis of major or minor depression. The discriminant validity of the GDS-15 was high for nonelderly, young-elderly, and old-elderly subjects (ROC area under curve = 0.92, 0.91, and 0.95, respectively), with optimal dichotomization at a cut-off of 4/5 (85% sensitivity and 84% specificity in nonelderly; 89% sensitivity and 82% specificity in young-elderly) and 5/6 (90% sensitivity and 90% specificity in old-elderly). In conclusion, the GDS-15 has comparable validity in younger and older PD patients, suggesting its appropriateness as a depression screening instrument in PD patients of all ages.
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Affiliation(s)
- Daniel Weintraub
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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146
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Althaus A, Becker OA, Spottke A, Dengler R, Schneider F, Kloss M, Eggert K, Oertel WH, Dillmann U, Herting B, Classen J, Dodel R. Frequency and treatment of depressive symptoms in a Parkinson's disease registry. Parkinsonism Relat Disord 2008; 14:626-32. [PMID: 18406197 DOI: 10.1016/j.parkreldis.2008.01.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Revised: 01/25/2008] [Accepted: 01/25/2008] [Indexed: 02/02/2023]
Abstract
Purpose of this cross-sectional study was to estimate the occurrence of depressive symptoms, as related to other clinical data, in a sample of Parkinson's disease (PD) patients (n=226). Furthermore, we examined the medical care of depressive symptoms in this sample. H&Y stages, cognitive status, sleeping disorders, and dysphagia resulted as significant predictors for depression. Prevalence of depressive symptoms was 35.4%. Only 25.0% of patients suffering from moderate to severe depressive symptoms were prescribed antidepressants. This study supports the view that depression may be underrecognized and undertreated in PD patients. A significant proportion of patients continues to experience depressive symptoms despite antidepressive medication. Recognition and treatment of depression remains a challenge for management of PD. Possible coexisting depressive symptoms should be revealed and assessed by standardized interviews in everyday clinical routine. Large scale randomized controlled trials examining efficacy and safety of antidepressants in PD patients are urgently required.
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Affiliation(s)
- Astrid Althaus
- Department of Neurology, Philipps-University of Marburg, Germany
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147
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Post B, Merkus MP, de Haan RJ, Speelman JD. Prognostic factors for the progression of Parkinson's disease: a systematic review. Mov Disord 2008; 22:1839-51; quiz 1988. [PMID: 17595026 DOI: 10.1002/mds.21537] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The purpose of this systematic review is to summarize studies that describe the course of Parkinson's disease (PD) and to identify factors that predict change in motor impairment, disability, and quality of life. A literature search was conducted in MEDLINE, EMBASE, CINAHL, and Web of Science limited to the English, French, German, Spanish, and Dutch language. Reports were selected if the study involved subjects with PD, the outcome measures described impairment, disability, or quality of life and follow-up was at least 6 months. All included studies were scored for methodological quality. Data were extracted and summarized in a best evidence synthesis. We screened 1,535 titles and abstracts, of which 27 fulfilled our inclusion criteria. A meta-analysis to quantitatively aggregate progression scores of motor impairment and disability was not possible because of the wide variety of outcome measures used and the heterogeneous study populations. Limited evidence is found for lower UPDRS-ME at baseline, dementia and SE < 70% as prognostic factors for future motor impairment. There is strong evidence for higher age at onset and higher PIGD-score; and limited evidence for higher bradykinesia-score, non-tremor dominant subtype, symmetrical disease at baseline, and depression as prognostic factors for progression of disability. Prognostic factors were identified for impairment and disability. The literature on prognosis in PD is not fulfilling the high methodological standards applied nowadays. There is a need for prospective cohorts of PD patients assembled at a common early point in the disease with long time follow-up.
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Affiliation(s)
- Bart Post
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
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148
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Truong DD, Bhidayasiri R, Wolters E. Management of non-motor symptoms in advanced Parkinson disease. J Neurol Sci 2008; 266:216-28. [PMID: 17804018 DOI: 10.1016/j.jns.2007.08.015] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Progress in pharmacology has markedly improved the treatment of early Parkinson's disease. The management of advanced Parkinson's symptoms, however, remains a challenge. These symptoms are divided into motor and non-motor symptoms. Non-motor symptoms may appear early or late in the disease and sometimes even before the onset of the first motor symptoms confirming the diagnosis. The spectrum of non-motor symptoms encompasses autonomic dysfunctions, sleep disorders, mood disorders, impulse control disorders, cognitive dysfunction, dementia, paranoia and hallucinations. They are often less appreciated than motor symptoms but are important sources of disability for many PD patients. This review describes these non-motor symptoms and their managements.
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Affiliation(s)
- Daniel D Truong
- The Parkinson's and Movement Disorder Institute, 9940 Talbert Avenue, Fountain Valley, CA 92708, USA.
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149
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Dobkin RD, Menza M, Bienfait KL. CBT for the treatment of depression in Parkinson's disease: a promising nonpharmacological approach. Expert Rev Neurother 2008; 8:27-35. [PMID: 18088199 DOI: 10.1586/14737175.8.1.27] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Depression is very common in Parkinson's disease (PD) and linked with a faster progression of physical symptoms, greater cognitive decline and poorer quality of life. Nonpharmacological approaches, such as cognitive-behavioral therapy (CBT), for the treatment of depression in PD (dPD) have received little experimental attention despite strong demonstrated efficacy in other geriatric and medical populations. Depressed PD patients often differ from the depressed non-PD elderly in that they present with increased rates of both executive dysfunction and comorbid psychiatric diagnoses, may differ in their depressive symptom presentation and typically have caregivers who are highly involved in their treatment. Therefore, it is not possible to conclude that empirically validated treatments in the depressed aged will generalize to those with PD. In order to be most effective for PD patients, CBT should be tailored to their unique needs. Additional controlled research is needed to further explore the efficacy of CBT for dPD.
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Affiliation(s)
- Roseanne DeFronzo Dobkin
- Department of Psychiatry, UMDNJ/Robert Wood Johnson Medical School, 675 Hoes Lane, Room D-317, Piscataway, NJ 08854, USA.
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150
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Elman LB, Houghton DJ, Wu GF, Hurtig HI, Markowitz CE, McCluskey L. Palliative care in amyotrophic lateral sclerosis, Parkinson's disease, and multiple sclerosis. J Palliat Med 2007; 10:433-57. [PMID: 17472516 DOI: 10.1089/jpm.2006.9978] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis, Parkinson's disease, atypical parkinsonian syndromes, and multiple sclerosis are progressive neurologic disorders that cumulatively afflict a large number of people. Effective end-of-life palliative care depends upon an understanding of the clinical aspects of each of these disorders. OBJECTIVES The authors review the unique and overlapping aspects of each of these disorders with an emphasis upon the clinical management of symptoms. DESIGN The authors review current management and the supporting literature. CONCLUSIONS Clinicians have many effective therapeutic options to choose from when managing the symptoms produced by these disorders.
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Affiliation(s)
- Lauren B Elman
- ALS Association Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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