101
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Hautzinger M, Hüll M. [Psychotherapy with older adults]. DER NERVENARZT 2017; 88:1211-1212. [PMID: 28871372 DOI: 10.1007/s00115-017-0413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- M Hautzinger
- Fachbereich Psychologie, Klinische Psychologie und Psychotherapie, Eberhard Karls Universität, Schleichstr. 4, 72076, Tübingen, Deutschland.
| | - M Hüll
- Zentrum für Geriatrie und Gerontologie Freiburg - ZGGF, Universitätsklinikum Freiburg, Freiburg, Deutschland
- Klinik für Geronto- und Neuropsychiatrie, Zentrum für Psychiatrie Emmendingen, Emmendingen, Deutschland
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102
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Obeso J, Stamelou M, Goetz C, Poewe W, Lang A, Weintraub D, Burn D, Halliday G, Bezard E, Przedborski S, Lehericy S, Brooks D, Rothwell J, Hallett M, DeLong M, Marras C, Tanner C, Ross G, Langston J, Klein C, Bonifati V, Jankovic J, Lozano A, Deuschl G, Bergman H, Tolosa E, Rodriguez-Violante M, Fahn S, Postuma R, Berg D, Marek K, Standaert D, Surmeier D, Olanow C, Kordower J, Calabresi P, Schapira A, Stoessl A. Past, present, and future of Parkinson's disease: A special essay on the 200th Anniversary of the Shaking Palsy. Mov Disord 2017; 32:1264-1310. [PMID: 28887905 PMCID: PMC5685546 DOI: 10.1002/mds.27115] [Citation(s) in RCA: 498] [Impact Index Per Article: 71.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 06/27/2017] [Indexed: 12/12/2022] Open
Abstract
This article reviews and summarizes 200 years of Parkinson's disease. It comprises a relevant history of Dr. James Parkinson's himself and what he described accurately and what he missed from today's perspective. Parkinson's disease today is understood as a multietiological condition with uncertain etiopathogenesis. Many advances have occurred regarding pathophysiology and symptomatic treatments, but critically important issues are still pending resolution. Among the latter, the need to modify disease progression is undoubtedly a priority. In sum, this multiple-author article, prepared to commemorate the bicentenary of the shaking palsy, provides a historical state-of-the-art account of what has been achieved, the current situation, and how to progress toward resolving Parkinson's disease. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- J.A. Obeso
- HM CINAC, Hospital Universitario HM Puerta del Sur, Mostoles, Madrid, Spain
- Universidad CEU San Pablo, Madrid, Spain
- CIBERNED, Madrid, Spain
| | - M. Stamelou
- Department of Neurology, Philipps University, Marburg, Germany
- Parkinson’s Disease and Movement Disorders Department, HYGEIA Hospital and Attikon Hospital, University of Athens, Athens, Greece
| | - C.G. Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - W. Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - A.E. Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J Safra Program in Parkinson’s Disease, Toronto Western Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - D. Weintraub
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Parkinson’s Disease and Mental Illness Research, Education and Clinical Centers (PADRECC and MIRECC), Corporal Michael J. Crescenz Veteran’s Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - D. Burn
- Medical Sciences, Newcastle University, Newcastle, UK
| | - G.M. Halliday
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, Australia
- School of Medical Sciences, University of New South Wales and Neuroscience Research Australia, Sydney, Australia
| | - E. Bezard
- Université de Bordeaux, Institut des Maladies Neurodégénératives, Centre National de la Recherche Scientifique Unité Mixte de Recherche 5293, Institut des Maladies Neurodégénératives, Bordeaux, France
- China Academy of Medical Sciences, Institute of Lab Animal Sciences, Beijing, China
| | - S. Przedborski
- Departments of Neurology, Pathology, and Cell Biology, the Center for Motor Neuron Biology and Disease, Columbia University, New York, New York, USA
- Columbia Translational Neuroscience Initiative, Columbia University, New York, New York, USA
| | - S. Lehericy
- Institut du Cerveau et de la Moelle épinière – ICM, Centre de NeuroImagerie de Recherche – CENIR, Sorbonne Universités, UPMC Univ Paris 06, Inserm U1127, CNRS UMR 7225, Paris, France
- Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - D.J. Brooks
- Clinical Sciences Department, Newcastle University, Newcastle, UK
- Department of Nuclear Medicine, Aarhus University, Aarhus, Denmark
| | - J.C. Rothwell
- Human Neurophysiology, Sobell Department, UCL Institute of Neurology, London, UK
| | - M. Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - M.R. DeLong
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - C. Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson’s disease, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - C.M. Tanner
- Movement Disorders and Neuromodulation Center, Department of Neurology, University of California–San Francisco, San Francisco, California, USA
- Parkinson’s Disease Research, Education and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - G.W. Ross
- Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii, USA
| | | | - C. Klein
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - V. Bonifati
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J. Jankovic
- Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - A.M. Lozano
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - G. Deuschl
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, Christian Albrechts University Kiel, Kiel, Germany
| | - H. Bergman
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada, Jerusalem, Israel
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
- Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel
| | - E. Tolosa
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, Barcelona, Spain
- Department of Medicine, Universitat de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - M. Rodriguez-Violante
- Movement Disorders Clinic, Clinical Neurodegenerative Research Unit, Mexico City, Mexico
- Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - S. Fahn
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | - R.B. Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada
| | - D. Berg
- Klinikfür Neurologie, UKSH, Campus Kiel, Christian-Albrechts-Universität, Kiel, Germany
| | - K. Marek
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - D.G. Standaert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - D.J. Surmeier
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - C.W. Olanow
- Departments of Neurology and Neuroscience, Mount Sinai School of Medicine, New York, New York, USA
| | - J.H. Kordower
- Research Center for Brain Repair, Rush University Medical Center, Chicago, Illinois, USA
- Neuroscience Graduate Program, Rush University Medical Center, Chicago, Illinois, USA
| | - P. Calabresi
- Neurological Clinic, Department of Medicine, Hospital Santa Maria della Misericordia, University of Perugia, Perugia, Italy
- Laboratory of Neurophysiology, Santa Lucia Foundation, IRCCS, Rome, Italy
| | - A.H.V. Schapira
- University Department of Clinical Neurosciences, UCL Institute of Neurology, University College London, London, UK
| | - A.J. Stoessl
- Pacific Parkinson’s Research Centre, Division of Neurology & Djavadf Mowafaghian Centre for Brain Health, University of British Columbia, British Columbia, Canada
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
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103
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Choudhury TK, Harris C, Crist K, Satterwhite TK, York MK. Comparative Patient Satisfaction and Feasibility of a Pilot Parkinson's Disease Enrichment Program. J Geriatr Psychiatry Neurol 2017; 30:253-260. [PMID: 28925334 DOI: 10.1177/0891988717720299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Available treatment options for Parkinson's disease (PD) are primarily aimed at pharmacological and/or neurosurgical management of motor symptoms. However, many patients also experience chronic non-motor symptoms (NMS), including significant cognitive and mood changes. Currently, there is a gap in the neuropsychological literature regarding the efficacy of nonpharmacological treatment options for cognitive and mood changes in PD. OBJECTIVE We sought to evaluate the efficacy and patient satisfaction of a pilot nonpharmacological intervention for alleviating NMS in patients with PD. METHODS Twenty-three independently functioning nondemented patients with PD participated in a 5-week Parkinson's Disease Enrichment Program. Each 4-hour weekly session included content which addressed the following components: education, exercise, recreation, and socialization/support. Participants received a pre-assessment, including cognitive tests and questionnaires for depression and quality of life. After the completion of the program, participants completed post-assessment batteries to measure changes in neurocognitive and psychiatric status, as well as patient satisfaction regarding the program. RESULTS Neuropsychological data from pre- and post-assessments revealed significant improvements in measures of executive functioning, memory, and depressive symptoms. No significant changes were observed on the remaining mood or cognitive measures. One hundred percent of participants reported enjoyment from socialization with other participants with PD and satisfaction with the program overall. CONCLUSIONS Positive preliminary results suggest that further expansion of this nonpharmacological pilot program for treatment of NMS may be beneficial for patients with PD. Future studies will investigate a larger cohort of participants with PD and cross-validate findings in demographically diverse samples.
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Affiliation(s)
- Tabina K Choudhury
- 1 Texas A&M University, College Station, TX, USA.,2 Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | | | | | | | - Michele K York
- 2 Department of Neurology, Baylor College of Medicine, Houston, TX, USA.,4 Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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104
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Mosley PE, Moodie R, Dissanayaka N. Caregiver Burden in Parkinson Disease: A Critical Review of Recent Literature. J Geriatr Psychiatry Neurol 2017; 30:235-252. [PMID: 28743212 DOI: 10.1177/0891988717720302] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Burden is a negative psychological state induced in caregivers by the demands of providing care to a person with an illness or a disability. Managing caregiver burden in Parkinson disease (PD) is significant because informal caregivers make a substantial contribution to the well-being of persons with PD, incurring financial, social, and personal losses. Failure to recognize and manage caregiver burden may lead to burnout and premature institutionalization of the person with PD. We conducted a comprehensive literature review to identify and summarize factors that may amplify burden, including motor and nonmotor symptoms of PD, caregiver psychiatric symptoms, and caregiver coping style. We review instruments designed to sample the construct of burden among caregivers and evaluate interventions that may reduce burden, either by directly targeting caregivers or by treating PD symptoms associated with burden. We aim to provide a concise synopsis of these issues for the clinician or researcher working with this population in order to facilitate recognition of caregiver burden, provide accurate assessment, administer appropriate interventions, and stimulate further research in this area.
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Affiliation(s)
- Philip E Mosley
- 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,2 Neurosciences Queensland, St Andrew's War Memorial Hospital, Spring Hill, Queensland, Australia.,3 Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia.,4 School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Rebecca Moodie
- 1 Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Nadeeka Dissanayaka
- 5 UQ Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia.,6 School of Psychology, University of Queensland, St Lucia, Queensland, Australia.,7 Department of Neurology, Royal Brisbane & Woman's Hospital, Herston, Queensland, Australia
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105
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Mace CZ. The complexities of advance care planning in patients with idiopathic Parkinson's disease. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/bjnn.2017.13.4.178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Clair Zoe Mace
- Parkinson's disease nurse specialist, Nottingham University NHS Trust
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106
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Timmer MHM, van Beek MHCT, Bloem BR, Esselink RAJ. What a neurologist should know about depression in Parkinson's disease. Pract Neurol 2017; 17:359-368. [PMID: 28739866 DOI: 10.1136/practneurol-2017-001650] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2017] [Indexed: 11/03/2022]
Abstract
Depression is a frequent non-motor symptom of Parkinson's disease. Its prevalence varies widely across studies (between 2.7% and 90%); around 35% have clinically significant depressive symptoms. Although depression can have an immense impact on the quality of life of affected patients and their caregivers, depressive symptoms in Parkinson's disease frequently remain unrecognised and, as a result, remain untreated. Here we overview the diagnostic challenges and pitfalls, including the factors contributing to the underdiagnosis of depression. We also discuss current ideas on the underlying pathophysiology. Finally, we offer a treatment approach based on currently available evidence.
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Affiliation(s)
- Monique H M Timmer
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurology and Parkinson Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria H C T van Beek
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bas R Bloem
- Department of Neurology and Parkinson Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rianne A J Esselink
- Department of Neurology and Parkinson Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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107
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Barone P, Erro R, Picillo M. Quality of Life and Nonmotor Symptoms in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:499-516. [PMID: 28802930 DOI: 10.1016/bs.irn.2017.05.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Health-related quality of life (HRQoL) is defined as "the perception and evaluation by patients themselves of the impact caused on their lives by the disease and its consequences." HRQoL is conceptualized as a combination of physical, psychological, and social well-being in the context of a particular disease. Following earlier studies revolving on the impact of the classic motor symptoms of Parkinson's disease on HRQoL, mounting evidence have been produced that nonmotor symptoms (NMS) significantly and independently contribute to worse HRQoL. This holds particularly true for such NMS such as neuropsychiatric disturbances, cognitive impairment, and fatigue, the burden of which might well exceed the effects of the motor symptoms. Nonetheless, there is very sparse evidence on how to manage these NMS and whether targeting NMS would in fact lead to an improvement of HRQoL, which calls for the need of future trials with NMS as primary outcomes.
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Affiliation(s)
- Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, University of Salerno, Salerno, Italy.
| | - Roberto Erro
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, University of Salerno, Salerno, Italy; University College London, Institute of Neurology, London, United Kingdom
| | - Marina Picillo
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, University of Salerno, Salerno, Italy
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108
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Starkstein SE, Brockman S. Management of Depression in Parkinson's Disease: A Systematic Review. Mov Disord Clin Pract 2017; 4:470-477. [PMID: 30363415 DOI: 10.1002/mdc3.12507] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/18/2017] [Accepted: 04/22/2017] [Indexed: 12/19/2022] Open
Abstract
Background Depression is a frequent psychiatric condition in Parkinson's disease (PD). The treatment of depression has been examined in several randomized controlled trials and meta-analyses, but no clear guidelines are available. Methods We carried out a systematic review of pharmacological and non-pharmacological treatments for depression in patients with PD using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched main medical databases up to December 12, 2016, and included randomized controlled trials, patient-control studies, and case series with data on treatment modality, outcome measures, and side effects. Results Selective serotonergic reuptake inhibitors and tricyclic antidepressants may have efficacy for the treatment of depression in patients with PD, although the evidence is not strong. The antidepressant efficacy of dopamine agonists is still controversial, and initial results were positive for pramipexole but not for rotigotine. Cognitive-behavioral therapy showed promising results in two recent randomized controlled trials, but further evidence is required. Studies using repetitive transcranial magnetic stimulation produced conflicting results, and the efficacy results for this treatment have been inconsistent. On the other hand, electroconclusive therapy produced strong positive results in patients with severe depression, but no randomized controlled trials are available. Conclusion Selective serotonergic reuptake inhibitors and cognitive-behavioral therapy are currently first-line treatments for depression in patients with PD, although the evidence is still weak. The heterogeneity among contributory factors for depression in PD should be considered for the most effective treatment of depression in this condition.
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Affiliation(s)
- Sergio E Starkstein
- Department of Psychiatry University of Western Australia Fremantle Hospital Perth Western Australia Australia
| | - Simone Brockman
- Department of Psychiatry University of Western Australia Fremantle Hospital Perth Western Australia Australia
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109
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Sajatovic M, Ridgel AL, Walter EM, Tatsuoka CM, Colón-Zimmermann K, Ramsey RK, Welter E, Gunzler SA, Whitney CM, Walter BL. A randomized trial of individual versus group-format exercise and self-management in individuals with Parkinson's disease and comorbid depression. Patient Prefer Adherence 2017; 11:965-973. [PMID: 28579759 PMCID: PMC5449131 DOI: 10.2147/ppa.s135551] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Depression is common in people with Parkinson's disease (PD), and exercise is known to improve depression and PD. However, lack of motivation and low self-efficacy can make exercise difficult for people with PD and comorbid depression (PD-Dep). A combined group exercise and chronic disease self-management (CDSM) program may improve the likeli-hood that individuals will engage in exercise and will show a reduction in depression symptoms. The purpose of this study was to compare changes in depression in PD-Dep between individual versus group exercise plus CDSM and to examine participant adherence and perception of the interventions. METHODS Participants (N=30) were randomized to either Enhanced EXerCisE thErapy for PD (EXCEED; group CDSM and exercise) or self-guided CDSM plus exercise. Outcomes were change in depression assessed with the Montgomery-Asberg Depression Rating Scale (MADRS), cognition, apathy, anxiety, sleep, quality of life, motor function, self-efficacy, and patient satisfaction. RESULTS Both groups showed significant improvement in MADRS (P<0.001) with no significant group difference. Individuals in EXCEED group enjoyed the group dynamics but noted difficulty with the fixed-time sessions. CONCLUSION Both group CDSM plus exercise and self-guided CDSM plus exercise can improve depression in PD-Dep. These findings suggest that development of a remotely delivered group-based CDSM format plus manualized exercise program could be useful for this population.
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Affiliation(s)
- Martha Sajatovic
- Department of Neurology, Case Western Reserve University School of Medicine
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland
| | - Angela L Ridgel
- Department of Exercise Physiology, Kent State University, Kent
| | - Ellen M Walter
- Department of Neurology, Case Western Reserve University School of Medicine
- Movement Disorders Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Curtis M Tatsuoka
- Department of Neurology, Case Western Reserve University School of Medicine
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland
| | - Kari Colón-Zimmermann
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland
| | - Riane K Ramsey
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland
| | - Elisabeth Welter
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland
| | - Steven A Gunzler
- Department of Neurology, Case Western Reserve University School of Medicine
- Movement Disorders Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Christina M Whitney
- Department of Neurology, Case Western Reserve University School of Medicine
- Movement Disorders Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Benjamin L Walter
- Department of Neurology, Case Western Reserve University School of Medicine
- Movement Disorders Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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110
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Shahmoon S, Jahanshahi M. Optimizing psychosocial adjustment after deep brain stimulation of the subthalamic nucleus in Parkinson's disease. Mov Disord 2017; 32:1155-1158. [PMID: 28504352 DOI: 10.1002/mds.27032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 11/06/2022] Open
Affiliation(s)
- Suzette Shahmoon
- Cognitive Motor Neuroscience Group & Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK
| | - Marjan Jahanshahi
- Cognitive Motor Neuroscience Group & Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK
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111
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Dissanayaka NNW, Pye D, Mitchell LK, Byrne GJ, O'Sullivan JD, Marsh R, Pachana NA. Cognitive Behavior Therapy for Anxiety in Parkinson's Disease: Outcomes for Patients and Caregivers. Clin Gerontol 2017; 40:159-171. [PMID: 28452666 DOI: 10.1080/07317115.2016.1240131] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Anxiety negatively impacts the quality of life of Parkinson's disease (PD) patients and caregivers. Despite high prevalence, there is a paucity of trials investigating effective treatments for anxiety in PD. This uncontrolled study investigated the use of a manualized and tailored Cognitive Behavior Therapy (CBT) for anxiety in PD. METHODS Participants completed 6 weekly CBT sessions. Pre-, post- and follow-up (3 and 6 months) assessments were made. Change in outcomes were analysed using t-tests and Reliability Change Index. Of 17 PD patients who agreed to CBT, 12 completed the intervention. RESULTS This study showed a significant reduction in Hamilton Anxiety Rating Scale scores in PD immediately post CBT (t(11) = 3.59, p < .01), maintained at 3-month (t(8) = 2.83, p = .02) and 6-month (t(7) = 2.07, p = .04) follow-up. A reduction in caregiver burden (t(11) = 2.68, p = .03) was observed post intervention. Improvements in motor disability (t(11) = 2.41, p = .04) and cognitive scores (t(11) = -2.92, p = .01) were also observed post intervention and at follow-up. CONCLUSIONS Tailored CBT can be used to treat anxiety in PD. CLINICAL IMPLICATIONS This study provides preliminary evidence suggesting that tailored CBT reduces anxiety in PD with persisting benefits, and lowers caregiver burden.
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Affiliation(s)
- Nadeeka N W Dissanayaka
- a The University of Queensland , Brisbane , Australia.,b Royal Brisbane & Women's Hospital , Brisbane , Australia
| | - Deidre Pye
- a The University of Queensland , Brisbane , Australia
| | | | - Gerard J Byrne
- a The University of Queensland , Brisbane , Australia.,b Royal Brisbane & Women's Hospital , Brisbane , Australia
| | - John D O'Sullivan
- a The University of Queensland , Brisbane , Australia.,b Royal Brisbane & Women's Hospital , Brisbane , Australia
| | - Rodney Marsh
- a The University of Queensland , Brisbane , Australia.,b Royal Brisbane & Women's Hospital , Brisbane , Australia
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112
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Hofmann SG, Curtiss J, Carpenter JK, Kind S. Effect of treatments for depression on quality of life: a meta-analysis. Cogn Behav Ther 2017; 46:265-286. [PMID: 28440699 DOI: 10.1080/16506073.2017.1304445] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are the two first-line treatments for depression, but little is known about their effects on quality of life (QOL). A meta-analysis was conducted to examine changes in QOL in adults with major depressive disorder who received CBT (24 studies examining 1969 patients) or SSRI treatment (13 studies examining 4286 patients) for their depression. Moderate improvements in QOL from pre to post-treatment were observed in both CBT (Hedges' g = .63) and SSRI (Hedges' g = .79) treatments. The effect size remained stable over the course of the follow-up period for CBT. No data were available to examine follow-ups in the SSRI group. QOL effect sizes decreased linearly with publication year, and greater improvements in depression were significantly associated with greater improvements in QOL for CBT, but not for SSRIs. CBT and SSRIs for depression were both associated with moderate improvements in QOL, but are possibly caused by different mechanisms.
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Affiliation(s)
- Stefan G Hofmann
- a Department of Psychological and Brain Sciences , Boston University , 648 Beacon Street, 6th Floor, Boston , MA 02215 , USA
| | - Joshua Curtiss
- a Department of Psychological and Brain Sciences , Boston University , 648 Beacon Street, 6th Floor, Boston , MA 02215 , USA
| | - Joseph K Carpenter
- a Department of Psychological and Brain Sciences , Boston University , 648 Beacon Street, 6th Floor, Boston , MA 02215 , USA
| | - Shelley Kind
- a Department of Psychological and Brain Sciences , Boston University , 648 Beacon Street, 6th Floor, Boston , MA 02215 , USA.,b Psychology Department , Suffolk University , 73 Tremont Street, 8th Floor, Boston , MA 02108 , USA
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113
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Goodarzi Z, Ismail Z. A practical approach to detection and treatment of depression in Parkinson disease and dementia. Neurol Clin Pract 2017; 7:128-140. [PMID: 28409063 PMCID: PMC5386841 DOI: 10.1212/cpj.0000000000000351] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/13/2017] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW To review the available evidence for the detection and management of depression in Parkinson disease (PD) and dementia. RECENT FINDINGS Depression is a common comorbidity in those with PD or dementia, and leads to increased morbidity. There are several available and accurate tools for the detection of depression in PD (e.g., Geriatric Depression Scale) and dementia (e.g., Cornell Scale for Depression in Dementia). Treatment of depression depends on patient preference, severity of depression, comorbidities, and available resources. Despite variable evidence, the use of nonpharmacologic strategies to manage depression is suggested. Pharmacologic management is guided by modest evidence in PD and dementia, but also informed by the management of late-life depression (LLD). SUMMARY There is evidence to guide the diagnosis and management of depression in PD or dementia. However, more research is required in this field to better inform clinical decision-making.
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Affiliation(s)
- Zahra Goodarzi
- Department of Medicine, Section of Geriatric Medicine (ZG), Department of Psychiatry (ZI), and Department of Clinical Neurosciences (ZI), University of Calgary and Alberta Health Services; and the Hotchkiss Brain Institute (ZI) and The Mathison Centre for Mental Health Research and Education (ZI), University of Calgary, Canada
| | - Zahinoor Ismail
- Department of Medicine, Section of Geriatric Medicine (ZG), Department of Psychiatry (ZI), and Department of Clinical Neurosciences (ZI), University of Calgary and Alberta Health Services; and the Hotchkiss Brain Institute (ZI) and The Mathison Centre for Mental Health Research and Education (ZI), University of Calgary, Canada
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114
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Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer's disease. The prevalence of PD increases with age. The spectrum of clinical features, the rate of progression of the disease, the burden of nonmotor symptoms, and the response to medications are different in older patients with PD from the relatively younger patients. Management of symptoms of PD in older patients is challenging because of possible existence of several age-related systemic illness. While dealing with older patients, it is crucial not to attribute all the physical symptoms to PD. Thorough evaluation for existence of diseases such as normal pressure hydrocephalus and vascular parkinsonism which partially mimic the symptoms of PD carries immense importance. Medical management of parkinsonian symptoms should be preferred with levodopa monotherapy. However, in patients with significant motor fluctuations, dopaminergic agents may be added with caution, as they are notorious for several adverse reactions. Nonmotor symptoms must be provided high importance as they substantially worsen the quality of life. In addition to parkinsonian symptoms, older patients with PD may need to undergo surgery for several conditions. Meticulous perioperative management is crucial as older patients with PD may face several surgery-related complications compared to the younger patients. Compliance to treatment is an important issue in old age. Hence multidisciplinary approach to management of PD in older patients should be emphasized.
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115
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Koychev I, Okai D. Cognitive-behavioural therapy for non-motor symptoms of Parkinson's disease: a clinical review. EVIDENCE-BASED MENTAL HEALTH 2017; 20:15-20. [PMID: 28073810 PMCID: PMC10688422 DOI: 10.1136/eb-2016-102574] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/23/2016] [Indexed: 11/03/2022]
Abstract
Neuropsychiatric symptoms are common in Parkinson's disease (PD) and have a disproportionate impact on quality of life and carer burden. Pharmacological treatment is the main approach in dealing with these symptoms, but it is limited by variable efficacy and risk of drug interactions. Non-pharmacological approaches using the cognitive-behavioural therapy (CBT) model are viable alternatives and in this review paper we summarise the evidence of CBT for three of the most common psychiatric manifestations of PD: depression and anxiety, impulse-control disorders and insomnia. Most studies modified the usual CBT format to include modules accounting for problems specific to PD: activity scheduling around motoric function, motor symptoms as triggers of anxiety, fear of falling and preparation for disease progression as well as accommodation of materials for suspected executive dysfunction. We found a growing evidence base that CBT (modified to account for PD-specific problems) is effective in the treatment of PD psychiatric symptoms. Where controlled study design was used, moderate effect sizes are reported for the efficacy of CBT for depression, including with distance administration of CBT. The effects were sustained during follow-up which was between 1 and 6 months. In addition, there are some initial data on the effects of CBT on impulse-control disorders and insomnia. The studies were limited by their small and potentially unrepresentative samples and the quality of sample reporting (eg, concomitant antidepressant and dopaminergic therapy use). Additional well-designed and adequately powered studies are required to determine the utility of CBT in PD.
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Affiliation(s)
- Ivan Koychev
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - David Okai
- Psychological Medicine Service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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116
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Bogosian A, Hurt CS, Vasconcelos E Sa D, Hindle JV, McCracken L, Cubi-Molla P. Distant delivery of a mindfulness-based intervention for people with Parkinson's disease: the study protocol of a randomised pilot trial. Pilot Feasibility Stud 2017; 3:4. [PMID: 28116120 PMCID: PMC5244573 DOI: 10.1186/s40814-016-0117-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 12/12/2016] [Indexed: 01/19/2023] Open
Abstract
Background Psychological difficulties, especially depression and anxiety, are the most prevalent non-motor symptoms in Parkinson’s disease. Pharmacological treatments for these conditions appear relatively ineffective in Parkinson’s disease. Mindfulness courses are increasingly popular and recognised as effective for managing emotional states, and there is growing evidence for the effectiveness of mindfulness courses for people with long-term medical conditions. With this exploratory pilot trial, we want to assess the feasibility of the procedures and processes, including recruitment, most appropriate outcome measure(s), acceptability of type and number of measures, potential nocebo effects, and potential effectiveness and cost-effectiveness of a specially adapted distance-delivered mindfulness-based intervention in people affected by Parkinson’s disease. Methods/Design This is a pilot two-arm randomised parallel group controlled trial. Sixty participants who meet eligibility criteria will be randomly assigned either to an 8-week mindfulness-based intervention group or a wait-list control group. The mindfulness intervention will include 1-h weekly sessions delivered by a health psychologist trained to facilitate mindfulness courses. Participants in both groups will complete standardised questionnaires assessing anxiety, depression, pain, insomnia, fatigue, and daily activities at four time points (baseline, 4, 8, and 20 weeks). The analysis will also consider potential mechanisms of change, such as acceptance, self-compassion, and tolerance of uncertainty, as well as health economic outcomes. Participants’ experiences of the mindfulness interventions will be explored via in-depth interviews. Discussion A mindfulness-based intervention for people with Parkinson’s delivered remotely, through Skype group videoconferences, may represent a viable, more accessible, intervention for people with mobility limitations and people who live in rural areas. The trial will provide important information about the feasibility, potential efficacy and cost-effectiveness, and acceptability of the intervention as well as mechanisms of psychosocial adjustment. The results of this pilot trial will help us design a phase III trial to assess efficacy of an online mindfulness-based intervention in Parkinson’s disease and evaluate significance. Trial registration ClinicalTrials.gov, NCT02683330
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Affiliation(s)
- A Bogosian
- Division of Health Services Research & Management, School of Health Sciences, City, University of London, EC1V 0HB London, UK
| | - C S Hurt
- Division of Health Services Research & Management, School of Health Sciences, City, University of London, EC1V 0HB London, UK
| | - D Vasconcelos E Sa
- Division of Health Services Research & Management, School of Health Sciences, City, University of London, EC1V 0HB London, UK
| | - J V Hindle
- School of Psychology, Bangor University, Bangor, UK
| | - L McCracken
- Health Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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117
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Hadinia A, Meyer A, Bruegger V, Hatz F, Nowak K, Taub E, Nyberg E, Stieglitz RD, Fuhr P, Gschwandtner U. Cognitive Behavioral Group Therapy Reduces Stress and Improves the Quality of Life in Patients with Parkinson's Disease. Front Psychol 2017; 7:1975. [PMID: 28101066 PMCID: PMC5209356 DOI: 10.3389/fpsyg.2016.01975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/05/2016] [Indexed: 12/11/2022] Open
Abstract
Objective: The aim of this study is to compare a cognitive behavioral group therapy (CBT) with a health enhancement program (HEP) for stress reduction and the impact on quality of life (QoL) in patients with Parkinson’s disease (PD). Method: Thirty patients with PD participated in the study: 16 received CBT including stress-reducing elements and 14 took part in a HEP. The two groups did not differ significantly in their baseline demographic characteristics. The patients in both groups underwent weekly sessions of 2 h duration for 9 weeks. The Parkinson’s Disease Questionnaire with 39 items (PDQ-39), the Burden Questionnaire for Parkinson’s Disease (translated from the original German: Belastungsfragebogen für Parkinsonpatienten (BELA) and the Disease-Related Questionnaire [Fragebogen zur krankheitsbezogenen Kommunikation (FKK)] were used for assessment. Ratings were completed at baseline and after 9 weeks (immediately after the last treatment session). Results: The patients in the CBT group achieved significantly better BELA, FKK and PDQ-39 scores (p < 0.05). Subscale analysis revealed that the scores on the BELA subscales “emotional well-being” and “somatic motor function” contributed significantly to stress reduction (p < 0.05). The FKK revealed significant improvement in social skills in the CBT group (p < 0.05). Conclusion: Cognitive Behavioral Group Therapy appears to be an effective way for patients with PD to lessen stress and improve their quality of life.
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Affiliation(s)
- Anousha Hadinia
- Department of Neurology, University Hospital of Basel Basel, Switzerland
| | - Antonia Meyer
- Department of Neurology, University Hospital of Basel Basel, Switzerland
| | - Viviane Bruegger
- Department of Neurology, University Hospital of Basel Basel, Switzerland
| | - Florian Hatz
- Department of Neurology, University Hospital of Basel Basel, Switzerland
| | - Karolina Nowak
- Department of Neurology, University Hospital of Basel Basel, Switzerland
| | - Ethan Taub
- Department of Neurosurgery, University Hospital of Basel Basel, Switzerland
| | - Elisabeth Nyberg
- Department of Psychiatry, University Hospital of Basel Basel, Switzerland
| | - Rolf-Dieter Stieglitz
- Department of Psychiatry, University Hospital of BaselBasel, Switzerland; Department of Psychology, University of BaselBasel, Switzerland
| | - Peter Fuhr
- Department of Neurology, University Hospital of Basel Basel, Switzerland
| | - Ute Gschwandtner
- Department of Neurology, University Hospital of Basel Basel, Switzerland
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118
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Dupouy J, Ory-Magne F, Brefel-Courbon C. [Other care in Parkinson's disease: Psychological, rehabilitation, therapeutic education and new technologies]. Presse Med 2017; 46:225-232. [PMID: 28040344 DOI: 10.1016/j.lpm.2016.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/07/2016] [Accepted: 11/14/2016] [Indexed: 11/19/2022] Open
Abstract
Diagnosis of Parkinson's disease (PD) is often traumatic. It is then important to organize this announcement in order to support the patient in this major step of his care course. Anxiety and depression are present in about 50% of PD patients. Besides pharmacological treatment, cognitive-behavioral therapy induces improvement in anxio-depressive symptoms. We have to promote physical activity for PD patients, from the beginning of the disease, because it prevents from deconditioning, improves motor and non-motor symptoms, quality of life, and decreases loneliness. Rehabilitation may be also proposed (physiotherapy, speech therapy, occupational therapy). But there is no specific recommendation in PD, and usual activities can be proposed. Therapeutic education is an answer for PD patients who need to know and understand their disease and treatment. Organization of therapeutic education is different depending of the teams: group workshop and/or individual sessions, conduct by doctors or paramedical staff (nurse, physiotherapist, psychologist…). Therapeutic education programs are always evolving. It will soon be proposed therapeutic education for care partners, and some patients may join therapeutic education staff.
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Affiliation(s)
- Julia Dupouy
- CHU de Toulouse, centre expert Parkinson, service de neurologie, 31059 Toulouse, France
| | - Fabienne Ory-Magne
- CHU de Toulouse, centre expert Parkinson, service de neurologie, 31059 Toulouse, France; UMR 1214, Inserm, imagerie cérébrale et handicaps neurologiques, Toulouse, France
| | - Christine Brefel-Courbon
- CHU de Toulouse, centre expert Parkinson, service de neurologie, 31059 Toulouse, France; UMR 1214, Inserm, imagerie cérébrale et handicaps neurologiques, Toulouse, France; CHU de Toulouse, service de pharmacologie clinique, 31000 Toulouse, France.
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119
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Butterfield LC, Cimino CR, Salazar R, Sanchez-Ramos J, Bowers D, Okun MS. The Parkinson's Active Living (PAL) Program. J Geriatr Psychiatry Neurol 2017; 30:11-25. [PMID: 28248557 DOI: 10.1177/0891988716673467] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Apathy, one of the most common neuropsychiatric symptoms in Parkinson's disease (PD), has been associated with reduced daily functioning, cognition, treatment compliance, quality of life, and increased caregiver burden and distress, among other outcomes. OBJECTIVES The purpose of the present study was to develop and gather pilot data on the feasibility, acceptability, and efficacy of the Parkinson's Active Living (PAL) program, to our knowledge, the first behavioral treatment specifically designed to target apathy in patients with PD. The Parkinson's Active Living is a primarily telephone-based, 6-week activity scheduling and monitoring intervention that incorporates external cueing to target disease-related self-generational deficits to reduce levels of apathy in nondemented, highly apathetic patients with PD. METHODS Participants aged 44 to 86 years (mean = 66, SD [standard deviation] = 10.7) ranging in disease duration from <1 to 23 years with elevated apathy (Apathy Evaluation Scale >35) were enrolled in a 1-arm trial and tested at 3 time points (baseline, posttest, and 1-month follow-up). RESULTS Feasibility aspects (ie, acceptability, demand, implementation, practicality, adaptation, integration, and expansion) and efficacy of PAL program are reported. Matched pairs t tests showed a medium to large effect of treatment on patient apathy (52% showing ≥1 SD improvement), depression (33% showing ≥1 SD improvement), and quality of life at posttest, with improvements in apathy and depression maintained at follow-up. CONCLUSIONS The program may hold promise as an effective nonpharmacological intervention for apathy in PD. Implications and future directions are discussed. Randomized controlled trials are needed.
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Affiliation(s)
- London C Butterfield
- 1 Department of Psychology, College of Arts and Sciences, University of South Florida, Tampa, FL, USA.,2 Department of Clinical and Health Psychology, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA.,3 Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Cynthia R Cimino
- 1 Department of Psychology, College of Arts and Sciences, University of South Florida, Tampa, FL, USA.,4 Department of Neurology, College of Medicine, University of South Florida, Tampa, FL, USA
| | - Robert Salazar
- 1 Department of Psychology, College of Arts and Sciences, University of South Florida, Tampa, FL, USA.,5 Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA
| | - Juan Sanchez-Ramos
- 4 Department of Neurology, College of Medicine, University of South Florida, Tampa, FL, USA.,6 Department of Molecular Pharmacology and Physiology, College of Medicine, University of South Florida, Tampa, FL, USA
| | - Dawn Bowers
- 2 Department of Clinical and Health Psychology, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA.,3 Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, University of Florida, Gainesville, FL, USA.,7 Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- 3 Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, University of Florida, Gainesville, FL, USA.,7 Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
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120
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Hummel J, Weisbrod C, Boesch L, Himpler K, Hauer K, Hautzinger M, Gaebel A, Zieschang T, Fickelscherer A, Diener S, Dutzi I, Krumm B, Oster P, Kopf D. AIDE-Acute Illness and Depression in Elderly Patients. Cognitive Behavioral Group Psychotherapy in Geriatric Patients With Comorbid Depression: A Randomized, Controlled Trial. J Am Med Dir Assoc 2016; 18:341-349. [PMID: 27956074 DOI: 10.1016/j.jamda.2016.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Comorbid depression is highly prevalent in geriatric patients and associated with functional loss, frequent hospital re-admissions, and a higher mortality rate. Cognitive behavioral psychotherapy (CBT) has shown to be effective in older depressive patients living in the community. To date, CBT has not been applied to older patients with acute physical illness and comorbid depression. OBJECTIVES To evaluate the effectiveness of CBT in depressed geriatric patients, hospitalized for acute somatic illness. DESIGN Randomized controlled trial with waiting list control group. SETTING Postdischarge intervention in a geriatric day clinic; follow-up evaluations at the patients' homes. PARTICIPANTS A total of 155 randomized patients, hospitalized for acute somatic illness, aged 82 ± 6 years and suffering from depression [Hospital Anxiety and Depression Scale (HADS) scores >7]. Exclusion criteria were dementia, delirium, and terminal state of medical illness. INTERVENTION Fifteen, weekly group sessions based on a CBT manual. Commencement of psychotherapy immediately after discharge in the intervention group and a 4-month waiting list interval with usual care in the control group. MEASUREMENTS HADS depression total score after 4 months. Secondary endpoints were functional, cognitive, psychosocial and physical status, resource utilization, caregiver burden, and amount of contact with physician. RESULTS The intervention group improved significantly in depression scores (HADS baseline 18.8; after 4 months 11.4), whereas the control group deteriorated (HADS baseline 18.1; after 4 months 21.6). Significant improvement in the intervention group, but not in the control group, was observed for most secondary outcome parameters such as the Barthel and Karnofsky indexes. Intervention effects were less pronounced in patients with cognitive impairment or acute fractures. CONCLUSIONS CBT is feasible and highly effective in geriatric patients. The benefits extend beyond effective recovery and include improvement in physical and functional parameters. Early diagnosis, good access to psychotherapy, and early intervention could improve care for depressive older patients. CLINICAL TRIAL REGISTRATION www.germanctr.de German Trial Register DRKS 00004728.
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Affiliation(s)
- Jana Hummel
- Geriatric and Gerontopsychotherapeutic Practice, Mannheim, Germany.
| | | | | | | | - Klaus Hauer
- Geriatric Center Bethanien, Heidelberg, Germany
| | | | | | | | | | | | - Ilona Dutzi
- Geriatric Center Bethanien, Heidelberg, Germany
| | - Bertram Krumm
- Central Institute of Mental Health, Mannheim, Germany
| | - Peter Oster
- Geriatric Center Bethanien, Heidelberg, Germany
| | - Daniel Kopf
- Department of Geriatrics, Marien Hospital, Hamburg, Germany
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121
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Molina Ruiz RM, Evans AH, Velakoulis D, Looi JC. A guide to management of neuropsychiatric manifestations of Parkinson's disease. Australas Psychiatry 2016; 24:534-537. [PMID: 27329643 DOI: 10.1177/1039856216654394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This clinical update review focuses on treatment approaches of neuropsychiatric manifestations in Parkinson's disease. METHODS We conducted a systematic search of the literature using Pubmed and selected recent and relevant papers for this review. RESULTS Neuropsychiatric symptoms in Parkinson's disease usually require optimization of levodopa therapy as a first step. Most psychotropic drugs can be used in Parkinson's disease, however there is still lack of an evidence base due to limited studies and difficulties in diagnosis of neuropsychiatric disorders. Non-pharmacological treatments have also proved effective in Parkinson's disease. Cognitive impairment requires special consideration. CONCLUSIONS Management of neuropsychiatric manifestations in Parkinson's disease is complicated by the lack of evidence. Treatment should be individualized and benefits and risks must be balanced.
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Affiliation(s)
- Rosa M Molina Ruiz
- Universitary Hospital Fundación Alcorcón, Rey Juan Carlos University, Madrid, Spain
| | - Andrew H Evans
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne Neuropsychiatry Centre, University of Melbourne & Northwestern Mental Health, Melbourne, VIC, Australia
| | - Jeffrey Cl Looi
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne Neuropsychiatry Centre, University of Melbourne & Northwestern Mental Health, Melbourne, VIC, and; Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Garran, ACT, Australia
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122
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Kolovos S, Kleiboer A, Cuijpers P. Effect of psychotherapy for depression on quality of life: meta-analysis. Br J Psychiatry 2016; 209:460-468. [PMID: 27539296 DOI: 10.1192/bjp.bp.115.175059] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 01/14/2016] [Accepted: 04/27/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Several meta-analyses have shown that psychotherapy is effective for reducing depressive symptom severity. However, the impact on quality of life (QoL) is as yet unknown. AIMS To investigate the effectiveness of psychotherapy for depression on global QoL and on the mental health and physical health components of QoL. METHOD We conducted a meta-analysis of 44 randomised clinical trials comparing psychotherapy for adults experiencing clinical depression or elevated depressive symptoms with a control group. We used subgroup analyses to explore the influence of various study characteristics on the effectiveness of treatment. RESULTS We detected a small to moderate effect size (Hedges' g = 0.33, 95% CI 0.24-0.42) for global QoL, a moderate effect size for the mental health component (g = 0.42, 95% CI 0.33-0.51) and, after removing an outlier, a small but statistically significant effect size for the physical health component (g = 0.16, 95% CI 0.05-0.27). Multivariate meta-regression analyses showed that the effect size of depressive symptoms was significantly related to the effect size of the mental health component of QoL. The effect size of depressive symptoms was not related to global QoL or the physical health component. CONCLUSIONS Psychotherapy for depression has a positive impact on the QoL of patients with depression. Improvements in QoL are not fully explained by improvements in depressive symptom severity.
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Affiliation(s)
- Spyros Kolovos
- Spyros Kolovos, MSc, Department of Health Sciences, VU University Amsterdam, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; Annet Kleiboer, PhD, Department of Clinical Psychology, VU University Amsterdam, EMGO Institute for Health and Care Research, VU University, Department of Clinical and Health Psychology, Utrecht University, The Netherlands; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University Amsterdam, EMGO Institute for Health and Care Research, VU University and VU University Medical Centre Amsterdam, The Netherlands, and Leuphana University, Lunebrug, Germany
| | - Annet Kleiboer
- Spyros Kolovos, MSc, Department of Health Sciences, VU University Amsterdam, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; Annet Kleiboer, PhD, Department of Clinical Psychology, VU University Amsterdam, EMGO Institute for Health and Care Research, VU University, Department of Clinical and Health Psychology, Utrecht University, The Netherlands; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University Amsterdam, EMGO Institute for Health and Care Research, VU University and VU University Medical Centre Amsterdam, The Netherlands, and Leuphana University, Lunebrug, Germany
| | - Pim Cuijpers
- Spyros Kolovos, MSc, Department of Health Sciences, VU University Amsterdam, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; Annet Kleiboer, PhD, Department of Clinical Psychology, VU University Amsterdam, EMGO Institute for Health and Care Research, VU University, Department of Clinical and Health Psychology, Utrecht University, The Netherlands; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University Amsterdam, EMGO Institute for Health and Care Research, VU University and VU University Medical Centre Amsterdam, The Netherlands, and Leuphana University, Lunebrug, Germany
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Goodarzi Z, Mele B, Guo S, Hanson H, Jette N, Patten S, Pringsheim T, Holroyd-Leduc J. Guidelines for dementia or Parkinson's disease with depression or anxiety: a systematic review. BMC Neurol 2016; 16:244. [PMID: 27887589 PMCID: PMC5124305 DOI: 10.1186/s12883-016-0754-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/10/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Depression and anxiety remain under-diagnosed and under-treated in those with neurologic diseases such as dementia or Parkinson's Disease (PD). Our objectives were to first, to provide a synthesis of high quality guidelines available for the identification and management of depression or anxiety in those with dementia or PD. Second, to identify areas for improvement for future guidelines. METHODS We searched MEDLINE, PsycINFO, and EMBASE (2009 to July 24, 2015), grey literature (83 sources; July 24-Sept 6, 2015), and bibliographies of included studies. Included studies were evaluated for quality by four independent reviewers the AGREE II tool. Guideline characteristics, statements and recommendations relevant to depression or anxiety for dementia and PD were then extracted. (PROSPERO CRD: 42016014584) RESULTS: 8121 citations were reviewed with 31 full text articles included for assessment with the AGREE II tool. 17 were of sufficient quality for inclusion. Mean overall quality scores were between 4.25 to 6.5. Domain scores were lowest in the areas of stakeholder involvement, applicability, and editorial independence. Recommendations for the screening and diagnosis of depression were found for PD and dementia. There was little evidence to guide diagnosis or management of anxiety. Non-pharmacologic therapies were recommended for dementia patients. Most advocated pharmacologic treatment for depression, for both PD and dementia, but did not specify an agent due to lack of evidence. CONCLUSIONS The available recent high quality guidelines outline several recommendations for the management of comorbid depression or anxiety in PD or dementia. However there remain significant gaps in the evidence.
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Affiliation(s)
- Zahra Goodarzi
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada
- #1104-South Tower. Foothills Medical Centre 3301 Hospital Drive, Calgary, NW T2N 2T9 Canada
| | - Bria Mele
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Selynne Guo
- Faculty of Medicine, Undergraduate Medical Education, University of Toronto, Toronto, Canada
| | - Heather Hanson
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Seniors Health Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Nathalie Jette
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, and O’Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Canada
| | - Scott Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Psychiatry, University of Calgary and Alberta Health Services, Calgary, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Canada
| | - Tamara Pringsheim
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, and O’Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Canada
- Department of Psychiatry and Pediatrics, University of Calgary and Alberta Health Services, Calgary, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada
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Garlovsky JK, Simpson J, Grünewald RA, Overton PG. Impulse control disorders in Parkinson's disease: Predominant role of psychological determinants. Psychol Health 2016; 31:1391-1414. [PMID: 27473645 DOI: 10.1080/08870446.2016.1218879] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Impulse Control Disorders (ICDs) in Parkinson's disease (PD) have previously almost exclusively been considered to result from anti-parkinsonian medication. However, this biomedical perspective has failed to achieve a full understanding of the phenomenon and it is argued that a failure to consider psychological factors is a critical omission. DESIGN The present study examined the predictive relationship between ICDs in PD and a range of psychological measures, whilst controlling for a number of biomedical determinants. MAIN OUTCOME MEASURES One hundred participants with idiopathic PD completed questionnaires that assessed demographic and clinical characteristics, psychological measures and the presence of ICDs (QUIP-RS). RESULTS Increased use of a 'negative' coping strategy, stronger illness identity, more emotional illness representations and stress were found to be significant predictors of ICDs, and different psychological predictors were associated with different ICDs. Medication was not found to predict ICDs in the presence of psychological factors, either when total treatment levels were considered or when agonist dose was considered alone. CONCLUSIONS This study provides the first quantitative evidence of a predominant predictive relationship between psychological factors and ICDs in PD. The results suggest that psychological interventions may have useful therapeutic role to play for ICDs in PD.
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Affiliation(s)
- Jack K Garlovsky
- a Department of Psychology , University of Sheffield , Sheffield , UK
| | - Jane Simpson
- b Division of Health Research , University of Lancaster , Bailrigg , UK
| | - Richard A Grünewald
- c Department of Neurology , Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust , Sheffield , UK
| | - Paul G Overton
- a Department of Psychology , University of Sheffield , Sheffield , UK
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125
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Aarsland D, Kramberger MG. Neuropsychiatric Symptoms in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2016; 5:659-67. [PMID: 26406147 DOI: 10.3233/jpd-150604] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Parkinson's disease (PD) is characterized by motor symptoms, but focused and extensive research in the last years has provided new knowledge in the field of non-motor symptoms. Non-motor symptoms include neuropsychiatric symptoms such as depression, anxiety, psychosis, apathy, impulse control disorders, and occur in the majority of patients with PD. They are associated with impaired quality of life for patients and relatives, additional deterioration of function and increased use of health resources. Medical and surgical therapies commonly used for treatment of PD can induce or worsen such symptoms. This paper discusses the epidemiology, clinical features and treatment approaches for neuropsychiatric symptoms (NPS) in PD in the perspective of clinical practice and management. The prevalence rates of various NPS are high, various demographic, clinical and treatment related variables have shown to be associated with higher risk of NPS. Randomized controlled trials of pharmacological and non-pharmacological treatments of NPS in PD are sparse. Current evidence supports tricyclic antidepressants as efficacious treatment of depression in PD and antipsychotic clozapine as efficacious choice for psychosis. Further studies to evaluate various other management strategies of NPS in PD are required. Neuropsychiatric symptoms in PD should be considered an integral part of the disease; hence a multidisciplinary approach is essential to improve the overall outcome of PD also through raised awareness and enriched knowledge on NPS.
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Affiliation(s)
- Dag Aarsland
- Karolinska Institute, Department of Neurobiology, Care Sciences and Society (NVS), H1, Division of Neurogeriatrics, Huddinge, Sweden.,Stavanger University Hospital, Stavanger, Norway
| | - Milica Gregoric Kramberger
- Karolinska Institute, Department of Neurobiology, Care Sciences and Society (NVS), H1, Division of Neurogeriatrics, Huddinge, Sweden.,Department of Neurology, University Medical Center Ljubljana, Slovenia
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126
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Egan SJ, Laidlaw K, Starkstein S. Cognitive Behaviour Therapy for Depression and Anxiety in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2016; 5:443-51. [PMID: 26406124 PMCID: PMC4923758 DOI: 10.3233/jpd-150542] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Evidence is reviewed demonstrating that cognitive behavior therapy (CBT) is effective in the treatment of depression and anxiety in Parkinson’s disease. The aims were to review the extant literature, specify a model of cognitive and behavioral maintenance factors in depression and anxiety in Parkinson’s disease and provide a guide to treatment. It is argued that treatment should take into account specific cognitive and behavioral maintaining factors. Symptoms of depression and anxiety are highly prevalent in Parkinson’s disease and therapists should consider how to augment the efficacy of CBT for patients with Parkinson’s disease. Cognitive and behavioral interventions can help people overcome some of the challenges in living with PD by maximizing wellbeing and overall quality of life.
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Affiliation(s)
- Sarah J Egan
- School of Psychology and Speech Pathology, Curtin University, WA, Australia
| | - Ken Laidlaw
- Department of Clinical Psychology, The University of East Anglia, Norfolk, UK
| | - Sergio Starkstein
- School of Psychiatry, University of Western Australia, Crawley WA, Australia
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127
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Lee J, Choi M, Yoo Y. A Meta-Analysis of Nonpharmacological Interventions for People With Parkinson’s Disease. Clin Nurs Res 2016; 26:608-631. [DOI: 10.1177/1054773816655091] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nonpharmacological interventions are important in providing care for Parkinson’s disease (PD) patients. However, there is limited evidence related to their impacts on health-related quality of life (HRQOL). We aimed to examine the effectiveness of nonpharmacological interventions for improving the HRQOL of PD patients. Articles published in peer-reviewed journals from 2000 to 2015 were searched through electronic searching, computerized author searching, and footnote chasing. A meta-analysis was performed using the RevMan 5.3 program. Overall, effect size for the studies ( n = 18) was −4.17 with 95% confidence interval (CI) from −7.63 to −0.70 ( Z = 2.36, p = .02), indicating positive effects of nonpharmacological interventions on HRQOL. In subgroup analysis regarding the intervention types, the effect size of exercise programs was −5.73 with 95% CI of −11.36 to −0.10 ( Z = 2.00, p = .05). Thus, nonpharmacological interventions, and particularly exercise programs, were effective in improving the HRQOL of PD patients.
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Affiliation(s)
- JuHee Lee
- Yonsei University, Seodaemun-gu, Seoul, Korea
| | - MoonKi Choi
- Yonsei University, Seodaemun-gu, Seoul, Korea
| | - Yonju Yoo
- University of Virginia, Charlottesville, VA, USA
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128
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Schrag A, Sauerbier A, Chaudhuri KR. New clinical trials for nonmotor manifestations of Parkinson's disease. Mov Disord 2016; 30:1490-504. [PMID: 26371623 DOI: 10.1002/mds.26415] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/22/2015] [Accepted: 08/03/2015] [Indexed: 11/07/2022] Open
Abstract
Nonmotor manifestations in Parkinson's disease (PD) encompass a range of clinical features, including neuropsychiatric problems, autonomic dysfunction, sleep disorders, fatigue, and pain. Despite their importance for patients' quality of life, the evidence base for their treatment is relatively sparse. Nevertheless, the last few years have seen a number of new trials starting that specifically address nonmotor features as an outcome measure in clinical trials. Large randomized, controlled trials in the last 3 years reported improvement of psychosis with the new selective serotonin 5-HT2A inverse agonist pimavanserin and of postural hypotension with the oral norepinephrine precursor droxidopa. Smaller new randomized, controlled trials support the effectiveness of Deep Brain Stimulation and opiates for pain, of rivastigmine for apathy and piribedil for apathy post-DBS, group cognitive behavioral therapy for depression and/or anxiety, continuous positive airway pressure for sleep apnea in PD and doxepin for insomnia, and of solifenacin succinate and transcutaneous tibial nerve stimulation for urinary symptoms. A number of new smaller or open trials as well as post-hoc analyses of randomized, controlled trials have suggested usefulness of other treatments, and new randomized, controlled trials are currently ongoing.
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Affiliation(s)
- Anette Schrag
- Department of Clinical Neurosciences, UCL Institute of Neurology, London, United Kingdom
| | - Anna Sauerbier
- National Parkinson Foundation International Center of Excellence, King's College London; National Institute for Health Research (NIHR) Mental Health Biomedical Research Center and Dementia Unit at South London and Maudsley NHS Foundation Trust and King's College London, United Kingdom; Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Kings College London, London, United Kingdom
| | - Kallol Ray Chaudhuri
- National Parkinson Foundation International Center of Excellence, King's College London; National Institute for Health Research (NIHR) Mental Health Biomedical Research Center and Dementia Unit at South London and Maudsley NHS Foundation Trust and King's College London, United Kingdom; Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Kings College London, London, United Kingdom
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129
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Shinmei I, Kobayashi K, Oe Y, Takagishi Y, Kanie A, Ito M, Takebayashi Y, Murata M, Horikoshi M, Dobkin RD. Cognitive behavioral therapy for depression in Japanese Parkinson's disease patients: a pilot study. Neuropsychiatr Dis Treat 2016; 12:1319-31. [PMID: 27354802 PMCID: PMC4908947 DOI: 10.2147/ndt.s104777] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study evaluated the feasibility of cognitive behavioral therapy (CBT) for Japanese Parkinson's disease (PD) patients with depression. To increase cultural acceptability, we developed the CBT program using manga, a type of Japanese comic novel. METHODS Participants included 19 non-demented PD patients who had depressive symptoms (GRID-Hamilton Rating Scale for Depression score ≥8). A CBT program comprising six sessions was individually administered. We evaluated the feasibility and safety of the CBT program in terms of the dropout rate and occurrence of adverse events. The primary outcome was depressive symptom reduction in the GRID-Hamilton Rating Scale for Depression upon completion of CBT. Secondary outcomes included changes in the self-report measures of depression (Beck Depression Inventory-II, Hospital Anxiety and Depression Scale-Depression), anxiety (Hospital Anxiety and Depression Scale-Anxiety, State and Trait Anxiety Inventory, Overall Anxiety Severity and Impairment Scale), functional impairment, and quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey). RESULTS Of the 19 participants (mean age =63.8 years, standard deviation [SD] =9.9 years; mean Hohen-Yahr score =1.7, SD =0.8), one patient (5%) withdrew. No severe adverse event was observed. The patients reported significant improvements in depression (Hedges' g =-1.02, 95% confidence interval =-1.62 to -0.39). The effects were maintained over a 3-month follow-up period. Most of the secondary outcome measurements showed a small-to-moderate but nonsignificant effect size from baseline to post-intervention. CONCLUSION This study provides preliminary evidence that CBT is feasible among Japanese PD patients with depression. Similar approaches may be effective for people with PD from other cultural backgrounds. The results warrant replication in a randomized controlled trial.
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Affiliation(s)
- Issei Shinmei
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Neuropsychiatry, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - Kei Kobayashi
- Department of Neurology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuki Oe
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuriko Takagishi
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychology, Surugadai University, Saitama, Japan
| | - Ayako Kanie
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masaya Ito
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoshitake Takebayashi
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
- Risk Analysis Research Center, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Miho Murata
- Department of Neurology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masaru Horikoshi
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Roseanne D Dobkin
- Department of Psychiatry, Rutgers-Robert Wood Johnson Medical school, NJ, USA
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130
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D'Ostilio K, Garraux G. The Network Model of Depression as a Basis for New Therapeutic Strategies for Treating Major Depressive Disorder in Parkinson's Disease. Front Hum Neurosci 2016; 10:161. [PMID: 27148016 PMCID: PMC4840253 DOI: 10.3389/fnhum.2016.00161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 04/01/2016] [Indexed: 01/29/2023] Open
Abstract
The high prevalence of major depressive disorder in people with Parkinson’s disease (PD), its negative impact on health-related quality of life and the low response rate to conventional pharmacological therapies call to seek innovative treatments. Here, we review the new approaches for treating major depressive disorder in patients with PD within the framework of the network model of depression. According to this model, major depressive disorder reflects maladaptive neuronal plasticity. Non-invasive brain stimulation (NIBS) using high frequency repetitive transcranial magnetic stimulation (rTMS) over the prefrontal cortex has been proposed as a feasible and effective strategy with minimal risk. The neurobiological basis of its therapeutic effect may involve neuroplastic modifications in limbic and cognitive networks. However, the way this networks reorganize might be strongly influenced by the environment. To address this issue, we propose a combined strategy that includes NIBS together with cognitive and behavioral interventions.
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Affiliation(s)
- Kevin D'Ostilio
- Movere Group, Cyclotron Research Center, University of Liege Liege, Belgium
| | - Gaëtan Garraux
- Movere Group, Cyclotron Research Center, University of LiegeLiege, Belgium; Department of Neurology, University Hospital CenterLiege, Belgium
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131
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Garlovsky JK, Overton PG, Simpson J. Psychological Predictors of Anxiety and Depression in Parkinson's Disease: A Systematic Review. J Clin Psychol 2016; 72:979-98. [PMID: 27062284 DOI: 10.1002/jclp.22308] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 01/01/2016] [Accepted: 02/23/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Parkinson's disease (PD) is a neurodegenerative disorder, affecting the motor system with psychological difficulties also frequently reported. While explanations for psychological difficulties are historically situated within a biomedical framework, more recently the relevance of psychological determinants has become a research focus. This review therefore examines this relationship with the two most commonly reported psychological difficulties (anxiety and depression) in people with PD. METHOD Databases were systematically searched up to December 17, 2013, identifying 24 studies meeting inclusion criteria. RESULTS Significant predictors of heightened anxiety and depression included increased emotion-focused coping; less problem-focused coping; lower perceived control; more dominant beliefs about PD as part of a person's identity and influence on life; less social support and more avoidant personality types. CONCLUSIONS Relationships between some specific psychological predictors and depression and anxiety seem well supported. The complexity of relationships between these psychological determinants should be taken into consideration when delivering psychological interventions.
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132
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Borisovskaya A, Bryson WC, Buchholz J, Samii A, Borson S. Electroconvulsive therapy for depression in Parkinson's disease: systematic review of evidence and recommendations. Neurodegener Dis Manag 2016; 6:161-76. [PMID: 27033556 DOI: 10.2217/nmt-2016-0002] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIM We performed a systematic review of evidence regarding treatment of depression in Parkinson's disease (PD) utilizing electroconvulsive therapy. METHODS The search led to the inclusion of 43 articles, mainly case reports or case series, with the largest number of patients totaling 19. RESULTS The analysis included 116 patients with depression and PD; depression improved in 93.1%. Where motor symptoms' severity was reported, 83% of patients improved. Cognition did not worsen in the majority (94%). Many patients experienced delirium or transient confusion, sometimes necessitating discontinuation of electroconvulsive therapy (ECT). Little is known about maintenance ECT in this population. CONCLUSION ECT can benefit patients suffering from PD and depression. We recommend an algorithm for treatment of depression in PD, utilizing ECT sooner rather than later.
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Affiliation(s)
- Anna Borisovskaya
- University of Washington Medical Center, Seattle, WA, USA.,Veterans' Affairs Medical Center, Seattle, WA, USA
| | | | - Jonathan Buchholz
- University of Washington Medical Center, Seattle, WA, USA.,Veterans' Affairs Medical Center, Seattle, WA, USA
| | - Ali Samii
- University of Washington Medical Center, Seattle, WA, USA.,Veterans' Affairs Medical Center, Seattle, WA, USA
| | - Soo Borson
- University of Washington Medical Center, Seattle, WA, USA
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133
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Julien CL, Rimes KA, Brown RG. Rumination and behavioural factors in Parkinson's disease depression. J Psychosom Res 2016; 82:48-53. [PMID: 26944399 PMCID: PMC4796022 DOI: 10.1016/j.jpsychores.2016.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Parkinson's disease is associated with high rates of depression. There is growing interest in non-pharmacological management including psychological approaches such as Cognitive Behaviour Therapy. To date, little research has investigated whether processes that underpin cognitive models of depression, on which such treatment is based, apply in patients with Parkinson's disease. The study aimed to investigate the contribution of core psychological factors to the presence and degree of depressive symptoms. METHODS 104 participants completed questionnaires measuring mood, motor disability and core psychological variables, including maladaptive assumptions, rumination, cognitive-behavioural avoidance, illness representations and cognitive-behavioural responses to symptoms. RESULTS Regression analyses revealed that a small number of psychological factors accounted for the majority of depression variance, over and above that explained by overall disability. Participants reporting high levels of rumination, avoidance and symptom focusing experienced more severe depressive symptoms. In contrast, pervasive negative dysfunctional beliefs did not independently contribute to depression variance. CONCLUSION Specific cognitive (rumination and symptom focusing) and behavioural (avoidance) processes may be key psychological markers of depression in Parkinson's disease and therefore offer important targets for tailored psychological interventions.
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Affiliation(s)
- Camille L Julien
- King's College London, Institute of Psychiatry Psychology and Neuroscience, Department of Psychology, London, UK; Department of Health and Rehabilitation Psychology, Barts Health NHS Trust, London, UK
| | - Katharine A Rimes
- King's College London, Institute of Psychiatry Psychology and Neuroscience, Department of Psychology, London, UK
| | - Richard G Brown
- King's College London, Institute of Psychiatry Psychology and Neuroscience, Department of Psychology, London, UK.
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134
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A Framework to Support Cognitive Behavior Therapy for Emotional Disorder After Stroke. COGNITIVE AND BEHAVIORAL PRACTICE 2016. [DOI: 10.1016/j.cbpra.2015.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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135
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Landau S, Harris V, Burn DJ, Hindle JV, Hurt CS, Samuel M, Wilson KC, Brown RG. Anxiety and anxious-depression in Parkinson's disease over a 4-year period: a latent transition analysis. Psychol Med 2016; 46:657-667. [PMID: 26492977 PMCID: PMC4697304 DOI: 10.1017/s0033291715002196] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 08/27/2015] [Accepted: 09/21/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Depression and anxiety in Parkinson's disease are common and frequently co-morbid, with significant impact on health outcome. Nevertheless, management is complex and often suboptimal. The existence of clinical subtypes would support stratified approaches in both research and treatment. METHOD Five hundred and thirteen patients with Parkinson's disease were assessed annually for up to 4 years. Latent transition analysis (LTA) was used to identify classes that may conform to clinically meaningful subgroups, transitions between those classes over time, and baseline clinical and demographic features that predict common trajectories. RESULTS In total, 64.1% of the sample remained in the study at year 4. LTA identified four classes, a 'Psychologically healthy' class (approximately 50%), and three classes associated with psychological distress: one with moderate anxiety alone (approximately 20%), and two with moderate levels of depression plus moderate or severe anxiety. Class membership tended to be stable across years, with only about 15% of individuals transitioning between the healthy class and one of the distress classes. Stable distress was predicted by higher baseline depression and psychiatric history and younger age of onset of Parkinson's disease. Those with younger age of onset were also more likely to become distressed over the course of the study. CONCLUSIONS Psychopathology was characterized by relatively stable anxiety or anxious-depression over the 4-year period. Anxiety, with or without depression, appears to be the prominent psychopathological phenotype in Parkinson's disease suggesting a pressing need to understanding its mechanisms and improve management.
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Affiliation(s)
- S. Landau
- Department of Biostatistics,
Institute of Psychiatry, Psychology and
Neuroscience, King's College London,
UK
| | - V. Harris
- Department of Biostatistics,
Institute of Psychiatry, Psychology and
Neuroscience, King's College London,
UK
| | - D. J. Burn
- Institute of Neuroscience,
Newcastle University, Newcastle upon
Tyne, UK
| | - J. V. Hindle
- Betsi Cadwaladr University Health
Board, Department of Care of the Elderly,
Llandudno, UK
- University of Bangor,
North Wales Organisation for Randomised Trials in Health (NWORTH),
UK
| | - C. S. Hurt
- School of Health Sciences,
City University London, London,
UK
| | - M. Samuel
- Department of Neurology,
King's College Hospital, King's Health
Partners, London, UK
- East Kent Hospitals NHS University Foundation
Trust, Ashford, Kent,
UK
| | - K. C. Wilson
- EMI Academic Unit,
University of Liverpool, St Catherine's
Hospital, Wirral, UK
| | - R. G. Brown
- Department of Psychology,
Institute of Psychiatry, Psychology and
Neuroscience, King's College London,
UK
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136
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Sapronova MR, Shnayder NA. Predictors and modifiers of impulse control disorders in Parkinson`s disease. Zh Nevrol Psikhiatr Im S S Korsakova 2016. [DOI: 10.17116/jnevro2016116111145-156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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137
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Cash TV, Lageman SK. Randomized controlled expressive writing pilot in individuals with Parkinson's disease and their caregivers. BMC Psychol 2015; 3:44. [PMID: 26621025 PMCID: PMC4666161 DOI: 10.1186/s40359-015-0101-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 11/23/2015] [Indexed: 11/18/2022] Open
Abstract
Background Individuals with Parkinson’s disease (PD) and their caregivers are at risk for emotional distress and hypercortisolism. Expressive writing is an effective complementary intervention to ameliorate the psychological and physiological effects of chronic illness. This pilot study aimed to evaluate feasibility and preliminary effectiveness of an expressive writing intervention for individuals with PD and their caregivers. Methods Individuals with PD (N = 27) and their caregivers (N = 14) were randomly assigned to expressive (N = 15 patients, eight caregivers) or neutral (N = 12 patients, six caregivers) writing conditions. Cortisol awakening response (CAR), non-motor functioning, quality of life, and performance on tests of cognitive functioning were assessed at baseline, immediate post, 4-month, and 10-month post intervention. Results Attrition was a challenge as eight patients (29.62 %) and four caregivers (28.57 %) chose to discontinue before beginning the intervention or were lost to follow up prior to completing the intervention or the first follow up visit. Significant reduction in anxiety, marginally significant improvement in depression and caregiver burden, and significant improvements in performance on tests of learning and memory were observed, but these changes did not differ by writing condition. CAR significantly differed over time between patients and caregivers and writing conditions. Conclusions Some evidence for the feasibility and effectiveness of writing to alleviate hypercortisolism was demonstrated in a small sample of PD patients; however, relatively high attrition rates and the lack of difference between expressive and neutral writing conditions on emotional and neurocognitive outcomes suggests expressive writing procedure modifications may be needed to obtain optimal results for this population. Trial registration ClinicalTrials.gov, NCT02217735, Study Start Date: August 30, 2011. Electronic supplementary material The online version of this article (doi:10.1186/s40359-015-0101-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Therese Verkerke Cash
- Parkinson's and Movement Disorders Center, Virginia Commonwealth University, P.O. Box 980539, Richmond, VA, 23298-0539, USA. .,Department of Psychology, Virginia Commonwealth University, Richmond, USA.
| | - Sarah K Lageman
- Parkinson's and Movement Disorders Center, Virginia Commonwealth University, P.O. Box 980539, Richmond, VA, 23298-0539, USA. .,Department of Neurology, Virginia Commonwealth University, Richmond, USA.
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138
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Abstract
The broad importance of dementia is undisputed, with Alzheimer's disease justifiably getting the most attention. However, dementia with Lewy bodies and Parkinson's disease dementia, now called Lewy body dementias, are the second most common type of degenerative dementia in patients older than 65 years. Despite this, Lewy body dementias receive little attention and patients are often misdiagnosed, leading to less than ideal management. Over the past 10 years, considerable effort has gone into improving diagnostic accuracy by refining diagnostic criteria and using imaging and other biomarkers. Dementia with Lewy bodies and Parkinson's disease dementia share the same pathophysiology, and effective treatments will depend not only on successful treatment of symptoms but also on targeting the pathological mechanisms of disease, ideally before symptoms and clinical signs develop. We summarise the most pertinent progress from the past 10 years, outlining some of the challenges for the future, which will require refinement of diagnosis and clarification of the pathogenesis, leading to disease-modifying treatments.
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Affiliation(s)
- Zuzana Walker
- Division of Psychiatry, University College London, London, UK; North Essex Partnership University NHS Foundation Trust, Epping, UK.
| | - Katherine L Possin
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Bradley F Boeve
- Division of Behavioral Neurology, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA; Division of Movement Disorders, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA; Center for Sleep Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Dag Aarsland
- Centre for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway; Department of Geriatric Psychiatry, Akershus University Hospital, Oslo, Norway; Department of Neurobiology, Care Sciences and Society, Division of Alzheimer's Disease Research Centre, Karolinska Institute, Stockholm, Sweden
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139
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Boison D, Aronica E. Comorbidities in Neurology: Is adenosine the common link? Neuropharmacology 2015; 97:18-34. [PMID: 25979489 PMCID: PMC4537378 DOI: 10.1016/j.neuropharm.2015.04.031] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 04/24/2015] [Accepted: 04/27/2015] [Indexed: 12/13/2022]
Abstract
Comorbidities in Neurology represent a major conceptual and therapeutic challenge. For example, temporal lobe epilepsy (TLE) is a syndrome comprised of epileptic seizures and comorbid symptoms including memory and psychiatric impairment, depression, and sleep dysfunction. Similarly, Alzheimer's disease (AD), Parkinson's disease (PD), and Amyotrophic Lateral Sclerosis (ALS) are accompanied by various degrees of memory dysfunction. Patients with AD have an increased likelihood for seizures, whereas all four conditions share certain aspects of psychosis, depression, and sleep dysfunction. This remarkable overlap suggests common pathophysiological mechanisms, which include synaptic dysfunction and synaptotoxicity, as well as glial activation and astrogliosis. Astrogliosis is linked to synapse function via the tripartite synapse, but astrocytes also control the availability of gliotransmitters and adenosine. Here we will specifically focus on the 'adenosine hypothesis of comorbidities' implying that astrocyte activation, via overexpression of adenosine kinase (ADK), induces a deficiency in the homeostatic tone of adenosine. We present evidence from patient-derived samples showing astrogliosis and overexpression of ADK as common pathological hallmark of epilepsy, AD, PD, and ALS. We discuss a transgenic 'comorbidity model', in which brain-wide overexpression of ADK and resulting adenosine deficiency produces a comorbid spectrum of seizures, altered dopaminergic function, attentional impairment, and deficits in cognitive domains and sleep regulation. We conclude that dysfunction of adenosine signaling is common in neurological conditions, that adenosine dysfunction can explain co-morbid phenotypes, and that therapeutic adenosine augmentation might be effective for the treatment of comorbid symptoms in multiple neurological conditions.
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Affiliation(s)
- Detlev Boison
- Robert Stone Dow Neurobiology Laboratories, Legacy Research Institute, Portland, OR 97232, USA.
| | - Eleonora Aronica
- Department of (Neuro)Pathology, Academic Medical Center and Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, The Netherlands; Stichting Epilepsie Instellingen (SEIN) Nederland, Heemstede, The Netherlands
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140
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Calleo JS, Amspoker AB, Sarwar AI, Kunik ME, Jankovic J, Marsh L, York M, Stanley MA. A Pilot Study of a Cognitive-Behavioral Treatment for Anxiety and Depression in Patients With Parkinson Disease. J Geriatr Psychiatry Neurol 2015; 28:210-7. [PMID: 26047635 DOI: 10.1177/0891988715588831] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 01/28/2015] [Indexed: 11/15/2022]
Abstract
Anxiety and depression often remain unrecognized or inadequately treated in patients with Parkinson disease (PD). Cognitive-behavioral therapy (CBT) is effective, but limited evidence supports its use for anxiety and depression in patients with PD. Sixteen patients with PD having significant anxiety and/or depressive symptoms were assigned to CBT or enhanced usual care. Assessments occurred at baseline, posttreatment, and 1-month follow-up. The CBT intervention included tools for anxiety, depression, and healthy living with PD symptoms. Individual sessions were delivered by telephone or in person, based on patient preference. Treatment was feasible with participants choosing 67% of sessions by telephone and 80% completed treatment. The between-group effect sizes for change scores from baseline to posttreatment and baseline to 1-month follow-up were large (posttreatment: d = 1.49 for depression and 1.44 for anxiety; 1-month follow-up: d = .73 for depression and 1.24 for anxiety), although only the posttreatment effect size for depression was significant. This pilot CBT program is feasible for treatment of anxiety and depression in patients with PD.
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Affiliation(s)
- Jessica S Calleo
- Houston VA Health Services Research and Development (HSR&D) Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA
| | - Amber B Amspoker
- Houston VA Health Services Research and Development (HSR&D) Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA
| | - Aliya I Sarwar
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA
| | - Mark E Kunik
- Houston VA Health Services Research and Development (HSR&D) Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA VA South Central Mental Illness Research, Education and Clinical Center
| | | | - Laura Marsh
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA
| | - Michele York
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA
| | - Melinda A Stanley
- Houston VA Health Services Research and Development (HSR&D) Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA VA South Central Mental Illness Research, Education and Clinical Center
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141
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Cristea IA, Huibers MJH, David D, Hollon SD, Andersson G, Cuijpers P. The effects of cognitive behavior therapy for adult depression on dysfunctional thinking: A meta-analysis. Clin Psychol Rev 2015; 42:62-71. [PMID: 26319193 DOI: 10.1016/j.cpr.2015.08.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 06/24/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND It is not clear whether cognitive behavior therapy (CBT) works through changing dysfunctional thinking. Although several primary studies have examined the effects of CBT on dysfunctional thinking, no meta-analysis has yet been conducted. METHOD We searched for randomized trials comparing CBT for adult depression with control groups or with other therapies and reporting outcomes on dysfunctional thinking. We calculated effect sizes for CBT versus control groups, and separately for CBT versus other psychotherapies and respectively, pharmacotherapy. RESULTS 26 studies totalizing 2002 patients met inclusion criteria. The quality of the studies was less than optimal. We found a moderate effect of CBT compared to control groups on dysfunctional thinking at post-test (g=0.50; 95% CI: 0.38-0.62), with no differences between the measures used. This result was maintained at follow-up (g=0.46; 95% CI: 0.15-0.78). There was a strong association between the effects on dysfunctional thinking and those on depression. We found no significant differences between CBT and other psychotherapies (g=0.17; p=0.31), except when restrict in outcomes to the Dysfunctional Attitudes Scale (g=0.29). There also was no difference between CBT and pharmacotherapy (g=0.04), though this result was based on only 4 studies. DISCUSSION While CBT had a robust and stable effect on dysfunctional thoughts, this was not significantly different from what other psychotherapies or pharmacotherapy achieved. This result can be interpreted as confirming the primacy of cognitive change in symptom change, irrespective of how it is attained, as well as supporting the idea that dysfunctional thoughts are simply another symptom that changes subsequent to treatment.
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Affiliation(s)
- Ioana A Cristea
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania; Clinical Psychology Branch, Department of Surgical, Medical, Molecular and Critical Pathology, University of Pisa, Pisa, Italy.
| | - Marcus J H Huibers
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, The Netherlands
| | - Daniel David
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, USA
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Sweden; Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, The Netherlands
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142
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Akbar U, Friedman JH. Recognition and treatment of neuropsychiatric disturbances in Parkinson's disease. Expert Rev Neurother 2015; 15:1053-65. [PMID: 26289491 DOI: 10.1586/14737175.2015.1077703] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The non-motor symptoms of Parkinson's disease (PD) have been attracting increasing attention due to their ubiquitous nature and their often devastating effects on the quality of life. Behavioral problems in PD include dementia, depression, apathy, fatigue, anxiety, psychosis, akathisia, personality change, sleep disorders and impulse control disorders. Some of these are intrinsic to the neuropathology while others occur as an interplay between pathology, psychology and pharmacology. While few data exist for guiding therapy, enough is known to guide therapy in a rational manner.
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Affiliation(s)
- Umer Akbar
- a Department of Neurology, Brown University, Providence, RI, USA
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143
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Berardelli I, Pasquini M, Roselli V, Biondi M, Berardelli A, Fabbrini G. Cognitive Behavioral Therapy in Movement Disorders: A Review. Mov Disord Clin Pract 2015; 2:107-115. [PMID: 30363949 DOI: 10.1002/mdc3.12160] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/13/2015] [Accepted: 01/21/2015] [Indexed: 12/20/2022] Open
Abstract
In addition to motor symptoms, patients with movement disorders often complain of psychiatric disturbances, including mood, anxiety, and impulse-control disorders and psychosis. These abnormalities are often misdiagnosed and left untreated, thus resulting in a worse prognosis and lower quality of life. Besides the use of standard pharmacological treatments, psychiatric abnormalities can be treated by means of nonpharmacological approaches. These approaches include various types of psychological therapies, the most widely used being cognitive behavioral therapy (CBT). We reviewed all articles, conducted until 2014, that contained primary data derived from clinical trials and case reports on the effect of CBT in the most common movement disorders. One randomized, controlled study and several uncontrolled studies on the efficacy of CBT in Parkinson's disease (PD) have shown a short-term benefit of depression and anxiety. In Tourette's syndrome (TS), CBT has been assessed in a number of large controlled clinical trials that have demonstrated an improvement in psychiatric disturbances and tics. There are no controlled studies on the efficacy of CBT in other types of movement disorders, such as dystonia, Huntington's disease, and essential tremor. Only a limited number of studies have evaluated the efficacy of CBT in the management of psychiatric disorders in movement disorders. The evidence available suggests that CBT is useful in TS and probably useful in PD. We recommend the planning of randomized, controlled clinical trials to investigate the effects of CBT and group CBT in the treatment of psychiatric disturbances in movement disorders.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurology and Psychiatry Sapienza University of Rome Rome Italy
| | - Massimo Pasquini
- Department of Neurology and Psychiatry Sapienza University of Rome Rome Italy
| | - Valentina Roselli
- Department of Neurology and Psychiatry Sapienza University of Rome Rome Italy
| | - Massimo Biondi
- Department of Neurology and Psychiatry Sapienza University of Rome Rome Italy
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry Sapienza University of Rome Rome Italy.,IRCSS Neuromed Pozzilli (IS) Italy
| | - Giovanni Fabbrini
- Department of Neurology and Psychiatry Sapienza University of Rome Rome Italy.,IRCSS Neuromed Pozzilli (IS) Italy
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144
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Dissanayaka NN, White E, O'Sullivan JD, Marsh R, Silburn PA, Copland DA, Mellick GD, Byrne GJ. Characteristics and Treatment of Anxiety Disorders in Parkinson's Disease. Mov Disord Clin Pract 2015; 2:155-162. [PMID: 30363816 PMCID: PMC6183244 DOI: 10.1002/mdc3.12157] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/12/2015] [Accepted: 12/14/2014] [Indexed: 01/18/2023] Open
Abstract
Background: Anxiety disorders are common in Parkinson's disease (PD) and are undertreated. The current study investigates demographic and PD-specific factors associated with Diagnostic and Statistical Manual (DSM-IV) anxiety disorders and subsyndromal anxiety in PD. It also examines the use of pharmacological and nonpharmacological treatments for anxiety in PD. Methods: Ninety nondemented PD patients completed a semistructured interview. Logistic regression models were constructed examining associations between several demographic, disease-specific, and treatment factors, as well as both current syndromal, DSM-IV anxiety disorders, and subsyndromal anxiety. Results: Associations were found between current DSM-IV anxiety disorder, as well as female gender, younger age, more severe stages of PD, and poor activities of daily living. Subsyndromal anxiety was related to a younger onset age of PD. Relationships were also found between both anxiety groups and more complications of PD therapy, as well as higher depression scores. There were no associations between anxiety and levodopa equivalent daily dosage, motor disability, and cognition. In our sample, 57% of patients with current DSM-IV anxiety disorders or subsyndromal anxiety were not currently treated with pharmacotherapy. Of those who currently received such treatment, 83% still experienced current anxiety disorders. Results suggest that anxiety is poorly recognized and treated in PD. Conclusions: Clinical trials investigating the efficacy of pharmacotherapy, tailored psychotherapy, and combination therapy primarily focusing on anxiety are much needed, with the aim of establishing novel targeted treatment protocols for the management of subtypes of anxiety disorders in PD.
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Affiliation(s)
- Nadeeka N.W. Dissanayaka
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- Neurology Research CenterRoyal Brisbane & Women's HospitalHerstonBrisbaneQueenslandAustralia
- School of PsychologyThe University of QueenslandBrisbaneQueenslandAustralia
| | - Elizabeth White
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- School of MedicineRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
| | - John D. O'Sullivan
- Neurology Research CenterRoyal Brisbane & Women's HospitalHerstonBrisbaneQueenslandAustralia
- School of MedicineRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
| | - Rodney Marsh
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- School of MedicineRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- Mental Health ServiceRoyal Brisbane & Women's HospitalHerstonBrisbaneQueenslandAustralia
| | - Peter A. Silburn
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- Neurology Research CenterRoyal Brisbane & Women's HospitalHerstonBrisbaneQueenslandAustralia
- School of MedicineRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
| | - David A. Copland
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- School of Health & Rehabilitation SciencesUniversity of QueenslandSt LuciaBrisbaneQueenslandAustralia
| | - George D. Mellick
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- Neurology Research CenterRoyal Brisbane & Women's HospitalHerstonBrisbaneQueenslandAustralia
- Eskitis Institute for Drug DiscoveryGriffith UniversityNathanBrisbaneQueenslandAustralia
| | - Gerard J. Byrne
- UQ Center for Clinical ResearchRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- School of PsychologyThe University of QueenslandBrisbaneQueenslandAustralia
- School of MedicineRoyal Brisbane & Women's HospitalUniversity of QueenslandHerstonBrisbaneQueenslandAustralia
- Mental Health ServiceRoyal Brisbane & Women's HospitalHerstonBrisbaneQueenslandAustralia
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145
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Laidlaw K, Kishita N. Age-Appropriate Augmented Cognitive Behavior Therapy to Enhance Treatment Outcome for Late-Life Depression and Anxiety Disorders. GEROPSYCH-THE JOURNAL OF GERONTOPSYCHOLOGY AND GERIATRIC PSYCHIATRY 2015. [DOI: 10.1024/1662-9647/a000128] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We present an explanation of the benefits of using gerontological theory to augment treatment outcome in cognitive behavior therapy (CBT). Traditional formulations/conceptualizations of CBT may not always be the most optimal fit when working with older people, who may be experiencing different developmental life stages compared to adults of working age. In addressing how CBT may be different with older people, it is proposed that one may augment CBT outcome by applying gerontological theory as “vehicles for change.” This evidence-based scientist approach is consistent with standard practice in CBT. This paper outlines some examples of how gerontological theory can be useful to bring about an enhanced treatment outcome.
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Affiliation(s)
- Ken Laidlaw
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Naoko Kishita
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
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146
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Bomasang-Layno E, Fadlon I, Murray AN, Himelhoch S. Antidepressive treatments for Parkinson's disease: A systematic review and meta-analysis. Parkinsonism Relat Disord 2015; 21:833-42; discussion 833. [PMID: 26037457 DOI: 10.1016/j.parkreldis.2015.04.018] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 04/14/2015] [Accepted: 04/17/2015] [Indexed: 11/25/2022]
Abstract
CONTEXT Depression affects 50-70% of patients with Parkinson's disease resulting in significant comorbidity, executive dysfunction, and poorer quality of life. Divergent results from studies of different treatments preclude definite treatment recommendations. OBJECTIVE To perform a systematic review and meta-analysis of published randomized controlled trials (RCTS) evaluating the efficacy of pharmacologic and behavioral interventions, and repetitive transcranial magnetic stimulation (rTMS) for depression among patients with idiopathic Parkinson's disease. DATA SOURCES Trial registers and the following databases were searched: PubMed, CINAHL, EMBASE, and PsycInfo. Bibliographies of relevant articles were cross-referenced. STUDY SELECTION AND DATA EXTRACTION RCTs comparing pharmacologic, behavioral, or rTMS with a placebo/other drugs or methods with no restrictions on participant age, gender, and duration or setting of treatment were included. Eligibility assessment was performed independently. Identified records were sequentially screened according to eligibility criteria. Differences in mean depression score and 95% confidence intervals were calculated. RESULTS A total of 893 idiopathic Parkinson's disease patients with clinical depression across 20 RCTs were included. The overall standard mean difference for all pharmacologic interventions was 0.30 (95% CI -0.00, 0.61, p = 0.054). On stratification, there was a distinct difference in effect between antidepressants (SMD of 0.54, 95%CI 0.24, 0.83, p = 0.000) and non-antidepressants (SMD of -0.29, 95% CI -0.86, 0.29, p = 0.328). Behavioral interventions demonstrated significant efficacy with an effect size of 0.87 (95% CI 0.41, 1.33, p = 0.000). CONCLUSIONS This meta-analysis demonstrates that pharmacologic treatment with antidepressant medications, specifically the selective serotonin reuptake inhibitors (SSRIs), and behavioral interventions (CBT) significantly improved depression among Parkinson's disease patients.
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Affiliation(s)
- Emily Bomasang-Layno
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Iris Fadlon
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrea N Murray
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Seth Himelhoch
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
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147
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Fernie BA, Kollmann J, Brown RG. Cognitive behavioural interventions for depression in chronic neurological conditions: a systematic review. J Psychosom Res 2015; 78:411-419. [PMID: 25777621 DOI: 10.1016/j.jpsychores.2015.02.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/17/2015] [Accepted: 02/19/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Chronic neurological conditions (CNCs) affect over one million people in the UK alone. Individuals with CNCs endure an increased prevalence of comorbid depression and anxiety. Poor mental health exacerbates the cost of the treatment and management of CNCs. CBT is recommended for the treatment of depression. However the application of CBT to individuals with CNCs may be limited by disease characteristics (e.g. mobility issues restricting therapy attendance and reducing engagement with behavioural activation, as well as difficulties challenging the veracity of disease-related negative thoughts that may reflect accurate appraisals). The objective of this review is to assess the clinical effectiveness of cognitive and behavioural interventions for depressive symptoms in individuals with non-acquired, medically explained CNCs. DATA SOURCES Searches of The Cochrane Controlled Trials Register, PubMed, and PsychINFO were conducted. RESULTS All studies suggested that CBT is an effective treatment for depression comorbid to CNCs, however when CBT was compared to an active therapy control condition, between group differences were unstable. CONCLUSION CBT has promise for the treatment for depression in such conditions; however treatment protocols and outcome measures should be adapted for this population. Future trials should control for non-specific effects of therapy and, as much as possible, introduce blinding into methodologies.
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Affiliation(s)
- Bruce A Fernie
- King's College London, Institute of Psychiatry, Department of Psychology, London, UK; CASCAID, South London & Maudsley NHS Foundation Trust, London, UK.
| | - Josianne Kollmann
- Philipps University Marburg, Institute of Psychology, Germany; King's College London, Institute of Psychiatry, Department of Psychology, London, UK
| | - Richard G Brown
- King's College London, Institute of Psychiatry, Department of Psychology, London, UK
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148
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Abdel-Salam OME. Prevalence, clinical features and treatment of depression in Parkinson’s disease: An update. World J Neurol 2015; 5:17-38. [DOI: 10.5316/wjn.v5.i1.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 01/10/2015] [Accepted: 02/09/2015] [Indexed: 02/06/2023] Open
Abstract
Parkinson’s disease (PD) is one of the most prevalent neurodegenerative diseases which typically affects individuals over 65 years. Although the symptomatology is predominantly motor, neuropsychiatric manifestations, e.g., depression, apathy, anxiety, and cognitive impairment occur in the course of the illness and can have a great impact on the quality of life in these patients. Parkinson’s disease is commonly comorbid with depression with prevalence rates of depression, generally higher than those reported in general population. Depression in PD is frequently underestimated and consequently undertreated, which have significant effects on the quality of life in these patients. The neurobiology of depression in PD is complex and involves alterations in dopaminergic, serotonergic, noradrenergic and possibly other neurotransmitter systems which are affected in the course of the disease. The tricyclic antidepressants and the selective serotonin reuptake inhibitors are the two classes of antidepressant drugs used for depressive symptoms in PD. Several published studies suggested that both classes are of comparable efficacy. Other serotonergic antidepressants, e.g., nefazodone and trazodone have also been of benefit. Meanwhile, there are limited data available on other drugs but these suggest a benefit from the serotonin and noradrenaline reuptake inhibitors such as mirtazapine, venlafaxine, atomoxetine and duloxetine. Some of the drugs used in symptomatic treatment of PD, e.g., the irreversible selective inhibitors of the enzyme monoamine oxidase-B, rasagiline and selegiline as well as the dopamine receptor agonist pramipexole are likely to have direct antidepressant activity independent of their motor improving action. This would make these drugs an attractive option in depressed subjects with PD. The aim of this review is to provide an updated data on the prevalence, clinical features of depression in subjects with PD. The effects of antiparkinsonian and antidepressant drugs on depressive symptoms in these patients are also discussed.
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149
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Berardelli I, Pasquini M, Bloise M, Tarsitani L, Biondi M, Berardelli A, Fabbrini G. CBT Group Intervention for Depression, Anxiety, and Motor Symptoms in Parkinson's Disease: Preliminary Findings. Int J Cogn Ther 2015. [DOI: 10.1521/ijct.2015.8.1.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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150
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A systematic review and meta-analysis of cognitive behavioral and psychodynamic therapy for depression in Parkinson’s disease patients. Neurol Sci 2015; 36:833-43. [DOI: 10.1007/s10072-015-2118-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/18/2015] [Indexed: 12/21/2022]
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