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Voon V, Howell NA, Krack P. Psychiatric considerations in deep brain stimulation for Parkinson’s disease. HANDBOOK OF CLINICAL NEUROLOGY 2013; 116:147-54. [DOI: 10.1016/b978-0-444-53497-2.00012-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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152
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Assogna F, Fagioli S, Cravello L, Meco G, Pierantozzi M, Stefani A, Imperiale F, Caltagirone C, Pontieri FE, Spalletta G. Depressive symptoms in Parkinson's disease and in non-neurological medical illnesses. Neuropsychiatr Dis Treat 2013; 9:389-96. [PMID: 23569379 PMCID: PMC3615851 DOI: 10.2147/ndt.s40013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with neurological and non-neurological medical illnesses very often complain of depressive symptoms that are associated with cognitive and functional impairments. We compared the profile of depressive symptoms in Parkinson's disease (PD) patients with that of control subjects (CS) suffering from non-neurological medical illnesses. METHODS One-hundred PD patients and 100 CS were submitted to a structured clinical interview for identification of major depressive disorder (MDD) and minor depressive disorder (MIND), according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR), criteria. The Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory (BDI) were also administered to measure depression severity. RESULTS When considering the whole groups, there were no differences in depressive symptom frequency between PD and CS apart from worthlessness/guilt, and changes in appetite reduced rates in PD. Further, total scores and psychic and somatic subscores of HDRS and BDI did not differ between PD and CS. After we separated PD and CS in those with MDD, MIND, and no depression (NODEP), comparing total scores and psychic/somatic subscores of HDRS and BDI, we found increased total depression severity in NODEP PD and reduced severity of the psychic symptoms of depression in MDD PD, with no differences in MIND. However, the severity of individual symptom frequency of depression was not different between PD and CS in MDD, MIND, and NODEP groups. CONCLUSION Although MDD and MIND phenomenology in PD may be very similar to that of CS with non-neurological medical illnesses, neurological symptoms of PD may worsen (or confound) depression severity in patients with no formal/structured DSM-IV-TR, diagnosis of depressive mood disorders. Thus, a thorough assessment of depression in PD should take into consideration the different impacts of neurological manifestations on MDD, MIND, and NODEP.
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153
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Leroi I, McDonald K, Pantula H, Harbishettar V. Cognitive impairment in Parkinson disease: impact on quality of life, disability, and caregiver burden. J Geriatr Psychiatry Neurol 2012; 25:208-14. [PMID: 23172765 DOI: 10.1177/0891988712464823] [Citation(s) in RCA: 244] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM To compare quality of life, level of disability, and caregiver burden in 3 groups of people with Parkinson disease (PD): those with mild cognitive impairment (PD-MCI), those with dementia (PDD), and those with no cognitive impairment (PD-NC). BACKGROUND Although the cognitive profile of those with PD-MCI and PDD has been well described, little is known about the personal and clinical impact of cognitive impairment and its impact on caregivers. METHOD Quality of life and disability were measured in 3 groups of participants with PD (PD-NC, n=54; PD-MCI, n=48; and PDD, n=25). The PD-MCI group was classified using Movement Disorder Society Task Force consensus criteria. Caregivers (n=102) in the 3 groups were assessed using the Zarit Burden Inventory. RESULTS Both quality of life and caregiver burden were similar in the 2 groups without dementia but were significantly different in those with PDD. In contrast, global disability was progressively greater as cognition declined across the 3 PD groups: PD-NC<PD-MCI<PDD and on the Activities of Daily Living scale a step up in impairment was seen with the presence of any cognitive impairment. CONCLUSIONS The presence of dementia significantly increases caregiver burden and decreases quality of life. However, even mild levels of cognitive impairment increase disability and overall functional impairment progresses in tandem with cognitive decline.
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Affiliation(s)
- Iracema Leroi
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
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154
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Abstract
L-dopa is a precursor for dopamine synthesis and a mainstay treatment for Parkinson's disease. However, l-dopa therapy is not without side effects that may be attributed to non-dopaminergic mechanisms. Synthesized dopamine can be neurotoxic through its enzymatic degradation by monoamine oxidase (MAO) to form the reactive byproduct, hydrogen peroxide and hydroxyl radicals or through auto-oxidation to form highly reactive quinones that can bind proteins and render them non-functional. Since l-dopa could be decarboxylated by aromatic amino acid decarboxylase (AADC) present within both dopamine and serotonin neurons, it was hypothesized that serotonin neurons convert l-dopa into dopamine to generate excessive reactive oxygen species and quinoproteins that ultimately lead to serotonin neuron death. To examine the effects of l-dopa on serotonin neurons, the RN46A-B14 cell line was used. These immortalized serotonergic cell cultures were terminally differentiated and then incubated with varying concentrations of l-dopa. Results show that RN46A-B14 cells contain AADC and can synthesize dopamine after incubation with l-dopa. Furthermore, l-dopa dose-dependently increased intracellular reactive oxygen species (ROS) and cell death. Dopamine, ROS production and cell death were attenuated by co-incubation with the AADC inhibitor, NSD-1015. The MAO inhibitor, pargyline, also attenuated cell death and ROS after l-dopa treatment. Lastly, quinoprotein formation was enhanced significantly by incubation with l-dopa. Taken together, these data illustrate that serotonergic cells can produce dopamine and that the accumulation of dopamine after l-dopa and its subsequent degradation can lead to ROS production and death of RN46A-B14 serotonergic cells.
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155
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Hua P, Liu W, Kuo SH, Zhao Y, Chen L, Zhang N, Wang C, Guo S, Wang L, Xiao H, Kwan JY, Wu T. Association of Tef polymorphism with depression in Parkinson disease. Mov Disord 2012; 27:1694-7. [PMID: 23138696 DOI: 10.1002/mds.25195] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 08/07/2012] [Accepted: 08/20/2012] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Circadian rhythm disturbance has been implicated in depression, and polymorphisms of circadian genes Cry1, Cry2, and Tef are associated with depression. However, the relationship between these genes and depression symptoms in Parkinson's disease (PD) has not been established. METHODS Four hundred eight subjects with PD participated in this study. Demographics, UPDRS, Mini-Mental Status Examination (MMSE), and Hamilton Rating Scale for Depression (HAMD) were obtained in all subjects. Frequency of polymorphisms of Cry1 rs2287161, Cry2 rs10838524, and Tef rs738499 was determined, and the association between genetic polymorphisms of circadian genes and HAMD scores in patients with PD was examined. RESULTS Tef, but not Cry1 or Cry2, is associated with HAMD scores in patients with PD in a linear regression model after adjusting for clinical variables (P = 0.004). CONCLUSIONS The polymorphism of Tef rs738499 is associated with depression symptoms in PD.
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Affiliation(s)
- Ping Hua
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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156
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Petrovic IN, Stefanova E, Kozic D, Semnic R, Markovic V, Daragasevic NT, Kostic VS. White matter lesions and depression in patients with Parkinson's disease. J Neurol Sci 2012; 322:132-6. [DOI: 10.1016/j.jns.2012.07.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 07/01/2012] [Accepted: 07/10/2012] [Indexed: 10/28/2022]
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157
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Willis AW, Schootman M, Kung N, Racette BA. Epidemiology and neuropsychiatric manifestations of Young Onset Parkinson's Disease in the United States. Parkinsonism Relat Disord 2012; 19:202-6. [PMID: 23083512 DOI: 10.1016/j.parkreldis.2012.09.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 09/26/2012] [Accepted: 09/29/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND To determine the demographic distribution of Young Onset Parkinson's Disease (YOPD) in the United States and to quantify the burden of neuropsychiatric disease manifestations. METHODS Cross sectional study of 3,459,986 disabled Americans, aged 30-54, who were receiving Medicare benefits in the year 2005. We calculated race and sex distributions of YOPD and used logistic regression to compare the likelihood of common and uncommon psychiatric disorders between beneficiaries with YOPD and the general disability beneficiary population, adjusting for race, age, and sex. RESULTS We identified 14,354 Medicare beneficiaries with YOPD (prevalence = 414.9 per 100,000 disabled Americans). White men comprised the majority of cases (48.9%), followed by White women (34.7%), Black men (6.8%), Black women (5.0%), Hispanic men (2.4%), and Hispanic women (1.2%). Asian men (0.6%) and Asian women (0.4%) were the least common race-sex pairs with a YOPD diagnosis in this population (chi square, p < 0.001). Compared to the general population of medically disabled Americans, those with YOPD were more likely to receive medical care for depression (OR: 1.89, 1.83-1.95), dementia (OR: 7.73, 7.38-8.09), substance abuse/dependence (OR: 3.00, 2.99-3.01), and were more likely to be hospitalized for psychosis (OR: 3.36, 3.19-3.53), personality/impulse control disorders (OR: 4.56, 3.28-6.34), and psychosocial dysfunction (OR: 3.85, 2.89-5.14). CONCLUSIONS Young Onset Parkinson's Disease is most common among white males in our study population. Psychiatric illness, addiction, and cognitive impairment are more common in YOPD than in the general population of disabled Medicare beneficiaries. These may be key disabling factors in YOPD.
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Affiliation(s)
- A W Willis
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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158
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Dubayova T, Krokavcova M, Nagyova I, Rosenberger J, Gdovinova Z, Middel B, Groothoff JW, van Dijk JP. Type D, anxiety and depression in association with quality of life in patients with Parkinson’s disease and patients with multiple sclerosis. Qual Life Res 2012; 22:1353-60. [DOI: 10.1007/s11136-012-0257-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2012] [Indexed: 11/30/2022]
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159
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Louis ED, Huey ED, Gerbin M, Viner AS. Depressive traits in essential tremor: impact on disability, quality of life, and medication adherence. Eur J Neurol 2012; 19:1349-54. [PMID: 22642492 PMCID: PMC3434295 DOI: 10.1111/j.1468-1331.2012.03774.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 04/24/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is growing study of the psychiatric features of essential tremor. Depressive symptoms occur in a considerable number of patients. Yet their impact, as a primary factor, has received almost no attention. We assessed whether, independent of tremor severity, patients with more depressive symptoms have more perceived tremor-related disability, lower tremor-related quality of life, and poorer compliance with tremor medication. METHODS On the basis of their Center for Epidemiological Studies Depression Scale score, we stratified 70 essential tremor patients into three groups: 41 with minimal depressive symptoms, 24 with moderate depressive symptoms, and five with severe depressive symptoms. Importantly, the three groups had similar tremor severity on neurological examination. We assessed self-reported tremor-related disability, tremor-related quality of life (Quality of Life in Essential Tremor) (QUEST) score, and medication compliance. RESULTS Cases with minimal depressive symptoms had the lowest QUEST scores (i.e., highest quality of life), cases with moderate depressive symptoms had intermediate scores, and those with severe depressive symptoms had the highest QUEST scores (i.e., lowest quality of life) (P < 0.001). Depressive symptoms were a stronger predictor of tremor-related quality of life than was the main motor feature of essential tremor (ET) itself (tremor). Self-reported medication compliance was lowest in cases with severe depressive symptoms and highest in cases with minimal depressive symptoms. CONCLUSIONS The physical disability caused by the tremor of ET has traditionally been regarded as the most important feature of the disease that causes distress, and it has received the most attention in the management of patients with this disease. Our data indicate that this may not be the case.
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Affiliation(s)
- E D Louis
- G H Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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160
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Thobois S, Ballanger B, Poisson A, Broussolle E. [Imaging non motor signs in Parkinson's disease]. Rev Neurol (Paris) 2012; 168:576-84. [PMID: 22921250 DOI: 10.1016/j.neurol.2012.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 05/25/2012] [Accepted: 05/29/2012] [Indexed: 11/18/2022]
Abstract
Parkinson's disease is mainly considered as a motor disorder defined by a motor triad. However, various non-motor manifestations may be encountered in Parkinson's disease, including hyposmia, pain, fatigue, sleep disorders, cognitive and behavioral disorders. The pathophysiology of these signs is complex, not univocal and remains poorly understood. Functional imaging techniques either by positron emission tomography, single photon emission tomography or functional magnetic resonance imaging provide an invaluable opportunity to better understand the pathophysiology of these signs. In this paper, we present a review of the recent advances provided by functional imaging in this area.
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Affiliation(s)
- S Thobois
- CNRS, UMR 5229, centre de neurosciences cognitives, Bron cedex, France.
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161
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Abstract
An increasing emphasis has been placed on the identification and management of non-motor features of Parkinson's disease (PD). Of the behavioural disorders in PD, mood disorders are amongst the most common and can occur in both early and late stages of PD. In some cases, these problems may even precede the development of motor symptoms of PD. These disorders have a major impact in the quality of life and affect daily function. This review will focus on depression, anxiety and apathy, and will discuss the epidemiological, clinical features, diagnosis and management of these disorders. The diagnosis and evaluation of these problems remain a challenge in view of the overlapping symptoms between these disorders and also with the clinical features of PD. The development and validation of diagnostic criteria and rating scales for these disorders remain a priority particularly in relation to anxiety and apathy. Another gap in the management of these disorders is the limited empirical evidence for the treatment of these problems. There is therefore an urgent need for systematic studies in the pharmacological and non-pharmacological management of these disorders to enable a holistic and evidence-based approach to the management of mood disorders in PD.
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Affiliation(s)
- Louis C S Tan
- Department of Neurology, Parkinson's Disease and Movement Disorders Centre, National Neuroscience Institute, Singapore, USA.
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162
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Marzinzik F, Wahl M, Doletschek CM, Jugel C, Rewitzer C, Klostermann F. Evaluation of a telemedical care programme for patients with Parkinson's disease. J Telemed Telecare 2012; 18:322-7. [DOI: 10.1258/jtt.2012.120105] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We reviewed a telemedicine-based care model for drug optimization in Parkinson's disease. In this model patients send video recordings made in the home to the treating team via the Internet. These serve as the basis for making therapeutic decisions, in particular drug adjustments. Data from 78 patients were analysed with respect to outcome, method acceptance and management of the procedure. During the 30-day telemedicine programme, the patients recorded an average of 3.2 videos per day. The patients’ motor score on the Unified Parkinson's Disease Rating Scale (UPDRS) was 31 points at enrolment and three months after ICP termination it was significantly lower at 24 points ( P < 0.01), i.e. there was less impairment. The patients rated their condition better at the end than at the beginning of the programme: on a 6-point scale, the mean rating at the beginning was 3.2 and the mean rating at the end was 2.8 ( P < 0.001). A blinded investigator rated the patients’ videos on the same scale: at the beginning the mean score was 3.0 and at the end it was 2.8 ( P < 0.05). The information from the questionnaire showed overall acceptance and practicability of the method. Both patients’ and neurologists’ use of the method was high. The method seems to be feasible for therapy optimization in Parkinson's disease, and of particular interest for patients with complex conditions who do not necessarily have to undergo hospital treatment.
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Affiliation(s)
- Frank Marzinzik
- Department of Neurology, Charité - University Medicine Berlin, Germany
| | - Michael Wahl
- Department of Neurology, Charité - University Medicine Berlin, Germany
| | | | - Constanze Jugel
- Department of Neurology, Charité - University Medicine Berlin, Germany
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163
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Crizzle AM, Newhouse IJ. Themes associated with exercise adherence in persons with Parkinson's disease: a qualitative study. Occup Ther Health Care 2012; 26:174-86. [PMID: 23899141 DOI: 10.3109/07380577.2012.692174] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACT The purpose of this study was to examine motivators important to exercise adherence in a group of older adults with Parkinson's disease (PD). Four participants with PD completed a 6-week hydrotherapy program, followed by participation in a focus group along with their caregivers (n = 4) to examine motivators that were important to exercise adherence. A semi-structured focus group was transcribed verbatim and analyzed using content analysis to identify common patterns and themes. Multiple themes were found that were important to exercise adherence. Constant reassurance and support from the exercise leader was a primary theme for remaining enrolled in an exercise program. Exercising in a group environment and social interaction with other persons with PD were also the themes. Perceived changes in physical ability increased participants' confidence and motivation to continue to exercise. The findings suggest that the perceived needs of PD exercise participants can be influenced and addressed by exercise leaders, provide opportunities to improve physical function, and support social interaction. Future exercise programs should be designed to provide a venue where the symptoms of PD are not a deterrent to exercise participation.
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Affiliation(s)
- Alexander M Crizzle
- 1Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida , Gainesville, FL , USA
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164
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Yang S, Sajatovic M, Walter BL. Psychosocial interventions for depression and anxiety in Parkinson's disease. J Geriatr Psychiatry Neurol 2012; 25:113-21. [PMID: 22689704 DOI: 10.1177/0891988712445096] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Depression has been estimated to affect 1 in 3 individuals with Parkinson's disease (PD) and can lead to worse health outcomes and decreased quality of life. Anxiety further complicates PD outcomes. Pharmacologic treatments of depression and anxiety can have negative side effects in patients with PD, including exacerbation of PD symptoms. There is a critical need for alternative treatment approaches that address depression and anxiety among patients with PD. Psychosocial or behavioral approaches are known to be effective for depression generally, but only a handful of studies have examined the role of psychosocial treatments of patients with depression in PD. OBJECTIVE The aim of this article was to review published psychosocial treatment studies of depression and anxiety in patients with PD. METHODS The PubMed database was searched for articles published in English before April 2011 using the terms Parkinson's disease, depression, anxiety, psychotherapy, cognitive therapy, behavioral treatment, behavioral therapy, nonpharmacologic treatment, psychoeducation, education, psychosocial treatment, and stress management. Articles included were prospective clinical trials utilizing specific depression or anxiety assessments as primary or secondary outcomes in patients with PD. RESULTS Nine reports derived from 8 separate studies fit the inclusion criteria and were included in this review. All studies were published between 1997 and 2011, and all but 3 had small sample sizes (<40 patients). Interventions included cognitive behavioral therapy (CBT), psychodrama, education, and behavior therapy as well as multidisciplinary rehabilitation. Cognitive behavioral therapy was the most studied and was shown to decrease depressive and anxiety symptoms in patients with PD. Other individual and group therapies may improve depression and anxiety in patients with PD, but the general paucity of studies and study methods limit the interpretation of these results. CONCLUSIONS There have been few studies on psychosocial treatments that specifically assess change in depression and anxiety among patients with PD. While results for CBT and other modes of therapy are promising for acute management of depression and anxiety, longer term effects after treatment have been variable. There is a need for additional studies on psychosocial interventions in people with PD.
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Affiliation(s)
- Sarah Yang
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
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165
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Abstract
BACKGROUND AND PURPOSE Hemifacial spasm (HFS), a movement disorder manifested by unilateral spasms of the muscles innervated by the facial nerve, interferes with social life in about 90% of patients, causing social isolation and depression and having a significant impact on the quality of life. The aim of the study was to assess factors affecting the quality of life in patients with HFS in respect of influence of the severity of depression symptoms and botulinum toxin type A (BTX-A) therapy. MATERIAL AND METHODS Eighty-five out of 129 patients included in the HFS database of the Movement Disorders Outpatient Clinic, Department of Neurology, University Hospital, Cracow who fulfilled the inclusion criteria and had no exclusion criteria (suffering from concomitant movement disorders, other severe chronic diseases or cognitive impairment) were studied. Demographic and clinical data (age at onset, disease duration and accompanying symptoms) were collected. Severity of HFS was assessed by the five-point clinical scale and seven-point Clinical Global Impression scale. Quality of life was assessed with the HFS-36 questionnaire and severity of depressive symptoms was evaluated with the Beck Depression Inventory. HFS-36 was performed twice, before BTX-A injection and two weeks later. RESULTS The mean global score of HFS-36 was 47 ± 31 (maximum: 140 pts). Decreased HFS-36 score resulted from divergent deterioration in all subscales included in the questionnaire. Independent risk factors of deterioration in HFS-36 were increased severity of HFS and depressive symptoms as well as accompanying trismus. The HFS-36 score depended on the number and type of accompanying symptoms as well. Botulinum toxin type A therapy led to a significant improvement of HFS-36, particularly high in patients with multiple (> 4) HFS-related symptoms. CONCLUSIONS The HFS-36 score depends mostly on severity of HFS, depressive symptoms and occurrence of accompanying trismus. It improves after BTX-A treatment.
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166
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Paumier KL, Siderowf AD, Auinger P, Oakes D, Madhavan L, Espay AJ, Revilla FJ, Collier TJ. Tricyclic antidepressants delay the need for dopaminergic therapy in early Parkinson's disease. Mov Disord 2012; 27:880-7. [PMID: 22555881 DOI: 10.1002/mds.24978] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 02/01/2012] [Accepted: 02/26/2012] [Indexed: 12/13/2022] Open
Abstract
This study examined whether antidepressants delay the need for dopaminergic therapy or change the degree of motor impairment and disability in a population of early Parkinson's disease (PD) patients. Preclinical studies have indicated that antidepressants modulate signaling pathways involved in cell survival and plasticity, suggesting they may serve to both treat PD-associated depression and slow disease progression. A patient-level meta-analysis included 2064 patients from the treatment and placebo arms of the following trials: FS1, FS-TOO, ELLDOPA, QE2, TEMPO, and PRECEPT. Depression severity was determined at baseline, and antidepressant use was reported in a medication log each visit. Kaplan-Meier curves and time-dependent Cox proportional hazards models determined associations between depression severity and antidepressant use with the primary outcome, time to initiation of dopaminergic therapy. ANCOVAs determined associations with the secondary outcome, degree of motor impairment and disability, reported as annualized change in UPDRS scores from baseline to final visit. When controlling for baseline depression, the initiation of dopaminergic therapy was delayed for subjects taking tricyclic antidepressants compared with those not taking antidepressants. No significant differences were found in UPDRS scores for subjects taking antidepressants compared with those not taking antidepressants. Tricyclic antidepressants are associated with a delay in reaching the end point of need to start dopaminergic therapy. The lack of change in overall UPDRS scores suggests the delay was not attributable to symptomatic effects.
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Affiliation(s)
- Katrina L Paumier
- Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
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167
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Kasten M, Kertelge L, Tadic V, Brüggemann N, Schmidt A, van der Vegt J, Siebner H, Buhmann C, Lencer R, Kumar KR, Lohmann K, Hagenah J, Klein C. Depression and quality of life in monogenic compared to idiopathic, early-onset Parkinson's disease. Mov Disord 2012; 27:754-9. [PMID: 22550041 DOI: 10.1002/mds.24999] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 02/28/2012] [Accepted: 03/14/2012] [Indexed: 01/01/2023] Open
Abstract
Quality of life (QoL) is decreased in PD and is linked with depression and anxiety. However, little is known about QoL in monogenic PD. Subjects with mutations in PD genes were recruited from ongoing family and genetic studies (manifesting carriers, n = 23; nonmanifesting carriers, n = 19). For comparison purposes, we included patients with idiopathic PD (IPD; n = 128; early onset, n = 38; late onset, n = 90), healthy controls (n = 127), and data on depressive symptoms of 144 patients with major depression (treated controls). Depression affected 31% of early-onset PD cases, 21% of late-onset cases, and 44% of manifesting carriers of mutations in PD genes, but was rare in the nonmanifesting carriers (7%) and healthy controls (5%). Subjects with Parkinson-associated depression reported fewer feelings of guilt or self-doubt than treated controls, but the occurrence of suicidal ideation was associated with severity of depression only. Social phobia (P = 0.018) and agoraphobia (P = 0.059) were more common in manifesting carriers than in any other group. QoL was decreased in the Parkinson groups, particularly in the early-onset cases (P < 0.001), and QoL correlated with depression in all analyses. In our study, monogenic and IPD cases were comparable in QoL and depression characteristics. The QoL and, possibly, overall prognosis of all PD patients can be improved by appropriate attention and treatment for depression, sleep impairments, and anxiety, even if the treatment of the motor problems cannot be further optimized.
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Affiliation(s)
- Meike Kasten
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany.
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168
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Shearer J, Green C, Counsell CE, Zajicek JP. The impact of motor and non motor symptoms on health state values in newly diagnosed idiopathic Parkinson's disease. J Neurol 2012; 259:462-8. [PMID: 21818689 DOI: 10.1007/s00415-011-6202-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 07/22/2011] [Accepted: 07/24/2011] [Indexed: 02/07/2023]
Abstract
The aim of the study was to estimate health state utility values in newly diagnosed idiopathic Parkinson's disease (PD) for use in the assessment of health-related quality-of-life (HRQL), and in the estimation of quality-adjusted life-years (QALYs). Data from 162 patients enrolled in a community-based incidence study of PD were used to estimate health state utility values. Self-report data from the EQ-5D, a generic measure of HRQL, were used to derive preference-based health state utility values. The impact of motor and non motor symptoms, and other clinical and demographic factors, on the derived EQ-5D health state values was examined in univariate and multivariate analyses. The mean health state utility value for recently diagnosed PD patients was estimated at 0.65 ± 0.27. Significant reductions in health state values were attributable to pain (-0.18), motor functioning (-0.16), depression (-0.12), and insomnia (-0.11). Depression had its greatest impact (-0.19) in patients in the less severe stages of PD (i.e. Hoehn Yahr stages ≤2.5). This study shows, through the presentation of QALY values, that there is scope to achieve significant health gains in newly diagnosed idiopathic PD patients via improved management of pain, depression and insomnia, alongside the treatment of primary motor symptoms.
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Affiliation(s)
- James Shearer
- Health Economics Group, Peninsula College of Medicine and Dentistry, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SG, UK.
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Sankar T, Tierney TS, Hamani C. Novel applications of deep brain stimulation. Surg Neurol Int 2012; 3:S26-33. [PMID: 22826807 PMCID: PMC3400483 DOI: 10.4103/2152-7806.91607] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 12/20/2011] [Indexed: 11/11/2022] Open
Abstract
The success of deep brain stimulation (DBS) surgery in treating medically refractory symptoms of some movement disorders has inspired further investigation into a wide variety of other treatment-resistant conditions. These range from disorders of gait, mood, and memory to problems as diverse as obesity, consciousness, and addiction. We review the emerging indications, rationale, and outcomes for some of the most promising new applications of DBS in the treatment of postural instability associated with Parkinson's disease, depression, obsessive–compulsive disorder, obesity, substance abuse, epilepsy, Alzheimer′s-type dementia, and traumatic brain injury. These studies reveal some of the excitement in a field at the edge of a rapidly expanding frontier. Much work still remains to be done on basic mechanism of DBS, optimal target and patient selection, and long-term durability of this technology in treating new indications.
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Affiliation(s)
- Tejas Sankar
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
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170
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Simmons AD. Parkinson Disease. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00013-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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171
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Sawa M, Yamashita H, Fujimaki K, Okada G, Takahashi T, Yamawaki S. Depressive symptoms and apathy are associated with psychomotor slowness and frontal activation. Eur Arch Psychiatry Clin Neurosci 2012; 262:493-9. [PMID: 22323151 PMCID: PMC3429768 DOI: 10.1007/s00406-012-0296-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 01/25/2012] [Indexed: 11/26/2022]
Abstract
Affective symptoms, such as depression and apathy, and cognitive dysfunction, such as psychomotor slowness, are known to have negative impacts on the quality of life (QOL) of patients with mental and physical diseases. However, the relationships among depressive symptoms, apathy, psychomotor slowness, and QOL in a non-clinical population are unclear. The aim of the present study was to assess these relationships and examine the underlying cortical mechanisms in a non-clinical population. Fifty-two healthy male volunteers were assessed for depressive symptoms using the Zung Self-rating Depression Scale (SDS), for apathy measured using the Apathy Scale, and QOL using the Short-Form 36 item questionnaire (SF36). The volunteers also performed the Trail Making Test Part A (TMT-A) while undergoing assessment of hemoglobin concentration changes in the frontal cortical surface using 24-channel near-infrared spectroscopy (NIRS). The scores of the SDS and Apathy Scale showed significant negative correlations with the scores of most of subscales of the SF36. In addition, the SDS score had a significant positive correlation with the time to complete the TMT-A. Further, activation of several frontal cortical areas had a significant positive correlation with the scores of the SDS and Apathy Scale. These results suggest that the degree of depressive symptoms and apathy are associated with a lower QOL in a non-clinical population and that cortical hyperactivation during a psychomotor task measured by NIRS may identify objectively individuals with a high degree of depressive symptoms and apathy.
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Affiliation(s)
- Masayo Sawa
- Daijikai Mihara Hospital, 6-31-1 Nakano-cho, Mihara, Hiroshima, 723-0003 Japan
- Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
| | - Hidehisa Yamashita
- Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
| | - Koichiro Fujimaki
- Department of Occupational Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, 1-1 Gakuen-cho, Mihara, Hiroshima, 723-0053 Japan
| | - Go Okada
- Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 8109-2700 USA
| | - Terumichi Takahashi
- Daijikai Mihara Hospital, 6-31-1 Nakano-cho, Mihara, Hiroshima, 723-0003 Japan
| | - Shigeto Yamawaki
- Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
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172
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Evans JR, Mason SL, Barker RA. Current status of clinical trials of neural transplantation in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2012. [DOI: 10.1016/b978-0-444-59575-1.00008-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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173
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Bahamin G, Taheri F, Moghaddas A, Sohrabi F, Dortaj F. The Effects of Hardiness Training on Suicide Ideation, Quality of Life and Plasma Levels of Lipoprotein (a) in Patients with Depressive Disorder. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.sbspro.2012.06.233] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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174
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Leonardi M, Raggi A, Pagani M, Carella F, Soliveri P, Albanese A, Romito L. Relationships between disability, quality of life and prevalence of nonmotor symptoms in Parkinson’s disease. Parkinsonism Relat Disord 2012; 18:35-9. [DOI: 10.1016/j.parkreldis.2011.08.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 07/20/2011] [Accepted: 08/12/2011] [Indexed: 01/15/2023]
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175
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Bryant M, Rintala D, Hou J, Rivas S, Fernandez A, Lai E, Protas E. The Relation of Falls to Fatigue, Depression and Daytime Sleepiness in Parkinsons Disease. Eur Neurol 2012; 67:326-30. [DOI: 10.1159/000335877] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 12/11/2011] [Indexed: 11/19/2022]
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176
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Cimino CR, Siders CA, Zesiewicz TA. Depressive symptoms in Parkinson disease: degree of association and rate of agreement of clinician-based and self-report measures. J Geriatr Psychiatry Neurol 2011; 24:199-205. [PMID: 22228826 DOI: 10.1177/0891988711422525] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Depression in Parkinson disease (PD) is associated with faster disease progression, lower activities of daily living, and more severe cognitive impairment. Even mild symptoms of depression may impact outcomes in patients with PD. Nevertheless, a low rate of agreement has been reported between patient and clinician ratings of depression, suggesting that clinicians may underestimate depression in patients with PD. However, to accurately compare the rates of agreement, comparable estimates are needed so that patient and clinician ratings have similar meaning (eg, mild, moderate, severe, etc). The purpose of this study was to examine this question by investigating the degree of association and rate of agreement of levels of symptom severity among self-report and clinician ratings using established cutoffs that correspond to more comparable estimates of these levels for both patient and clinician. Our findings suggest that patient's self-report of depressive symptoms was significantly correlated with clinician-based report irrespective of the stage of disease. Moreover, patients demonstrated a 72% rate of agreement with clinicians in classifying symptoms as asymptomatic, mildly symptomatic, or fully symptomatic, a rate significantly higher than the rate of 35% previously reported. This difference in rate of agreement may be accounted for using varying criteria for severity levels across the studies. Findings suggest that clinician and patient reports show a high rate of agreement across a range of depressive symptoms and that self-report measures may provide a relatively efficient means of detecting depressive symptoms especially if patients are disinclined to initiate their report.
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Affiliation(s)
- Cynthia R Cimino
- Department of Psychology, University of South Florida, Tampa, FL 33620, USA.
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177
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Proteomics in Parkinson's disease: An unbiased approach towards peripheral biomarkers and new therapies. J Biotechnol 2011; 156:325-37. [DOI: 10.1016/j.jbiotec.2011.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 06/24/2011] [Accepted: 08/08/2011] [Indexed: 12/27/2022]
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178
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Bach JP, Riedel O, Klotsche J, Spottke A, Dodel R, Wittchen HU. Impact of complications and comorbidities on treatment costs and health-related quality of life of patients with Parkinson's disease. J Neurol Sci 2011; 314:41-7. [PMID: 22133477 DOI: 10.1016/j.jns.2011.11.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 09/28/2011] [Accepted: 11/02/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Data regarding both drug-related and non-drug-related costs in patients with Parkinson's disease (PD) are scarce, mainly due to the difficulties in data acquisition in experimental designs. Likewise, the reported impact of drug costs on total direct costs varies across different studies. In addition, the influence of comorbidities on both treatment costs and health-related quality of life has not been adequately evaluated. METHODS A sample of office-based neurologists (n=315) in Germany was asked to examine up to five consecutive patients with PD (n=1449) on a specified day during the study period. Patients of all ages were eligible and their evaluation was performed using standardized questionnaires. RESULTS PD-specific therapy costs increased with the stage of the disease, early onset of the disease and disease duration. The major costs were due to PD-related therapy, whereas other medications only resulted in minor costs. Disease stage mainly influenced direct therapy costs, with an observed increase of total daily costs from €7.3 to €11.3/day. In addition, disease onset at age <65 years resulted in total daily costs of €11.2 compared to late onset of disease (>75 years) with daily therapy costs of €5.3. In this patient group neuropsychiatric comorbidities such as dementia and depression were only insufficiently treated. In addition, these comorbidities severely affected health-related quality of life. CONCLUSION Therapy costs were influenced by disease stage, disease onset as well as present comorbidities. Furthermore, comorbidities such as depression and dementia were diagnosed but were not adequately treated.
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179
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The importance of non-motor disturbances to quality of life in Parkinson's disease. J Neurol Sci 2011; 310:12-6. [DOI: 10.1016/j.jns.2011.05.006] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 05/07/2011] [Indexed: 11/20/2022]
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180
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Perez-Lloret S, Perez Lloret S, Rey MV, Ratti L, Rascol O. Pramipexole for the treatment of early Parkinson's disease. Expert Rev Neurother 2011; 11:925-35. [PMID: 21721909 DOI: 10.1586/ern.11.75] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pramipexole is a nonergolinic dopamine agonist, with high affinity for the D2 subfamily of dopamine receptors. Pramipexole is efficacious for the symptomatic treatment of early Parkinson's Disease (PD) and its early use, before that of levodopa can delay the emergence of levodopa-related motor complication. Dosage should be increased gradually from a starting dose of 0.375 mg/day up to a maximum of 4.5 mg/day in equally divided doses taken three times per day with pramipexole immediate-release or equivalent daily dosages once-daily with pramipexole extended-release. Pramipexole can also improve depressive symptoms and possibly health-related quality of life in PD. Nonetheless, its use is not devoid of tolerability problems. While peripheral adverse drug reactions, such as nausea, vomiting or orthostatic hypotension, can be effectively treated and usually pose few problems to most patients, neuropsychiatric events can seriously limit the use of pramipexole in some cases. Indeed, excessive daytime somnolence, impulse-control disorders, hallucinations or delusions can severely affect patients, causing important personal or social handicap. Patients should be informed about the risk of such neuropsychiatric complications and their presence should be actively detected at each consultation. More effort will have to be put into further studying the risk-benefit ratio of pramipexole and other dopamine agonists in the treatment of early PD.
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Affiliation(s)
- Santiago Perez-Lloret
- Departments of Clinical Pharmacology and Neurosciences, University Hospital and University of Toulouse, France and INSERM CIC-9023 and UMR-825, Toulouse, France; Department of Clinical Pharmacology, Faculty of Medicine, 37 Allées Jules Guesde, 31000, Toulouse, France
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181
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Stress, depression and Parkinson's disease. Exp Neurol 2011; 233:79-86. [PMID: 22001159 DOI: 10.1016/j.expneurol.2011.09.035] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 09/16/2011] [Accepted: 09/30/2011] [Indexed: 12/13/2022]
Abstract
In this review, we focus on the relationship among Parkinson's disease (PD), stress and depression. Parkinson's disease patients have a high risk of developing depression, and it is possible that stress contributes to the development of both pathologies. Stress dysfunction may have a role in the etiology of preclinical non-motor symptoms of PD (such as depression) and, later in the course of the disease, may worsen motor symptoms. However, relatively few studies have examined stress or depression and the injured nigrostriatal system. This review discusses the effects of stress on neurodegeneration and depression, and their association with the symptoms and progression of PD.
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182
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Leroi I, Ahearn DJ, Andrews M, McDonald KR, Byrne EJ, Burns A. Behavioural disorders, disability and quality of life in Parkinson's disease. Age Ageing 2011; 40:614-21. [PMID: 21788252 DOI: 10.1093/ageing/afr078] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND although non-motor symptoms of Parkinson's disease (PD) are known to adversely affect disability and health-related quality of life, the impact that specific disorders of reward and motivation have remains unclear. Impulse control disorders are more likely in those with a younger disease onset although there is no strong evidence to date that apathy is related to age of onset or correlated with a longer duration of disease. OBJECTIVE to examine the effects of apathy and impulse controls disorders on disability and health-related quality of life. METHODS a total of 99 non-demented participants with PD (35 with impulse control disorders, 26 with apathy and 38 with neither behavioural complication) were assessed using the Unified Parkinson's Disease Rating Scale (Activities of Daily Living component) and the Schwab-England scale to evaluate disability, and the PDQ (eight items) to assess quality of life. RESULTS quality of life was reduced in both behavioural groups compared with participants without either condition. Disability was greater in the group with apathy. Variation in disability score (56%, P < 0.001) was explained by greater levels of apathy, depression, motor impairment and longer disease duration. Variation in quality of life score (54%, P < 0.001) was explained by higher levels of impulsivity, depression, dopaminergic load, motor complications, working memory problems and younger age at onset. CONCLUSION apathy and impulsivity negatively impact on disability and health-related quality of life, emphasising the importance of effective diagnosis and management of these PD-related behavioural disturbances.
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Affiliation(s)
- Iracema Leroi
- Lancashire Care Foundation Trust/University of Manchester, Royal Blackburn Hospital, Haslingden Rd, Blackburn, Lancashire BB2 3HH, UK.
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183
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Andreadou E, Anagnostouli M, Vasdekis V, Kararizou E, Rentzos M, Kontaxis T, Evdokimidis I. The impact of comorbidity and other clinical and sociodemographic factors on health-related quality of life in Greek patients with Parkinson's disease. Aging Ment Health 2011; 15:913-21. [PMID: 21547746 DOI: 10.1080/13607863.2011.569477] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study was designed to evaluate the impact of other common self-reported comorbid disorders (hypertension, dyslipidemia, ischemic heart disease, diabetes mellitus, minor stroke, arthritis, low back pain or osteoporosis and depression) on health-related Quality of Life (HRQoL) of Parkinson's disease (PD) patients and to explore the association of their HRQoL with various sociodemographic and clinical factors. METHODS Data about age, gender, education, occupation, income, marital and residential status, social relations, disease duration, functional status, treatment and concomitant diseases were collected of 139 Greek patients (68 men and 71 women) with PD. Patients were consecutively recruited from the outpatient clinic of the first Neurology Department of Athens National University at Aeginition Hospital. Disease severity was assessed using the unified Parkinson's disease rating scale including Hoehn and Yahr and Schwab and England (S&E) scales. HRQoL was measured by the specific Parkinson's disease questionnaire (PDQ-39). A multivariate multiple regression model with normal errors was used for the statistical analysis. RESULTS The main determinants of HRQoL were low degree of independence measured by the S&E scale (F = 35.942, p < 0.001), social isolation (F = 20.508, p < 0.001), disease duration (F = 14.983, p < 0.001), sleep (F = 6.507, p = 0.013) and gastrointestinal disturbances (F = 4.643, p = 0.035) and the presence of depression (F = 6.022, p = 0.017). CONCLUSION Among the other chronic comorbidities only depression was associated with a poor HRQoL in PD patients. Functional dependence and social isolation contributed most to worse HRQoL. Our findings suggest that adequate social support and management of depression, sleep and gastrointestinal disturbances could reduce the distress and improve HRQoL in patients with PD.
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Affiliation(s)
- Elisabeth Andreadou
- 1st Department of Neurology, Medical School, Athens National and Kapodistrian University, 'Aeginition' Hospital, Greece.
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184
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Daniels C, Krack P, Volkmann J, Raethjen J, Pinsker MO, Kloss M, Tronnier V, Schnitzler A, Wojtecki L, Bötzel K, Danek A, Hilker R, Sturm V, Kupsch A, Karner E, Deuschl G, Witt K. Is improvement in the quality of life after subthalamic nucleus stimulation in Parkinson's disease predictable? Mov Disord 2011; 26:2516-21. [DOI: 10.1002/mds.23907] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 06/23/2011] [Accepted: 07/15/2011] [Indexed: 11/12/2022] Open
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185
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van der Hoek TC, Bus BAA, Matui P, van der Marck MA, Esselink RA, Tendolkar I. Prevalence of depression in Parkinson's disease: effects of disease stage, motor subtype and gender. J Neurol Sci 2011; 310:220-4. [PMID: 21802694 DOI: 10.1016/j.jns.2011.07.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 06/22/2011] [Accepted: 07/05/2011] [Indexed: 12/29/2022]
Abstract
Depression is one of the most common non-motor symptoms of Parkinson's disease (PD) with a large negative impact on the quality of life. Factors such as disease stage, subtype of PD and gender might play an important role in the prevalence of depression, but a large study investigating all these factors in a within-subject design is lacking. Therefore we studied a homogeneous group of 256 Dutch PD patients (60% men, mean age=65.12 (±9.6) years). In total, 36.3% of the subjects had a BDI-score indicative for a minor depression, while 12.9% had a major depression. Notably, only 8.6% of the minor depressed patients and 30.3% of the major depressed patients were taking antidepressants. A higher prevalence of depression was observed in the later stages of the disease. However, this finding was absent in a smaller subsample after correction for cognitive impairment. Our data did not show a difference in the prevalence of depression between the motor subtypes and showed a trend towards higher prevalence of depression in the tremor dominant group. There was no significant difference in the prevalence of depression between men and women. We will discuss the relevance of these results in relation to the findings of other studies.
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Affiliation(s)
- Take C van der Hoek
- Radboud University Nijmegen Medical Centre, Department of Psychiatry, Nijmegen, The Netherlands.
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186
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Dissanayaka NN, O'Sullivan JD, Silburn PA, Mellick GD. Assessment methods and factors associated with depression in Parkinson's disease. J Neurol Sci 2011; 310:208-10. [PMID: 21764079 DOI: 10.1016/j.jns.2011.06.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 05/25/2011] [Accepted: 06/17/2011] [Indexed: 01/25/2023]
Abstract
Depression is a common problem experienced by patients with Parkinson's disease (PD). Identifying depression in PD is difficult and the determinants of depression in PD are complex and debatable. Here we review our recent studies which have (i) examined the validity of current depression rating scales in PD, (ii) introduced a self-reported and validated strategy to identify a lifetime history of depression in PD, and (iii) investigated genetic and non-genetic factors associated with depression in the context of PD. Our research showed PD-specific cut-off values suitable to use for the Hamilton Depression Scales (HAMD and HDI) and the Geriatric Depression Scale (GDS-15) when dichotomising patients with and without a current depression. Using the GDS-15 specific cut-off scores and a number of self-reported questions that screen for a lifetime history of depression, we developed a novel method to dichotomise PD patients according to current depression or a past history of depression. This method was applied in a large-scale study examining the factors associated with depression in PD. We clarified that the severity of PD is positively related to depression. We also showed that a number of other clinical factors including a longer duration of PD, a younger PD onset age, frequent falls, a history of anxiety disorder and memory problems were associated with depression in PD. In addition to these clinical factors, we observed associations between depression, and lower education levels, a history of smoking and a regular use of non-aspirin bases NSAIDs or analgesics. No associations were found between depression in PD and common genetic variations examined across the serotonin and dopamine transporter genes. Our studies provide a focus for future intervention strategies.
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187
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Dissanayaka NNW, Sellbach A, Silburn PA, O'Sullivan JD, Marsh R, Mellick GD. Factors associated with depression in Parkinson's disease. J Affect Disord 2011; 132:82-8. [PMID: 21356559 DOI: 10.1016/j.jad.2011.01.021] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 01/31/2011] [Accepted: 01/31/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Depression is common in Parkinson's disease (PD) and contributes significantly to a reduced quality of life in PD patients. The determinants of depression in PD are complex and poorly understood. We investigated the factors associated with depression in PD. METHODS PD patients were recruited from Neurology clinics. A validated method was used to screen for a lifetime history of depression. 'Depressed' patients were identified by a score of >6 in the Geriatric Depression Scale (GDS-15) or by having had prescribed treatment for depression. 'Never depressed' patients were recognised by a score of <5 in the GDS-15 with no signs of a history of depression. A newly developed and validated questionnaire was used to collect other information. RESULTS Depression was identified in 66% of the 639 PD patients who met the inclusion criteria. Depression was associated with an increased severity of illness as evidenced by higher Unified PD Rating Scale scores and a higher Hoehn and Yahr stage. Other clinical factors associated with disease severity were also more frequently observed in depressed patients. Similar to findings in non-PD samples, depressed PD patients were more likely to have a lower education level, a history of smoking and to regularly use non-aspirin based NSAIDs or analgesics. Comorbidities such as anxiety, memory problems, hallucinations, sleep disturbances and postural hypotension were more common in depressed PD patients. LIMITATIONS To avoid patient exhaustion of over-surveying, some factors within the psychological domain were not examined. CONCLUSION Our results provide a focus for future intervention strategies.
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188
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Freezing of Gait and Activity Limitations in People With Parkinson's Disease. Arch Phys Med Rehabil 2011; 92:1159-65. [DOI: 10.1016/j.apmr.2011.02.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 01/28/2011] [Accepted: 02/10/2011] [Indexed: 11/21/2022]
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189
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Charidimou A, Seamons J, Selai C, Schrag A. The role of cognitive-behavioural therapy for patients with depression in Parkinson's disease. PARKINSONS DISEASE 2011; 2011:737523. [PMID: 21766001 PMCID: PMC3135065 DOI: 10.4061/2011/737523] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 02/25/2011] [Indexed: 11/20/2022]
Abstract
Depression is a common complication of Parkinson's disease (PD) with considerable impact on patients' quality of life. However, at present the most appropriate treatment approach is unclear. There are limited data on antidepressant medications in PD-associated depression (dPD) and those available suggest limited efficacy and tolerability of these drugs. Cognitive behavioural therapy (CBT) has been shown to be an effective treatment of depressive disorders. Treatment of dPD with CBT may pose particular challenges, including possible different pathophysiology, physical and mental comorbidities, and barriers to treatment through disability, which do not allow simple transfer of these results to patients with dPD. However, a number of case reports, case series, and small pilot studies suggest that this is a promising treatment for patients with PD. We here summarise the published evidence on this treatment in dPD.
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Affiliation(s)
- Andreas Charidimou
- Institute of Neurology, The National Hospital for Neurology and Neurosurgery, University College London (UCL), Queen Square, London WC1N 3BG, UK
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190
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Knipe MDW, Wickremaratchi MM, Wyatt-Haines E, Morris HR, Ben-Shlomo Y. Quality of life in young- compared with late-onset Parkinson's disease. Mov Disord 2011; 26:2011-8. [PMID: 21574185 DOI: 10.1002/mds.23763] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 03/14/2011] [Accepted: 03/28/2011] [Indexed: 12/30/2022] Open
Affiliation(s)
- M Duleeka W Knipe
- Department of Neurology, School of Medicine, Cardiff University, Cardiff, United Kingdom
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191
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Kano O, Ikeda K, Cridebring D, Takazawa T, Yoshii Y, Iwasaki Y. Neurobiology of depression and anxiety in Parkinson's disease. PARKINSONS DISEASE 2011; 2011:143547. [PMID: 21687804 PMCID: PMC3109308 DOI: 10.4061/2011/143547] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 03/13/2011] [Indexed: 12/11/2022]
Abstract
Depression and anxiety are common in Parkinson's disease (PD) and have important consequences on quality of life. These have long been recognized as frequent accompanying syndromes of PD, and several reports suggest that these are the causative process or risk factors that are present many years before the appearance of motor symptoms. The neurochemical changes in PD involving dopamine, norepinephrine, and serotonin might be related to the pathophysiology of depression and anxiety, but this is still not clear. Several studies showed that anxiety in PD patients occurs earlier than depression, during premotor phase, suggesting that there may be a link between the mechanisms that cause anxiety and PD. Whereas a recent study reported that PD patients with depression and anxiety were associated with different demographic and clinical features.
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Affiliation(s)
- Osamu Kano
- Department of Neurology, Toho University Omori Medical Center, 6-11-1 Omorinishi, Otaku, Tokyo 143-8541, Japan
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192
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Sampaio C, Bronzova J, Hauser RA, Lang AE, Rascol O, van de Witte SV, Theeuwes AA. Pardoprunox in early Parkinson's disease: results from 2 large, randomized double-blind trials. Mov Disord 2011; 26:1464-76. [PMID: 21542016 DOI: 10.1002/mds.23590] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 10/25/2010] [Accepted: 11/22/2010] [Indexed: 02/05/2023] Open
Abstract
This report presents the results of 2 randomized trials-Rembrandt and Vermeer-on the efficacy and safety of pardoprunox in patients with early Parkinson's disease. Patients with Parkinson's disease with a Unified Parkinson's Disease Rating Scale-Motor score ≥ 10 and modified Hoehn and Yahr stage ≤ 3 were randomized to pardoprunox (fixed doses of 6 mg/day [n = 115] or 12 mg/day [n = 118] or a flexible-dose range of 12-42 mg/day [n = 116]) or placebo (n = 119) in Rembrandt and pardoprunox 12-42 mg/day (n = 108), pramipexole 1.5-4.5 mg/day (n = 116), or placebo (n = 110) in Vermeer. Pardoprunox showed a significant benefit over placebo in the primary efficacy variable, least-square mean change from baseline in Unified Parkinson's Disease Rating Scale-Motor score: Rembrandt-fixed doses of 6 and 12 mg/day, -6.0 and -4.7 points, respectively; flexible-dose 12-42 mg/day, -5.5 points; placebo, -2.9 points; Vermeer-flexible-dose 12-42 mg/day, -4.9 points; placebo, -2.5 points; pramipexole, -5.7 points. No minimum effective dose was established. Secondary efficacy parameters supported the results of the primary efficacy variable. Pardoprunox tolerability was dose related: flexible-dose 12-42 mg/day showed the highest dropout rate due to treatment-emergent adverse events (Rembrandt, 56.0%; Vermeer, 46.3%) and overall incidence of treatment-emergent adverse events (Rembrandt, 97.4%; Vermeer, 92.6%), primarily due to nausea, somnolence, and dizziness. Because pardoprunox showed similar efficacy across all dose groups, these observations suggest that the 12-42 mg/day dose range was higher than therapeutically required. Furthermore, the early onset of treatment-emergent adverse events and dropouts observed for pardoprunox suggest that titration was too rapid. Pardoprunox significantly improved motor symptoms in patients with early Parkinson's disease, but further investigation into the dose and titration schedule is required to improve tolerability.
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Affiliation(s)
- Cristina Sampaio
- Laboratório de Farmacologia Clinica e Terapêutica e Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Edifício do Hospital de Santa Maria, Lisboa, Portugal.
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193
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Go CL, Rosales RL, Schmidt P, Lyons KE, Pahwa R, Okun MS. Generic versus branded pharmacotherapy in Parkinson's disease: does it matter? A review. Parkinsonism Relat Disord 2011; 17:308-12. [PMID: 21367644 DOI: 10.1016/j.parkreldis.2011.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 02/02/2011] [Accepted: 02/04/2011] [Indexed: 11/20/2022]
Abstract
There is an ongoing debate about generic drug use for a multitude of conditions including epilepsy, psychosis, hypertension, post-organ transplantation, and several infectious diseases. Most of the concerns involve drugs with narrow therapeutic indices. There is a heightened attention to health care costs and macroeconomic policy as well as microeconomic business decisions that may impact the use of generic drugs. The issues surrounding generic substitution for chronic degenerative conditions such as in Parkinson's disease (PD) continue to be controversial subjects for physicians, pharmacists, patients, Medicare/governmental insurance programs, and for private insurance companies. The United States Food and Drug Administration (FDA) requires that generic drugs meet a standard for bioequivalence prior to market approval, but this may not translate to therapeutic efficacy or to overall patient tolerance. In this review we will address issues related to the use of generics versus branded drugs in PD, and the potential impact substitution of generics may have on patients and on clinicians. Having proper documentation may help in deciding the appropriate usage of these drugs in PD. Medicare, governmental run health care systems, and third party insurance companies should in a complex disease such as PD, allow physicians and patients the chance to properly document the superiority of brand versus generic approaches. Currently, in the U.S, and in many countries around the world, there is no obligation for payers to respect these types of patient specific bedside trials, and there has been no standardization of the process.
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Affiliation(s)
- Criscely L Go
- Department of Neurology, University of Florida, McKnight Brain Institute, Movement Disorders Center, 100 S. Newell Drive, Gainesville, FL 32611, USA.
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194
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Depression in Parkinson's disease: symptom improvement and residual symptoms after acute pharmacologic management. Am J Geriatr Psychiatry 2011; 19:222-9. [PMID: 20808132 PMCID: PMC3010522 DOI: 10.1097/jgp.0b013e3181e448f7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Parkinson's disease (PD) is frequently complicated by depression and there is a paucity of controlled research that can inform the management of this disabling nonmotor complaint. A randomized controlled trial of nortriptyline, paroxetine, and placebo for the treatment of depression in PD (dPD) was recently completed. The purpose of this article is to describe the baseline pattern of depressive symptom presentation in PD, the specific symptoms of dPD that improve with pharmacotherapy, and the residual symptoms that remain in patients who meet a priori criteria for response or remission after acute treatment (8 weeks). SETTING The Departments of Psychiatry and Neurology at Robert Wood Johnson Medical School, New Jersey. PARTICIPANTS : Fifty-two depressed patients (major depression or dysthymia based on Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria) with Parkinson's disease (by research criteria). DESIGN/INTERVENTION A randomized controlled trial of nortriptyline, paroxetine, and placebo. MEASUREMENT The four subscales (core mood, anxiety, insomnia, and somatic) and individual items from the Hamilton Rating Scale for Depression-17 were the focus of this study. These measures were assessed at baseline and Week 8. RESULTS Baseline depressive symptoms were unrelated to motor functioning. Treatment response was associated with significant improvements in the core mood, anxiety, insomnia, and somatic symptoms seen in dPD. Residual symptoms, such as sadness and loss of interest, persisted in treatment responders in a milder form than was initially present. CONCLUSIONS Antidepressants may influence all symptoms of dPD, including those that share great overlap with the physical disease process. Additional research regarding adjunctive interventions is needed to help optimize the management of dPD.
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195
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Evans JR, Barker RA. Defining meaningful outcome measures in trials of disease-modifying therapies in Parkinson's disease. Expert Opin Pharmacother 2011; 12:1249-58. [PMID: 21345151 DOI: 10.1517/14656566.2011.548807] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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196
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Millán-Calenti JC, Maseda A, Rochette S, García-Monasterio I. [Relationship between sensory hearing loss and depression in elderly people: a literature review]. Rev Esp Geriatr Gerontol 2011; 46:30-5. [PMID: 21300418 DOI: 10.1016/j.regg.2010.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 09/02/2010] [Accepted: 09/03/2010] [Indexed: 11/28/2022]
Abstract
Advances in health, social and economic conditions in the developed countries have increased life expectancy and the number of elderly people. However, although health conditions have improved, age-related diseases are still increasing. One of the most common ailments is the age-related hearing loss, which has several pathophysiological causes and may be influenced by age-related morpho-functional changes. Hearing loss may also have underlying conditions in each individual. Sensory hearing loss tends to negatively affect the quality of life of the elderly, interfering with their capacity to communicate and affecting mood and the level of participation in social life. This may be independent of the cognitive and physical state of individuals, which in the long term and in many cases may end in depression. Detection and early treatment of hearing loss is an important bio-psycho-social benefit to the elderly.
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197
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Pontone GM, Williams JR, Anderson KE, Chase G, Goldstein SR, Grill S, Hirsch ES, Lehmann S, Little JT, Margolis RL, Rabins PV, Weiss HD, Marsh L. Anxiety and self-perceived health status in Parkinson's disease. Parkinsonism Relat Disord 2011; 17:249-54. [PMID: 21292531 DOI: 10.1016/j.parkreldis.2011.01.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 01/07/2011] [Accepted: 01/10/2011] [Indexed: 11/16/2022]
Abstract
Both anxiety and depression are associated with lower self-perceived health status (HS) in persons with Parkinson's disease (PD). Given the high co-morbidity with depression and other non-motor symptoms, it is unclear whether anxiety disorders, in general, versus specific anxiety subtypes have an independent effect on HS in PD. To examine this question, comprehensive assessments of motor and non-motor symptoms from 249 subjects with idiopathic PD followed in three community-based movement disorders neurology practices were analyzed. HS was measured using the 8-item PD Questionnaire (PDQ-8). Psychiatric diagnoses were established by consensus using a panel of six psychiatrists with expertise in geriatric psychiatry and movement disorders. Stepwise multiple regression analyses were used, with the PDQ-8 score as the dependent variable, to identify independent predictors of HS among motor, psychiatric, and other non-motor variables. Among the anxiety disorders, only anxiety associated with motor fluctuations was an independent predictor of HS after accounting for co-morbid depression and other clinical features. In addition, depressive disorders were also an independent predictor of lower HS. Prevention or treatment of state-dependent anxiety may improve HS in persons with PD.
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Affiliation(s)
- Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
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198
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Tierney TS, Sankar T, Lozano AM. Deep brain stimulation emerging indications. PROGRESS IN BRAIN RESEARCH 2011; 194:83-95. [PMID: 21867796 DOI: 10.1016/b978-0-444-53815-4.00015-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
There are a number of emerging surgical indications for deep brain stimulation. We have shown that modulation of activity within motor, mood, and cognitive circuits has beneficial effects in patients with Parkinson's disease, treatment-resistant depression, and perhaps Alzheimer's type dementia. We review the rationale, safety, and efficacy for each of these indications, focusing on disease mechanisms and relevant data that are necessary to document therapeutic value in each case. The review closes with some thoughts on possible future directions for deep brain stimulation. It is likely that applications for deep brain stimulation will continue to expand as accumulating data establish its safety and efficacy profile in these and other conditions.
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Affiliation(s)
- Travis S Tierney
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
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199
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Behavioral and neurochemical effects of chronic L-DOPA treatment on nonmotor sequelae in the hemiparkinsonian rat. Behav Pharmacol 2010; 21:627-37. [PMID: 20838211 DOI: 10.1097/fbp.0b013e32833e7e80] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Depression and anxiety are the prevalent nonmotor symptoms that worsen quality of life for Parkinson's disease (PD) patients. Although dopamine (DA) cell loss is a commonly proposed mechanism, the reported efficacy of DA replacement therapy with L-DOPA on affective symptoms is inconsistent. To delineate the effects of DA denervation and chronic L-DOPA treatment on affective behaviors, male Sprague-Dawley rats received unilateral 6-hydroxydopamine or sham lesions and were treated daily with L-DOPA (12 mg/kg+benserazide, 15 mg/kg, subcutaneously) or vehicle (0.9% NaCl, 0.1% ascorbic acid) for 28 days before commencing investigations into anxiety (locomotor chambers, social interaction) and depression-like behaviors (forced swim test) during the OFF phase of L-DOPA. One hour after the final treatments, rats were killed and striatum, prefrontal cortex, hippocampus, and amygdala were analyzed through high-performance liquid chromatography for monoamine levels. In locomotor chambers and social interaction, DA lesions exerted mild anxiogenic effects. Surprisingly, chronic L-DOPA treatment did not improve these effects. Although DA lesion reduced climbing behaviors on day 2 of exposure to the forced swim test, chronic L-DOPA treatment did not reverse these effects. Neurochemically, L-DOPA treatment in hemiparkinsonian rats reduced norepinephrine levels in the prefrontal cortex, striatum, and hippocampus. Collectively, these data suggest that chronic L-DOPA therapy in severely DA-lesioned rats does not improve nonmotor symptoms and may impair nondopaminergic processes, indicating that long-term L-DOPA therapy does not exert necessary neuroplastic changes for improving affect.
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200
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Kuhn DM, Sykes CE, Geddes TJ, Jaunarajs KLE, Bishop C. Tryptophan hydroxylase 2 aggregates through disulfide cross-linking upon oxidation: possible link to serotonin deficits and non-motor symptoms in Parkinson's disease. J Neurochem 2010; 116:426-37. [PMID: 21105877 DOI: 10.1111/j.1471-4159.2010.07123.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by the loss of dopamine neurons of the nigrostriatal system, resulting in severe motor disturbances. Although much less appreciated, non-motor symptoms are also very common in PD and many can be traced to serotonin neuronal deficits. Tryptophan hydroxylase (TPH) 2, the rate-limiting enzyme in the serotonin biosynthesis, is a phenotypic marker for serotonin neurons and is known to be extremely labile to oxidation. Therefore, the oxidative processes that prevail in PD could cause TPH2 misfolding and modify serotonin neuronal function much as is seen in dopamine neurons. Oxidation of TPH2 inhibits enzyme activity and leads to the formation of high molecular weight aggregates in a dithiothreitol-reversible manner. Cysteine-scanning mutagenesis shows that as long as a single cysteine residue (out of a total of 13 per monomer) remains in TPH2, it cross-links upon oxidation and only cysteine-less mutants are resistant to this effect. The effects of oxidants on TPH2 catalytic function and cross-linking are also observed in intact TPH2-expressing HEK293 cells. Oxidation shifts TPH2 from the soluble compartment into membrane fractions and large inclusion bodies. Sequential non-reducing/reducing 2-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting confirmed that TPH2 was one of a small number of cytosolic proteins that form disulfide-bonded aggregates. The propensity of TPH2 to misfold upon oxidation of its cysteine residues is responsible for its catalytic lability and may be related to loss of serotonin neuronal function in PD and the emergence of non-motor (psychiatric) symptoms.
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Affiliation(s)
- Donald M Kuhn
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA.
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