1
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Wu X, Shi M, Lian Y, Zhang H. Cognitive behavioral therapy approaches to the improvement of mental health in Parkinson's disease patients: a systematic review and meta-analysis. BMC Neurol 2024; 24:352. [PMID: 39300337 DOI: 10.1186/s12883-024-03859-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Non-motor symptoms (NMS) such as impaired cognition, anxiety, and depression can have a strong adverse effect on the quality of life (QoL) of Parkinson's disease (PD) patients. The clinical application of cognitive behavioral therapy (CBT) offers an opportunity to improve cognitive function, mental health, and overall QoL for these patients. OBJECTIVE CBT is frequently applied as a treatment option aimed at benefiting the mental health of PD patients, but the relative utility of CBT in this patient population has yet to be rigorously assessed. The present review was thus conducted with the goal of examining the relative safety and efficacy of CBT as a treatment option for PD patients suffering from cognitive impairment, anxiety, and depression, with a particular focus on the impact of CBT on PD patient QoL. METHODS The PubMed, Embase, Medline, and Cochrane Library databases were searched for all studies published from their inception to present using keywords including "cognitive behavioral therapy" and "Parkinson's disease". Two reviewers independently screened these published studies and extracted relevant data from studies that met with defined inclusion/exclusion criteria, in addition to assessing the risk of bias. Those randomized controlled trials (RCTs) assessing the impact of CBT on older PD patients were eligible for study inclusion. In total, 22 articles incorporating 1,053 patients were included in this meta-analysis. Study quality was examined as per the Cochrane risk of bias framework. Heterogeneity and associated outcomes were assessed based on mean difference (MD), I2, and 95% confidence interval (95%CI) values. RESULTS In total, 22 RCTs were ultimately found to be eligible for inclusion in the present meta-analysis. The results of this meta-analysis indicated that CBT significantly impacted cognition as compared to other treatment options (including placebo treatment, clinical monitoring, clinic-based treatment, psychoeducation, physical activity training, health enhancement) (I2 = 49%, MD = 0.23, 95%CI: 0.03-0.44, P = 0.03). CBT was also associated with significant improvements in PD patient QoL (I2 = 0%, MD = 3.45, 95%CI: 1.13-5.57, P = 0.04), anxiety symptoms (I2 = 57%, MD = -2.01, 95%CI: -4.01-0.01, P = 0.05), and depression symptoms (I2 = 74%, MD = -3.94, 95%CI: -6.47 to -1.42, P = 0.04). CONCLUSIONS These results reveal that CBT can have beneficial effects on PD patient cognitive status and QoL. Notably, CBT represents an effective option for treating NMS such as anxiety and depression in PD patients. These results offer strong evidence in favor of applying CBT as a means of enhancing the mental health, cognition, and QoL of individuals with PD. However, additional high-quality large-scale studies will be essential to confirm and expand upon these results.
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Affiliation(s)
- Xiaoke Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Mengmeng Shi
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China.
| | - Haifeng Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China.
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2
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Wan Z, Rasheed M, Li Y, Li Q, Wang P, Li J, Chen Z, Du J, Deng Y. miR-218-5p and miR-320a-5p as Biomarkers for Brain Disorders: Focus on the Major Depressive Disorder and Parkinson's Disease. Mol Neurobiol 2023; 60:5642-5654. [PMID: 37329382 DOI: 10.1007/s12035-023-03391-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/18/2023] [Indexed: 06/19/2023]
Abstract
Depression is one of the early and most persistent non-motor symptoms of Parkinson's disease (PD), which remains ignored, resulting in the underdiagnosis of PD. Unfortunately, scarce studies and the non-availability of diagnostic strategies cause countless complications, highlighting the need for appropriate diagnostic biomarkers. Recently, brain-enriched miRNAs regulating vital neurological functions have been proposed as potent biomarkers for therapeutic strategies. Therefore, the present study is aimed to identify the brain-enriched miR-218-5p and miR-320-5p in the serum of the Chinese depressed PD patients (n = 51) than healthy controls (n = 51) to identify their potency as biomarkers. For this purpose, depressive PD patients were recruited based on HAMA and HAMD scores and miR-218-5p and miR-320-5p and IL-6, and S100B levels were analyzed using real-time PCR (qRT-PCR) and ELISA assay, respectively. In silico analysis was performed to identify key biological pathways and hub genes involved in the psychopathology of depression in PD. Here, we found significantly downregulated miR-218-5p and miR-320-5p following higher levels of IL-6 and S100B in depressed PD patients than in control (p < 0.05). The correlation analysis revealed that both miRNAs were negatively correlated with HAMA and HAMD, and IL-6 scores, along with a positive correlation with PD duration and LEDD medication. ROC analysis showed AUC above 75% in both miRNAs in depressed PD patients, and in silico analysis revealed that both miRNA's targets regulate key neurological pathways such as axon guidance, dopaminergic synapse, and circadian rhythm. Additional analysis revealed PIK3R1, ATRX, BM1, PCDHA10, XRCC5, PPP1CB, MLLT3, CBL, PCDHA4, PLCG1, YWHAZ, CDH2, AGO3, PCDHA3, and PCDHA11 as hub-genes in PPI network. In summary, our findings show that miR-218-5p and miR-320-5p can be utilized as future biomarkers for depression in PD patients, which may aid in the early diagnosis and treatment of Parkinson's disease.
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Affiliation(s)
- Zhirong Wan
- Department of Neurology, Aerospace Central Hospital, Beijing, 100049, People's Republic of China
| | - Madiha Rasheed
- Beijing Key Laboratory for Separation and Analysis in Biomedicine and Pharmaceuticals, School of Medical Technology, Beijing Institute of Technology, Beijing, 100081, People's Republic of China
| | - Yumeng Li
- Beijing Key Laboratory for Separation and Analysis in Biomedicine and Pharmaceuticals, School of Medical Technology, Beijing Institute of Technology, Beijing, 100081, People's Republic of China
| | - Qin Li
- Department of Neurology, Aerospace Central Hospital, Beijing, 100049, People's Republic of China
| | - Peifu Wang
- Department of Neurology, Aerospace Central Hospital, Beijing, 100049, People's Republic of China
| | - Jilai Li
- Department of Neurology, Aerospace Central Hospital, Beijing, 100049, People's Republic of China
| | - Zixuan Chen
- Beijing Key Laboratory for Separation and Analysis in Biomedicine and Pharmaceuticals, School of Medical Technology, Beijing Institute of Technology, Beijing, 100081, People's Republic of China
| | - Jichen Du
- Department of Neurology, Aerospace Central Hospital, Beijing, 100049, People's Republic of China.
| | - Yulin Deng
- Beijing Key Laboratory for Separation and Analysis in Biomedicine and Pharmaceuticals, School of Medical Technology, Beijing Institute of Technology, Beijing, 100081, People's Republic of China.
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3
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Pinto C, Geraghty AWA, McLoughlin C, Pagnini F, Yardley L, Dennison L. Experiences of psychological interventions in neurodegenerative diseases: a systematic review and thematic synthesis. Health Psychol Rev 2023; 17:416-438. [PMID: 35546326 DOI: 10.1080/17437199.2022.2073901] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/01/2022] [Indexed: 11/04/2022]
Abstract
Background: Psychological interventions for managing emotional distress in neurodegenerative diseases are needed, but progressive worsening of symptoms and increasing disability might pose difficulties with engagement. We aimed to synthesise the experiences of engaging with and using psychological interventions in neurodegenerative diseases and identify relevant barriers and facilitators. Methods: Systematic searches were conducted in six electronic databases and results were screened. We included qualitative and mixed methods studies reporting patient or caregivers' views or experiences of psychological interventions. Qualitative data were extracted and thematically synthesised. Results: 34 papers were included, covering a range of diseases and interventions. Engagement was facilitated by flexible intervention formats and tailoring to the specific needs of people with neurodegenerative diseases. Interventions were sometimes inaccessible or burdensome because of physical and cognitive symptoms, and the time and effort required for the intervention. Participants' levels of acceptance and readiness often differed and influenced engagement with the intervention. Across different interventions, participants experienced wide-ranging benefits including changes in insight, perspective, self-efficacy, emotions and relationships. Conclusion: Although people with neurodegenerative diseases and caregivers experience benefits from psychological interventions, burden-reducing adaptations and sensitive tailoring to the specific disease context is required to improve acceptability and engagement.
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Affiliation(s)
- Cathryn Pinto
- Department of Psychology, University of Southampton, Southampton, UK
| | - Adam W A Geraghty
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | | | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Laura Dennison
- Department of Psychology, University of Southampton, Southampton, UK
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4
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Marchetti I, Alloy LB, Koster EH. Breaking the vise of hopelessness: Targeting its components, antecedents, and context. Int J Cogn Ther 2023; 16:285-319. [PMID: 39131585 PMCID: PMC11314313 DOI: 10.1007/s41811-023-00165-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 08/13/2024]
Abstract
Hopelessness is a painful cognitive state that is related to depression and suicide. Despite its importance, only unsystematic efforts have been made to specifically target hopelessness in interventions, and no comprehensive review is currently available to guide future clinical studies. In this narrative review, we first analyze the phenomenon of hopelessness, by highlighting its components (e.g., dismal expectations, blocked goal-directed processing, and helplessness), antecedents (e.g., inferential styles), and contextual factors (e.g., loneliness and reduced social support). Then, we review the currently available interventions and manipulations that target these mechanisms, either directly or indirectly, and we highlight both their strengths and lacunae. Finally, we propose possible avenues to improve our clinical toolbox for breaking the vise of hopelessness.
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Affiliation(s)
- Igor Marchetti
- University of Trieste, Department of Life Sciences, Via Edoardo Weiss 21, 34128, Trieste, Italy
| | - Lauren B. Alloy
- Temple University, Department of Psychology and Neuroscience, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA 19122, USA
| | - Ernst H.W. Koster
- Ghent University, Department of Experimental-Clinical and Health Psychology, Henri Dunantlaan 2, Ghent, B-9000, Belgium
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5
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Erga AH, Alves G, Leentjens AF. The ePark study protocol: A decentralized trial of individual video-assisted cognitive behavioural therapy for depressive disorder in Parkinson's disease. Contemp Clin Trials Commun 2023; 32:101080. [PMID: 36817735 PMCID: PMC9931891 DOI: 10.1016/j.conctc.2023.101080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/06/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Affiliation(s)
- Aleksander H. Erga
- The Norwegian Centre for Movement Disorders, Stavanger, Norway
- Institute of Social Sciences, University of Stavanger, Stavanger, Norway
- Center for Alcohol and Drug Research (KORFOR), Stavanger University Hospital, Stavanger, Norway
| | - Guido Alves
- The Norwegian Centre for Movement Disorders, Stavanger, Norway
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Albert F.G. Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, the Netherlands
- School of Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
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6
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Interian A, Miller RB, Hill LMS, Latorre M, King AR, Rodriguez KM, Mann SL, Kashan RS, Dissanayaka NN, Dobkin RD. A Pilot Study of Telehealth Mindfulness-Based Cognitive Therapy for Depression in Parkinson's Disease. J Geriatr Psychiatry Neurol 2023; 36:143-154. [PMID: 35603772 DOI: 10.1177/08919887221103579] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Parkinson's disease (PD) is characterized by high-rates of depression with limited evidence-based treatment options to improve mood. Objective: To expand therapeutic options, we evaluated the feasibility and effect of a telehealth mindfulness-based cognitive therapy intervention adapted for PD (MBCT-PD) in a sample of participants with DSM-5 depressive disorders. Methods: Fifteen participants with PD and clinically-significant depression completed 9 sessions of MBCT-PD. Depression, anxiety, and quality of life were evaluated at baseline, endpoint, and 1-month follow-up. Results: Telehealth MBCT-PD was feasible and beneficial. Completion rates exceeded 85% and treatment satisfaction rates were high. Notable improvements were observed for depression, anxiety, and quality of life over the course of the trial. Conclusion: Telehealth MBCT-PD shows promise and warrants further evaluation via randomized clinical trial with more diverse participants. Such research holds the potential to expand the range of therapeutic options for depression in PD, thereby setting the stage for personalized care.
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Affiliation(s)
- Alejandro Interian
- 20063VA New Jersey Healthcare System, Lyons, NJ, USA.,20061Rutgers-Robert Wood Johnson Medical School, Department of Psychiatry, Piscataway, NJ, USA
| | | | | | | | - Arlene R King
- 20063VA New Jersey Healthcare System, Lyons, NJ, USA
| | | | - Sarah L Mann
- 20063VA New Jersey Healthcare System, Lyons, NJ, USA
| | - Rachel S Kashan
- 20061Rutgers-Robert Wood Johnson Medical School, Department of Psychiatry, Piscataway, NJ, USA
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, 25056The University of Queensland, Brisbane, AU-QLD, Australia.,School of Psychology, 12287University of Queensland, Brisbane, AU-QLD, Australia.,Department of Neurology, 303224Royal Brisbane & Women's Hospital, Brisbane, AU-QLD, Australia
| | - Roseanne D Dobkin
- 20061Rutgers-Robert Wood Johnson Medical School, Department of Psychiatry, Piscataway, NJ, USA
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7
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Koszycki D, Taljaard M, Kogan C, Bradwejn J, Grimes D. Interpersonal Psychotherapy for Depression in Parkinson's Disease: A Feasibility Study. J Geriatr Psychiatry Neurol 2023; 36:52-62. [PMID: 35446178 PMCID: PMC9755694 DOI: 10.1177/08919887221090220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Individuals living with Parkinson's disease (PD) experience interpersonal stressors that contribute to depressive risk. Interpersonal psychotherapy (IPT) emphasizes the bidirectional relationship between interpersonal stressors and mood may therefore be a suitable treatment for PD-depression. The primary aim of this study was to evaluate the feasibility of delivering 12 sessions of IPT to depressed PD patients and explore the need for modifications. A secondary aim was to obtain descriptive information about efficacy outcomes. The study used a pre-post design without a comparison group. Participants were 12 PD patients with a major depressive disorder. IPT was well accepted and tolerated by patients and required minimal modifications. Compliance with session attendance and completion of study questionnaires were excellent and treatment satisfaction was high. Depression scores declined from baseline to endpoint, with 7 patients meeting criteria for remission at endpoint. Findings are encouraging and a larger randomized controlled trial is currently underway to ascertain if IPT is an efficacious treatment for PD-depression.
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Affiliation(s)
- Diana Koszycki
- University of Ottawa, Ottawa, ON, Canada,Institut du savoir Montfort, Montfort Hospital, Ottawa, ON, Canada,University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada,Diana Koszycki, PhD, University of Ottawa, 145 Jean-Jacques Lussier Ottawa, ON K1N 6N5, Canada.
| | - Monica Taljaard
- University of Ottawa, Ottawa, ON, Canada,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Cary Kogan
- University of Ottawa, Ottawa, ON, Canada
| | - Jacques Bradwejn
- University of Ottawa, Ottawa, ON, Canada,Institut du savoir Montfort, Montfort Hospital, Ottawa, ON, Canada,Université de Montreal, QC, Canada
| | - David Grimes
- University of Ottawa, Ottawa, ON, Canada,University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada,Ottawa Hospital Research Institute, Ottawa, ON, Canada
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8
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Zarotti N, Eccles FJR, Foley JA, Paget A, Gunn S, Leroi I, Simpson J. Psychological interventions for people with Parkinson's disease in the early 2020s: Where do we stand? Psychol Psychother 2021; 94:760-797. [PMID: 33174688 DOI: 10.1111/papt.12321] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/27/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To explore the heterogeneity of the literature on psychological interventions for psychological difficulties in people with Parkinson's disease (PD). METHODS A scoping review was performed across five major databases (MEDLINE Complete, PsycINFO, CINAHL, Academic Search Ultimate, and Cochrane Library) up to June 2020. RESULTS From an initial return of 4911 citations, 56 studies were included, of which 21 were RCTs. A relatively wide range of therapeutic models have been adopted with people with PD, from common therapies such as cognitive behavioural therapy (CBT) and mindfulness, to less frequent approaches, for example, acceptance and commitment therapy (ACT) and psychodrama. The clinical implications of the findings are discussed, and suggestions are provided for future research on intervention studies and key psychological outcomes. CONCLUSIONS CBT appears to be effective in treating depression and sleep disorders in people with PD, while psychoeducation programmes alone should be avoided. The use of CBT to improve anxiety, quality of life, and impulse control, as well mindfulness-based interventions, should be undertaken with some caution because of insufficient research and inconsistent results. As we enter the new decade, more high-quality evidence is required for psychological interventions in people with PD in general and to corroborate preliminary positive findings on the adoption of less frequent approaches such as ACT. PRACTITIONER POINTS Parkinson's disease is a progressive neurodegenerative condition associated with several psychological difficulties which be targeted by psychological interventions. Currently, cognitive behavioural therapy (CBT) can be recommended to treat depression and sleep disorders in people with Parkinson's, while psychoeducation alone should be avoided. Caution is advised regarding the use of CBT and mindfulness-based interventions to improve anxiety, quality of life, and impulse control. Further evidence is required for less common approaches, such as acceptance and commitment therapy, psychodrama, and EMDR.
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Affiliation(s)
- Nicolò Zarotti
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, UK
| | - Fiona J R Eccles
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, UK
| | - Jennifer A Foley
- Department of Neuropsychology, National Hospital of Neurology & Neurosurgery, London, UK.,UCL Queen Square Insitute of Neurology, Queen Square, London, UK
| | - Andrew Paget
- Department of Neuropsychology, National Hospital of Neurology & Neurosurgery, London, UK.,UCL Queen Square Insitute of Neurology, Queen Square, London, UK
| | - Sarah Gunn
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, UK
| | - Iracema Leroi
- Global Brain Health Institute, Trinity College Dublin, Ireland
| | - Jane Simpson
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, UK
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9
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Lopes SR, Khan S, Chand S. The Growing Role of Cognitive Behavior Therapy in the Treatment of Parkinson's Disease. J Geriatr Psychiatry Neurol 2021; 34:310-320. [PMID: 34219525 DOI: 10.1177/08919887211018274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Neuropsychiatric symptoms occur frequently in Parkinson's disease (PD) patients. Pharmacological treatment of the psychiatric symptoms has been found to be inadequate. Cognitive behavior therapy (CBT) is an evidence based form of psychotherapy that is effective in treating a number of psychiatric disorders. In this article we examine the evidence of CBT in treating common psychiatric symptoms seen in PD patients, namely depression, anxiety, insomnia and impulse control behaviors. Most of the studies adapted CBT to address PD related concerns. Caregivers were frequently part of the CBT programs. Among the studies reviewed, randomized controlled trials showed significant effects in treating depression with CBT in PD patients. Studies have also provided preliminary data for effects of CBT on anxiety, impulse-control behaviors and insomnia. There is a need for more well designed studies with sufficient power for CBT to be established as a useful non-pharmacological treatment for psychiatric symptoms in PD.
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Affiliation(s)
- Sneha R Lopes
- Department of Psychiatry and Behavioral Neuroscience, 7547Saint Louis University, St. Louis, MO, USA
| | - Sunna Khan
- Department of Psychiatry and Behavioral Neuroscience, 7547Saint Louis University, St. Louis, MO, USA
| | - Suma Chand
- Department of Psychiatry and Behavioral Neuroscience, 7547Saint Louis University, St. Louis, MO, USA
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10
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Perrin PB, Henry RS, Donovan EK, Cariello AN, Lageman SK, Villaseñor T, Dzierzewski JM, Arroyo M, Avila J. Parkinson's family needs and caregiver mental health: A cross-cultural comparison between Mexico and the United States. NeuroRehabilitation 2019; 45:433-442. [PMID: 31868689 DOI: 10.3233/nre-192894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVE Given the growing population of individuals with Parkinson's disease (PD) worldwide and the growing need for family members to take on a caregiving role, it is critical that cross-cultural differences be examined in order to better meet the needs of PD caregivers. The purpose of this study was to examine the connections between the unmet needs and mental health of PD caregivers differentially in Mexico and the United States. METHODS In Parkinson's clinics at public, academic medical centers, PD caregivers from Mexico (n = 148) and the United States (n = 105) completed measures of unmet family needs and mental health. RESULTS Caregivers in the United States had higher unmet needs for emotional support and for a community support network than caregivers in Mexico, although caregivers at the two sites had comparable levels of anxiety and depression. Unmet family needs explained 29.5% of the variance in caregiver anxiety in the United States (p < 0.001) but only 5.7% in Mexico (p = 0.209). Unmet family needs explained 30.4% of the variance in caregiver depression in the United States (p < 0.001) and 14.0% in Mexico (p = 0.001). In the United States, unmet needs for emotional support and for instrumental support uniquely predicted caregiver anxiety and depression, and in Mexico only the unmet need for instrumental support was a unique predictor. CONCLUSIONS PD caregivers in the United States are at increased risk for poor emotional and community support, and these unmet needs channel directly into caregiver anxiety and depression. In Mexico, where caregivers have stronger emotional and community support, caregivers' unmet need for instrumental support generates anxiety and depression. Important targets for PD caregiver interventions may differ between Mexico and the United States.
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Affiliation(s)
- Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Richard S Henry
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Emily K Donovan
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Annahir N Cariello
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Sarah K Lageman
- Department of Neurology, Parkinson's & Movement Disorders Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Teresita Villaseñor
- Hospital Civil Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.,Master's of Neuropsychology, Neurosciences Department, University of Guadalajara, Guadalajara, Mexico
| | | | - Monica Arroyo
- Hospital Civil Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.,Master's of Neuropsychology, Neurosciences Department, University of Guadalajara, Guadalajara, Mexico
| | - Judith Avila
- Master's of Neuropsychology, Neurosciences Department, University of Guadalajara, Guadalajara, Mexico
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11
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Assogna F, Pellicano C, Savini C, Macchiusi L, Pellicano GR, Alborghetti M, Caltagirone C, Spalletta G, Pontieri FE. Drug Choices and Advancements for Managing Depression in Parkinson's Disease. Curr Neuropharmacol 2019; 18:277-287. [PMID: 31622207 PMCID: PMC7327944 DOI: 10.2174/1570159x17666191016094857] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/27/2019] [Accepted: 10/15/2019] [Indexed: 12/21/2022] Open
Abstract
Depression is a frequent non-motor symptom of Parkinson’s disease (PD), and may even precede the onset of motor symptoms of parkinsonism. Beyond its negative influence on mood, depression in PD is frequently associated with other neuropsychiatric symptoms and with late-stage complications such as dementia. Despite its profound impact on the quality of life and cognitive functioning in PD, depression in PD is often under-recognized and poorly treated. Pathophysiological studies demonstrated that depression in PD is associated with global dysfunction of interactions between discrete brain areas rather than focal structural or functional abnormalities, and that it is sustained by pathological changes of several neurotransmitter/receptor complexes. In general, all traditional antidepressants and some dopamine agonists have been found to be safe and well-tolerated to treat depressive symptoms in PD, despite initial warning on worsening of parkinsonism. Available data suggest that the time-course of response differs among antidepressants. Efficacy results from clinical trials with antidepressant in PD are, however, rather uncertain,
although pooled analysis suggests a moderate benefit. Several issues may critically impact the
results of clinical trials with antidepressants in PD, including the correct psychiatric diagnosis, the overlap of symptoms between depression and PD, and the selection of appropriate end-points and rating scales.
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Affiliation(s)
| | - Clelia Pellicano
- Fondazione Santa Lucia, IRCCS, Via Ardeatina, 306-00179 Roma, Italy.,Neurology Unit, "Belcolle" Hospital, Str. Sammartinese-01100 Viterbo, Italy
| | - Cinzia Savini
- Fondazione Santa Lucia, IRCCS, Via Ardeatina, 306-00179 Roma, Italy
| | - Lucia Macchiusi
- Fondazione Santa Lucia, IRCCS, Via Ardeatina, 306-00179 Roma, Italy
| | - Gaia R Pellicano
- Dipartimento di Psicologia Dinamica e Clinica, "Sapienza" Università di Roma, Via degli Apuli, 1-00185 Roma, Italy
| | - Marika Alborghetti
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS), "Sapienza" Universita di Roma, Via di Grottarossa, 1035-00189 Roma, Italy
| | | | | | - Francesco E Pontieri
- Fondazione Santa Lucia, IRCCS, Via Ardeatina, 306-00179 Roma, Italy.,Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS), "Sapienza" Universita di Roma, Via di Grottarossa, 1035-00189 Roma, Italy
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12
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Berardelli I, Belvisi D, Pasquini M, Fabbrini A, Petrini F, Fabbrini G. Treatment of psychiatric disturbances in hypokinetic movement disorders. Expert Rev Neurother 2019; 19:965-981. [PMID: 31241368 DOI: 10.1080/14737175.2019.1636648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: We reviewed studies that assessed the treatment of psychiatric disturbances in Parkinson's disease and atypical parkinsonisms. Neuropsychiatric disturbances in these conditions are frequent and have a profound impact on quality of life of patients and of their caregivers. It is therefore important to be familiar with the appropriate pharmacological and non-pharmacological interventions for treating these disorders. Areas covered: The authors searched for papers in English in Pubmed using the following keywords: Parkinson's disease, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, Lewy body dementia, depression, apathy, anxiety, fatigue, sleep disorders, obsessive compulsive disorders, psychosis, hallucinations, delusions, impulse control disorders. Expert opinion: In Parkinson's disease, depression may benefit from the optimization of dopaminergic therapy, from the use of antidepressants acting on both the serotoninergic and noradrenergic pathways and from cognitive behavioral therapy. Psychosis in Parkinson's disease may improve with the use of clozapine; the serotonin inverse agonist pimavanserin has been shown to be effective. Treatment of impulse control disorders is primarily based on the removal of dopamine agonists. No controlled studies have investigated the treatment of neuropsychiatric disorders in multiple system atrophy, progressive supranuclear palsy or corticobasal degeneration. Acethylcholinesterase inhibitors may be used to treat hallucinations in Lewy body dementia.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | | | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome , Rome , Italy
| | - Andrea Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome , Rome , Italy
| | - Federica Petrini
- Department of Neurosciences and Mental Health, Azienda Universitaria Policlinico Umberto I° , Rome , Italy
| | - Giovanni Fabbrini
- IRCCS Neuromed , Pozzilli , Italy.,Department of Human Neurosciences, Sapienza University of Rome , Rome , Italy
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Galts CP, Bettio LE, Jewett DC, Yang CC, Brocardo PS, Rodrigues ALS, Thacker JS, Gil-Mohapel J. Depression in neurodegenerative diseases: Common mechanisms and current treatment options. Neurosci Biobehav Rev 2019; 102:56-84. [DOI: 10.1016/j.neubiorev.2019.04.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/22/2019] [Accepted: 04/02/2019] [Indexed: 12/19/2022]
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Nonpharmacologic Interventions for the Self-Management of Anxiety in Parkinson's Disease: A Comprehensive Review. Behav Neurol 2019; 2019:8459579. [PMID: 31191740 PMCID: PMC6525888 DOI: 10.1155/2019/8459579] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/13/2019] [Accepted: 03/17/2019] [Indexed: 12/21/2022] Open
Abstract
Anxiety in Parkinson's disease (aPD) is underdiagnosed, undertreated, and understudied. As many as 50% of persons diagnosed with Parkinson's disease (PD) are reported to suffer from anxiety. Current treatment is largely pharmacologic, which can result in a myriad of undesirable and unsafe side effects. The aim of this paper is to examine intervention studies of self-managed nonpharmacological strategies for the treatment of anxiety. A comprehensive review was conducted on experimental or quasi-experimental trials that included self-management approaches for the nonpharmacologic treatment of anxiety as a primary or secondary aim or outcome measure. Thirteen studies were identified from four databases. Study quality demonstrated variability in design and delivery of self-managed interventions; sample sizes were small; anxiety was most commonly a secondary aim; and the use of anxiety measures varied widely. Statistical significance was evident in slightly more than 50% of the anxiety intervention studies. A common element in the interventions in all studies was the focused use of breath. Further research is needed to determine the feasibility of using focused breathing, alone, as an intervention for the self-management of anxiety in Parkinson's disease.
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Laurencin C, Thobois S. Malattia di Parkinson e depressione. Neurologia 2019. [DOI: 10.1016/s1634-7072(19)42021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Dobkin RD, Mann SL, Interian A, Gara MA, Menza M. Cognitive behavioral therapy improves diverse profiles of depressive symptoms in Parkinson's disease. Int J Geriatr Psychiatry 2019; 34:722-729. [PMID: 30714202 DOI: 10.1002/gps.5077] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 01/28/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Depression is among the most common and debilitating nonmotor complaints in Parkinson's disease (PD), yet there is a paucity of controlled research to guide treatment. Little research has focused on the extent to which specific depressive symptom profiles may dictate unique clinical recommendations to ultimately improve treatment outcomes. The current study examined the impact of cognitive behavioral therapy (CBT) on different types of depressive symptoms in PD. It was hypothesized that the cognitive (eg, guilt, rumination, and negative attitudes towards self) and behavioral (eg, avoidance and procrastination) symptoms targeted most intensively by the treatment protocol would show the most robust response. The extent to which stabilized antidepressant use moderated specific symptom change was examined on an exploratory basis. METHOD Eighty depressed people with PD participated in a randomized controlled trial of CBT plus clinical management, versus clinical management only. Hamilton Depression Rating Scale (HAMD) and Beck Depression Inventory (BDI) subscale scores, reflecting depressive symptom heterogeneity in PD, were the focus of this investigation. RESULTS CBT response was associated with significant improvements in mood, sleep, anxiety, and somatic symptoms (HAMD), and negative attitudes toward self, performance impairment, and somatic symptoms (BDI). As hypothesized, the largest effect sizes were observed for cognitive and behavioral (vs somatic) symptoms of depression. Stabilized antidepressant use moderated the effect of CBT on somatic complaints (HAMD and BDI). CONCLUSIONS CBT may improve a diverse array of depressive symptoms in PD. Cognitive and behavioral (vs somatic) symptoms showed the greatest change. Combining CBT with antidepressants may help optimize the management of somatic complaints in depression in PD (dPD).
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Affiliation(s)
- Roseanne D Dobkin
- Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey.,VA New Jersey Health Care System, Lyons, New Jersey
| | - Sarah L Mann
- VA New Jersey Health Care System, Lyons, New Jersey
| | | | - Michael A Gara
- Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Matthew Menza
- Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey.,Department of Neurology, Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey
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17
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Third-Wave Therapies for Long-Term Neurological Conditions: A Systematic Review to Evaluate the Status and Quality of Evidence. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: Adults with long-term neurological conditions can face complex challenges including anxiety and depression. Emerging research suggests the utility of third-wave approaches (the third development of psychotherapies) in working transdiagnostically with these difficulties.Aims: This systematic review sought to summarise and appraise the quality of published empirical studies using third-wave therapies such as Compassion Focused Therapy; Acceptance and Commitment Therapy; and Mindfulness-Based Cognitive Therapy or Mindfulness-Based Stress Reduction.Method: Review procedures followed PRISMA guidelines, with 437 abstracts screened, 24 full-text articles retrieved and 19 studies found to meet inclusion criteria. Six out of seven randomised studies had unclear or high risk of bias, whilst the majority of non-randomised studies were considered moderate quality.Results: Overall, studies reported a statistically significant reduction in emotional distress. Of the 13 studies that used model-specific process measures, 10 found statistically significant improvements in transdiagnostic factors.Discussion: The findings indicate that third-wave therapies show promise in addressing transdiagnostic difficulties within neurological conditions. A number of methodological and conceptual issues for the included studies were highlighted during the quality appraisal process. Clinical implications include consideration of intervention length and use of outcome measures. Research implications are discussed by considering the progressive stages of development for behavioural treatments.
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Clare L, Teale JC, Toms G, Kudlicka A, Evans I, Abrahams S, Goldstein LH, Hindle JV, Ho AK, Jahanshahi M, Langdon D, Morris R, Snowden JS, Davies R, Markova I, Busse M, Thompson-Coon J. Cognitive rehabilitation, self-management, psychotherapeutic and caregiver support interventions in progressive neurodegenerative conditions: A scoping review. NeuroRehabilitation 2019; 43:443-471. [DOI: 10.3233/nre-172353] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
- PenCLAHRC, University of Exeter Medical School, Exeter, UK
- Centre for Research Excellence in Cognitive Health, Australian National University, Canberra City, ACT, Australia
| | | | - Gill Toms
- Wales School for Social Care Research, Bangor University, Bangor, Wales, UK
| | - Aleksandra Kudlicka
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
- PenCLAHRC, University of Exeter Medical School, Exeter, UK
| | - Isobel Evans
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Sharon Abrahams
- Psychology-PPLS and Euan MacDonald Centre for Motor Neurone Disease Research, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Laura H. Goldstein
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - John V. Hindle
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Aileen K. Ho
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | | | - Dawn Langdon
- Department of Psychology, Royal Holloway University of London, London, UK
| | - Robin Morris
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Julie S. Snowden
- Cerebral Function Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Rhys Davies
- Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Ivana Markova
- Hull York Medical School, University of Hull, Hull, UK
| | - Monica Busse
- School of Medicine, Cardiff University, Cardiff, Wales, UK
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Abstract
ABSTRACTObjective:Over two-thirds of Parkinson's disease (PD) patients experience comorbid neuropsychiatric symptoms, which adversely impact their quality of life and often require intervention. There is a preference for non-pharmacological, psychological approaches in addressing these symptoms. Given mobility limitations, travel burden, and cost, accessibility to psychological treatment can be problematic in this population. There has been a recent shift toward delivering care via telehealth in PD. Accordingly, this review aimed to examine remotely delivered psychological interventions for PD patients.Results:Most of the telehealth studies for PD involved Cognitive Behavioral Therapy (CBT) based anxiety and depression telephone interventions with relatively short (one month) follow-up periods.Conclusion:Although a preliminary work indicates efficacy, future studies should demonstrate the non-inferiority of these telehealth programs compared to face-to-face delivery, and examine the long-term outcomes of remotely delivered therapy. Video-conferencing (VC) appears to be a promising modality to overcome noted limitations of telephone delivery, and has demonstrated efficacy for PD speech programs. Further research should be conducted evaluating telehealth VC modalities for delivery of psychotherapy including CBT, as well as mindfulness-based therapy and acceptance and commitment therapy for remote treatment of depression and anxiety in PD.
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Heusinkveld LE, Hacker ML, Turchan M, Davis TL, Charles D. Impact of Tremor on Patients With Early Stage Parkinson's Disease. Front Neurol 2018; 9:628. [PMID: 30123178 PMCID: PMC6085452 DOI: 10.3389/fneur.2018.00628] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 07/11/2018] [Indexed: 01/03/2023] Open
Abstract
Tremor is one of the most visible features of Parkinson's disease (PD), and the majority of PD patients experience tremor during the course of the disease. However, the distress caused by this cardinal motor feature for patients early in the course of their PD is commonly underappreciated. People living with early stage PD often experience intense embarrassment and difficulties due to their tremor that limit social interactions, and tremor frequently interferes with the ability to perform activities of daily living and simple tasks at home and work. Although tremor is primarily managed with medications, both tremor response and satisfaction with medical therapy are highly variable. This review offers an overview of reports of the patient experience of tremor in early stage PD and current management options for this cardinal motor feature.
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Affiliation(s)
- Lauren E Heusinkveld
- Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Mallory L Hacker
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Maxim Turchan
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Thomas L Davis
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - David Charles
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
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21
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Dobkin RD, Interian A, Durland JL, Gara MA, Menza MA. Personalized Telemedicine for Depression in Parkinson's Disease: A Pilot Trial. J Geriatr Psychiatry Neurol 2018; 31:171-176. [PMID: 29945467 DOI: 10.1177/0891988718783274] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
High rates of depression are observed in Parkinson's disease, and limited access to care complicates management. The purpose of this pilot project was to evaluate the feasibility and impact of a personalized cognitive-behavioral telemedicine program for depression in Parkinson's disease (dPD). Thirty-four individuals with dPD and their carepartners participated in this pilot study. A 10-module self-help workbook, tailored to the unique needs of the dPD population, was created to be used as either a stand-alone intervention, with minimal therapist support, or a supplement to formal telephone-administered cognitive-behavioral therapy sessions. Improvements in depression, anxiety, quality of life, sleep, negative thoughts, and caregiver burden were observed over the course of the 4-month study, independent of treatment modality (guided self-help vs formal telephone-based psychotherapy). Future research will utilize randomized controlled designs and continue to focus on delivery models that can improve access to this and other evidence-based mental health interventions for dPD.
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Affiliation(s)
- Roseanne D Dobkin
- 1 Department of Psychiatry, RUTGERS, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Alejandro Interian
- 2 VA NJ Healthcare System-Lyons Campus, Mental Health and Behavioral Sciences, Lyons, NJ, USA
| | - John Logan Durland
- 1 Department of Psychiatry, RUTGERS, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Michael A Gara
- 1 Department of Psychiatry, RUTGERS, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Matthew A Menza
- 1 Department of Psychiatry, RUTGERS, The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Hindle JV, Watermeyer TJ, Roberts J, Brand A, Hoare Z, Martyr A, Clare L. Goal-orientated cognitive rehabilitation for dementias associated with Parkinson's disease-A pilot randomised controlled trial. Int J Geriatr Psychiatry 2018; 33:718-728. [PMID: 29314218 DOI: 10.1002/gps.4845] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/21/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine the appropriateness and feasibility of cognitive rehabilitation for people with dementias associated with Parkinson's in a pilot randomised controlled study. METHODS This was a single-blind pilot randomised controlled trial of goal-oriented cognitive rehabilitation for dementias associated with Parkinson's. After goal setting, participants were randomised to cognitive rehabilitation (n = 10), relaxation therapy (n = 10), or treatment-as-usual (n = 9). Primary outcomes were ratings of goal attainment and satisfaction with goal attainment. Secondary outcomes included quality of life, mood, cognition, health status, everyday functioning, and carers' ratings of goal attainment and their own quality of life and stress levels. Assessments were at 2 and 6 months following randomisation. RESULTS At 2 months, cognitive rehabilitation was superior to treatment-as-usual and relaxation therapy for the primary outcomes of self-rated goal attainment (d = 1.63 and d = 1.82, respectively) and self-rated satisfaction with goal attainment (d = 2.04 and d = 1.84). At 6 months, cognitive rehabilitation remained superior to treatment-as-usual (d = 1.36) and relaxation therapy (d = 1.77) for self-rated goal attainment. Cognitive rehabilitation was superior to treatment as usual and/or relaxation therapy in a number of secondary outcomes at 2 months (mood, self-efficacy, social domain of quality of life, carers' ratings of participants' goal attainment) and at 6 months (delayed recall, health status, quality of life, carer ratings of participants' goal attainment). Carers receiving cognitive rehabilitation reported better quality of life, health status, and lower stress than those allocated to treatment-as-usual. CONCLUSIONS Cognitive rehabilitation is feasible and potentially effective for dementias associated with Parkinson's disease.
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Affiliation(s)
- John V Hindle
- Department of Care for the Elderly, Betsi Cadwaladr University Health Board, Llandudno, UK and School of Psychology, Bangor University, Bangor, UK
| | - Tamlyn J Watermeyer
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, Scotland, UK
| | - Julie Roberts
- Division of Mental Health and Learning Disabilities, Betsi Cadwaladr University Health Board, UK
| | - Andrew Brand
- The North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Bangor, UK
| | - Zoe Hoare
- The North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Bangor, UK
| | - Anthony Martyr
- Centre for Research in Ageing and Cognitive Health (REACH), School of Psychology, University of Exeter, Exeter, UK and PenCLAHRC, Institute of Health Research, University of Exeter Medical School, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health (REACH), School of Psychology, University of Exeter, Exeter, UK and PenCLAHRC, Institute of Health Research, University of Exeter Medical School, UK
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24
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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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Kanapathy J, Bogle V. The effectiveness of cognitive behavioural therapy for depressed patients with diabetes: A systematic review. J Health Psychol 2017; 24:137-149. [PMID: 28810481 DOI: 10.1177/1359105317713360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Depression is common among patients with diabetes, who have a higher risk of diabetes-related complications such as diabetic retinopathy, nephropathy, neuropathy and macrovascular complications. The aim of the systematic review is to determine whether cognitive behavioural therapy is effective in reducing depressive symptoms and improving glycaemic control among depressed diabetic patients. The results reveal diversified application of cognitive behavioural therapy. All studies reported that cognitive behavioural therapy had a positive impact on depressive symptoms; three found an improvement in glycated haemoglobin, and one demonstrated improved self-efficacy and self-concept related to successful diabetes management. There is a need for controlled studies with larger sample sizes and long-term follow-up.
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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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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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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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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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Bernstein CJ, Ellard DR, Davies G, Hertenstein E, Tang NKY, Underwood M, Sandhu H. Behavioural interventions for people living with adult-onset primary dystonia: a systematic review. BMC Neurol 2016; 16:40. [PMID: 27000094 PMCID: PMC4802601 DOI: 10.1186/s12883-016-0562-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary dystonia is a chronic neurological movement disorder that causes abnormal muscle movements. Pain and emotional distress may accompany these physical symptoms. Behavioural interventions are used to help people with long term conditions improve their quality of life. Little is known about behavioural interventions applied to Dystonia. We report a systematic review of studies reporting current evidence of behavioural interventions for people with primary dystonia. METHODS We did systematic searches of Medline, PsycINFO, AHMED and CINAHL. We assessed the methodological quality of included studies using a risk of bias tool. Any disagreements were resolved by liaising with an independent rater. Physiological outcomes such as dystonia severity and psychological outcomes such as sleep and depression were selected on the basis that primary dystonia causes motor and non-motor symptoms. No time limit was placed on the searches. A narrative synthesis of the results is presented. RESULTS Of 1798 titles and abstracts screened, 14 full articles were retrieved and inclusion and exclusion criteria applied. Of these a final nine were eligible for the review (N = 73). Only two were Randomised Controlled Trials (RCTs). Using the Movement Disorders Society (MDS) dystonia classification, that was published after this work started, all of the included studies were of idiopathic adult onset focal dystonia without associated features. These included: blepharospasm (eye dystonia) (N = 1), cervical dystonia (neck dystonia) (N = 2), writer's cramp (hand dystonia) (N = 3) and the yips (N = 3). No studies reported on dystonia that affects two or more body regions. Studies reported good adherence and response rates to treatment. Physiological and psychological improvements were noted in all studies at weekly, monthly and yearly follow-ups. Caution should be taken when interpreting the results because of the scarcity of RCTs identified, use of small sample sizes, and inappropriate statistical methods. CONCLUSION We identified few studies; mainly of poor methodological quality that all studied a focal dystonia. It is not possible to draw firm conclusions. Nevertheless, the data suggests that a combined behavioural therapy approach including relaxation practice for people with idiopathic adult onset focal dystonia merits further investigation.
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Affiliation(s)
- C. J. Bernstein
- />Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - D. R. Ellard
- />Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - G. Davies
- />University of Southampton, Southampton, UK
| | - E. Hertenstein
- />Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Freiburg, Germany
| | - N. K. Y. Tang
- />Department of Psychology, University of Warwick, Coventry, UK
| | - M. Underwood
- />Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - H. Sandhu
- />Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Altered Resting-State Connectivity within Executive Networks after Aneurysmal Subarachnoid Hemorrhage. PLoS One 2015; 10:e0130483. [PMID: 26172281 PMCID: PMC4501762 DOI: 10.1371/journal.pone.0130483] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/19/2015] [Indexed: 01/02/2023] Open
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is associated with significant mortality rates, and most survivors experience significant cognitive deficits across multiple domains, including executive function. It is critical to determine the neural basis for executive deficits in aSAH, in order to better understand and improve patient outcomes. This study is the first examination of resting-state functional Magnetic Resonance Imaging in a group of aSAH patients, used to characterize changes in functional connectivity of the frontoparietal network. We scanned 14 aSAH patients and 14 healthy controls, and divided patients into “impaired” and “unimpaired” groups based on a composite executive function score. Impaired patients exhibited significantly lower quality of life and neuropsychological impairment relative to controls, across multiple domains. Seed-based functional connectivity analysis demonstrated that unimpaired patients were not significantly different from controls, but impaired patients had increased frontoparietal connectivity. Patients evidenced increased frontoparietal connectivity as a function of decreased executive function and decreased mood (i.e. quality of life). In addition, T1 morphometric analysis demonstrated that these changes are not attributable to local cortical atrophy among aSAH patients. These results establish significant, reliable changes in the endogenous brain dynamics of aSAH patients, that are related to cognitive and mood outcomes.
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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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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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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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Bae ES, Yeum DM. Effect of a Telephone-administered Cognitive Behavioral Therapy for the Management of Depression, Anxiety, and Chronic Illness Anticipated Stigma in Parkinson's Disease. ACTA ACUST UNITED AC 2015. [DOI: 10.7475/kjan.2015.27.2.223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Eun Sook Bae
- Department of Nursing Science, Dong-Eui University, Busan, Korea
| | - Dong Moon Yeum
- Department of Social Welfare, International University of Korea, Jinju, Korea
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Ajimsha MS, Majeed NA, Chinnavan E, Thulasyammal RP. Effectiveness of autogenic training in improving motor performances in Parkinson's disease. Complement Ther Med 2014; 22:419-25. [PMID: 24906579 DOI: 10.1016/j.ctim.2014.03.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 03/23/2014] [Accepted: 03/31/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Relaxation training can be an important adjunct in reducing symptoms associated with Parkinson's disease (PD). Autogenic Training (AT) is a simple, easily administered and inexpensive technique for retraining the mind and the body to be able to relax. AT uses visual imagery and body awareness to promote a state of deep relaxation. OBJECTIVE To investigate whether AT when used as an adjunct to Physiotherapy (PT) improves motor performances in PD in comparison with a control group receiving PT alone. DESIGN Randomized, controlled, single blinded trial. SETTING Movement Disorder Clinic and Department of Physiotherapy, Sree Chithira Thirunal Institute of Medical Sciences and Technology in Trivandrum, Kerala, India. PARTICIPANTS Patients with PD of grade 2 or 3 of Hoehn & Yahr (H&Y) scale (N = 66). INTERVENTIONS AT group or control group. The techniques were administered by Physiotherapists trained in AT and consisted of 40 sessions per patient over 8 weeks. MAIN OUTCOME MEASURE Motor score subscale of Unified Parkinson's Disease Rating Scale (UPDRS) was used to measure the motor performances. The primary outcome measure was the difference in Motor score subscale of UPDRS scores between Week 1 (pretest score), Week 8 (posttest score), and follow-up at Week 12 after randomization. RESULTS The simple main effects analysis showed that the AT group performed better than the control group in weeks 8 and 12 (P < .005). Patients in the AT and control groups reported a 51.78% and 35.24% improvement, respectively, in their motor performances in Week 8 compared with that in Week 1, which persisted, in the follow-up (Week 12) as 30.82% in the AT group and 21.42% in the control group. CONCLUSIONS This study provides evidence that AT when used as an adjunct to PT is more effective than PT alone in improving motor performances in PD patients.
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Affiliation(s)
- M S Ajimsha
- Department of Physiotherapy, Hamad Medical Corporation, Doha, Qatar.
| | - Nisar A Majeed
- Faculty of Physiotherapy, School of Medical Education, India
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Simpson J, Lekwuwa G, Crawford T. Predictors of quality of life in people with Parkinson's disease: evidence for both domain specific and general relationships. Disabil Rehabil 2014; 36:1964-70. [PMID: 24499208 DOI: 10.3109/09638288.2014.883442] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess the determinants of health-related quality of life (HrQoL) in people with Parkinson's disease (PD). METHOD Eighty-one people with a diagnosis of idiopathic PD took part in a cross-sectional questionnaire-based study. Measures were collected in a community setting and included established determinants of HrQoL (demographic, clinical and cognitive variables) but also included a wide range of mental health variables (depression, anxiety and stress) and, for the first time, positive psychological functioning (optimism and self-esteem). HrQoL was measured by the full version of the Parkinson's Disease Questionnaire (PDQ-39) which includes eight domains of functioning. RESULTS Mental health measures (depression, anxiety and stress) were more influential than any other block of determinants and influenced a broader array of HrQoL domains including physical ones. There was some evidence of domain-specific relationships, e.g. between physical determinants and the more physically-oriented HrQoL domains, and between mental health determinants and emotional well-being. However, cognitive ability did not influence the HrQoL domain of cognitive impairment. CONCLUSIONS The contribution of a multi-disciplinary approach is crucial given the many variables which affect HrQoL; in particular, significant overall improvements on HrQoL are unlikely if only physical rehabilitation is offered. Rehabilitation is likely to be beneficial in terms of HrQoL only if it is planned and delivered holistically. Implications for Rehabilitation Interventions to improve physical function may have only limited impact on quality of life and might be limited to more physical HrQoL domains. Psychological interventions have the potential to improve quality of life over a wider range of both emotional and physical HrQoL domains. Clinician-measured level of functioning does not necessarily translate into patient-perceived levels of functional ability and relatively small objective decreases in ability can be appraised much more significantly disabling by people with PD.
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Affiliation(s)
- Jane Simpson
- Division of Health Research, Lancaster University , Lancaster , United Kingdom
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A waitlist-controlled trial of group cognitive behavioural therapy for depression and anxiety in Parkinson's disease. BMC Psychiatry 2014; 14:19. [PMID: 24467781 PMCID: PMC3907935 DOI: 10.1186/1471-244x-14-19] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 12/30/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy of a group Cognitive Behavioural Therapy (CBT) treatment for depression and anxiety in Parkinson's disease (PD). METHODS A waitlist-controlled trial design was used. Eighteen adults with PD and a comorbid DSM-IV-TR diagnosis of depression and/or anxiety were randomised to either Intervention (8-week group CBT treatment) or Waitlist (8-week clinical monitoring preceding treatment). The Depression, Anxiety, Stress Scale-21 (DASS-21) was the primary outcome. Assessments were completed at Time 1 (pretreatment), Time 2 (posttreatment/post-waitlist) and 1-month and 6-month follow-ups. RESULTS At Time 2, participants who received CBT reported greater reductions in depression (M(change) = -2.45) than Waitlist participants (M(change) = .29) and this effect was large, d = 1.12, p = .011. Large secondary effects on anxiety were also observed for CBT participants, d = .89, p = .025. All treatment gains were maintained and continued to improve during the follow-up period. At 6-month follow-up, significant and large effects were observed for both depression (d = 2.07) and anxiety (d = 2.26). CONCLUSIONS Group CBT appears to be an efficacious treatment approach for depression and anxiety in PD however further controlled trials with larger numbers of participants are required. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12610000455066).
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Charyton C, Elliott JO, Moore JL, Klatte ET. Is it time to consider cognitive behavioral therapy for persons with epilepsy? Clues from pathophysiology, treatment and functional neuroimaging. Expert Rev Neurother 2014; 10:1911-27. [DOI: 10.1586/ern.10.138] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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40
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Troeung L, Egan SJ, Gasson N. A meta-analysis of randomised placebo-controlled treatment trials for depression and anxiety in Parkinson's disease. PLoS One 2013; 8:e79510. [PMID: 24236141 PMCID: PMC3827386 DOI: 10.1371/journal.pone.0079510] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 09/30/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Psychopharmacotherapy currently constitutes the first-line treatment for depression and anxiety in Parkinson's disease (PD) however the efficacy of antidepressant treatments in PD is unclear. Several alternative treatments have been suggested as potentially more viable alternatives including dopamine agonists, repetitive transcranial magnetic stimulation, and cognitive behavioural therapy (CBT). METHOD A meta-analysis of randomised placebo-controlled trials for depression and/or anxiety in PD was conducted to systematically examine the efficacy of current treatments for depression and anxiety in PD. RESULTS Nine trials were included. There was only sufficient data to calculate a pooled effect for antidepressant therapies. The pooled effect of antidepressants for depression in PD was moderate but non-significant (d = .71, 95% CI = -1.33 to 3.08). The secondary effect of antidepressants on anxiety in PD was large but also non-significant (d = 1.13, 95% CI = -.67 to 2.94). Two single-trials of non-pharmacological treatments for depression in PD resulted in significant large effects; Omega-3 supplementation (d = .92, 95% CI = .15 to 1.69) and CBT (d = 1.57, 95% CI = 1.06 to 2.07), and warrant further exploration. CONCLUSIONS There remains a lack of controlled trials for both pharmacological and non-pharmacological treatments for depression and anxiety in PD which limits the conclusions which can be drawn. While the pooled effects of antidepressant therapies in PD were non-significant, the moderate to large magnitude of each pooled effect is promising. Non-pharmacological approaches show potential for depression in PD however more research is required.
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Affiliation(s)
- Lakkhina Troeung
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Sarah J. Egan
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Natalie Gasson
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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41
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Depressive syndromes in neurological disorders. Eur Arch Psychiatry Clin Neurosci 2013; 263 Suppl 2:S123-36. [PMID: 24077889 DOI: 10.1007/s00406-013-0448-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 09/16/2013] [Indexed: 12/18/2022]
Abstract
Depressive syndromes represent a common and often characteristic feature in a number of neurological disorders. One prominent example is the development of post-stroke depression, which can be observed in more than one-third of stroke survivors in the aftermath of an ischemic stroke. Thus, post-stroke depression represents one of the most prevalent, disabling, and potentially devastating psychiatric post-stroke complications. On the other hand, depressive syndromes may also be considered as a risk factor for certain neurological disorders, as recently revealed by a meta-analysis of prospective cohort studies, which demonstrated an increased risk for ischemic events in depressed patients. Moreover, depressive syndromes represent common comorbidities in a number of other neurological disorders such as Parkinson's disease, multiple sclerosis, or epilepsy, in which depression has a strong impact on both quality of life and outcome of the primary neurological disorder.
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Pachana NA, Egan SJ, Laidlaw K, Dissanayaka N, Byrne GJ, Brockman S, Marsh R, Starkstein S. Clinical issues in the treatment of anxiety and depression in older adults with Parkinson's disease. Mov Disord 2013; 28:1930-4. [PMID: 24123116 DOI: 10.1002/mds.25689] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 07/27/2013] [Accepted: 08/04/2013] [Indexed: 11/08/2022] Open
Abstract
A significant proportion of persons affected by Parkinson's disease (PD) are over age 65 years. Mental health issues are often less a focus of treatment in this population than physical manifestations of the illness. Anxiety or depression alone, as well as comorbid depression and anxiety, are underrecognized in patients with PD and are associated with deleterious effects on physical and interpersonal functioning, negatively impacting quality of life and well-being. We offer a brief overview of salient clinical points with respect to assessment and treatment approaches to enhance efficacy of the treatment of mental health symptoms in older adults with PD. Cognitive behavior therapy involves the patient learning to overcome behavioral avoidance associated with anxiety and challenge unhelpful negative cognitions. It is suggested that cognitive behavior therapy is an effective approach to treatment of anxiety and depression in PD and should be offered as a treatment to patients.
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Affiliation(s)
- Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
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Piber D, Hinkelmann K, Gold SM, Heesen C, Spitzer C, Endres M, Otte C. [Depression and neurological diseases]. DER NERVENARZT 2013; 83:1423-33. [PMID: 23095843 DOI: 10.1007/s00115-012-3674-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In many neurological diseases a depressive syndrome is a characteristic sign of the primary disease or is an important comorbidity. Post-stroke depression, for example, is a common and relevant complication following ischemic brain infarction. Approximately 4 out of every 10 stroke patients develop depressive disorders in the course of the disease which have a disadvantageous effect on the course and the prognosis. On the other hand depression is also a risk factor for certain neurological diseases as was recently demonstrated in a meta-analysis of prospective cohort studies which revealed a much higher stroke risk for depressive patients. Furthermore, depression plays an important role in other neurological diseases with respect to the course and quality of life, such as Parkinson's disease, multiple sclerosis and epilepsy. This article gives a review of the most important epidemiological, pathophysiological and therapeutic aspects of depressive disorders as a comorbidity of neurological diseases and as a risk factor for neurological diseases.
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Affiliation(s)
- D Piber
- Klinik für Psychiatrie und Psychotherapie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Eschenallee 3, 14050 Berlin, Deutschland.
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Abstract
OBJECTIVE Parkinson's disease (PD) is a degenerative and disabling disease in which medical providers focus mainly on ameliorating problems in day-to-day functioning. This review summarizes current knowledge about the efficacy and tolerability of psychopharmacological agents in the treatment of depression, anxiety, psychosis, and insomnia in patients with PD. Recommended or promising nonpharmacological interventions are also reviewed. METHOD Studies were identified using computerized searches, with further references obtained from the bibliographies of the reviewed articles. RESULT Findings in the research literature provide growing evidence concerning the antidepressant treatment of patients with PD. Psychoeducational interventions for managing depression and anxiety symptoms also appear promising. Music therapy has proven to be particularly effective for patients with PD. Psychosis is common in patients with PD. When psychosis is induced by antiparkinson drugs, a dose reduction can be considered, but it is seldom successful. Patients with PD do not generally tolerate conventional antipsychotic medications, justifying evaluation of newer atypical agents in this population. Cholinesterase inhibitors have also become increasingly important in the treatment of PD in recent years. Finally, insomnia is a very frequent complaint in patients with PD and may also contribute to the development of depression. Patients should be encouraged to improve sleep hygiene and use behavioral interventions. Definitive trials of treatments for sleep disorders in this population are also warranted. CONCLUSION Therapeutic approaches to the treatment of PD and its associated psychiatric symptoms must be individualized and may involve a combination of antiparkinson drugs, psychopharmacological treatment, and/or psychotherapeutic interventions.
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Cognitive behavioural therapy for depression in advanced Parkinson's disease: a case illustration. COGNITIVE BEHAVIOUR THERAPIST 2012. [DOI: 10.1017/s1754470x12000049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AbstractParkinson's disease (PD) is associated with significant symptoms of depression. Cognitive behaviour therapy (CBT) has been shown to be effective for depression in PD. However, much of the previous research focuses on working with younger adults in the earlier stages of the disease, despite evidence for greater risk of depression when PD symptoms are more severe. This paper provides a case illustration of using CBT for depression with an 84-year-old man with advanced PD. The results of an assessment are described and a psychological formulation is presented. The specific adaptations made to the therapy and illustrations of the content of therapy are discussed. This intervention resulted in improvements in global mental health and moderate reductions in depression. However, there was no effect on anxiety. This case highlights the complexity of conducting CBT with this population, and further research is needed to determine the modifications necessary to make such interventions effective.
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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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Gallagher DA, Schrag A. Psychosis, apathy, depression and anxiety in Parkinson's disease. Neurobiol Dis 2012; 46:581-9. [PMID: 22245219 DOI: 10.1016/j.nbd.2011.12.041] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 12/19/2011] [Accepted: 12/22/2011] [Indexed: 02/06/2023] Open
Abstract
Psychiatric symptoms are important non-motor features in PD, which occur at high frequency and have significant impact on health related quality of life. This review concentrates on the prevalence, pathophysiology, diagnosis and treatment of depression, anxiety, apathy and psychosis. The pathophysiology of these disorders is complex, reflecting the widespread brainstem and cortical pathology in PD, with involvement of several neurotransmitters, including dopaminergic, serotonergic, noradrenergic and cholinergic systems. The diagnosis of psychiatric conditions, in particular affective disorders, is challenging because of the overlap of somatic features of psychiatric disorders and underlying movement disorder. The pathogenesis is likely to differ considerably from non-PD patients, and treatments used in general psychiatry services may not be as effective in PD and will require clearer clarification in well-designed clinical studies. Management strategies include adjustment of dopaminergic medication, use of psychotropic treatments and behavioural and psychological approaches. However, the future challenge will be to develop treatments developed specifically for the pathogenesis of these disorders in PD.
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Jiménez-Murcia S, Bove FI, Israel M, Steiger H, Fernández-Aranda F, Alvarez-Moya E, Granero R, Penelo E, Vergé B, Aymamí MN, Santamaría JJ, Gómez-Peña M, Moragas L, Savvidou LG, Menchón JM. Cognitive-behavioral therapy for pathological gambling in Parkinson's disease: a pilot controlled study. Eur Addict Res 2012; 18:265-74. [PMID: 22760081 DOI: 10.1159/000337442] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 02/06/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The main objective of this study was to compare the clinical characteristics and differences in response to treatment of two groups of pathological gamblers: with comorbid Parkinson's disease (PG + PD) and without (PG - PD). METHODS Clinical and psychopathological profiles and response to cognitive-behavioral treatment were assessed in 15 PG + PD and 45 PG - PD individuals consulting a specialized hospital Unit. RESULTS Statistically significant differences were observed between the two groups on a series of clinical variables. PG + PD patients were older and presented later onset of problematic gambling behaviors, lower alcohol consumption and higher bingo playing than PG - PD patients. No significant differences were noted in psychopathology except for lower measures of hostility in the PG + PD group. No statistical differences were detected between groups in terms of response to treatment. CONCLUSION These results may provide guidance for obtaining accurate diagnostic information in pathological gamblers by properly identifying patients with specific needs that may be targeted with treatment.
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Affiliation(s)
- Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.
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Abstract
Depression occurs in around 35% of patients with Parkinson disease (PD) and is often persistent. Symptoms of depression can be evident in individuals at the time of diagnosis and might develop in the premotor stage of the disease. The underlying mechanisms of depression in PD are not known in detail, but changes in brain structure, signaling by neurotransmitters, and levels of inflammatory and neurotrophic factors are all suggested to contribute to its development. Psychosocial factors and pain could also have roles in depression. Changes in dopaminergic, noradrenergic and serotonergic systems in patients with PD might help to explain the incidence of depression in these individuals. Antidepressants that have dual serotonergic and noradrenergic effects are the drugs of choice for treating depression in PD. However, antiparkinsonian drugs might have beneficial effects not only on the motor symptoms of disease, but also on a patient's mood. Deep brain stimulation can worsen depression in some patients, but a preliminary study has suggested that transcranial magnetic stimulation could improve symptoms of depression. This Review describes the frequency and course of depression in patients with PD. The mechanisms that underlie depression in this disease are also discussed, and the management strategies for these patients are highlighted.
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