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Angelopoulou E, Stanitsa E, Karpodini CC, Bougea A, Kontaxopoulou D, Fragkiadaki S, Koros C, Georgakopoulou VE, Fotakopoulos G, Koutedakis Y, Piperi C, Papageorgiou SG. Pharmacological and Non-Pharmacological Treatments for Depression in Parkinson's Disease: An Updated Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1454. [PMID: 37629744 PMCID: PMC10456434 DOI: 10.3390/medicina59081454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/19/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
Depression represents one of the most common non-motor disorders in Parkinson's disease (PD) and it has been related to worse life quality, higher levels of disability, and cognitive impairment, thereby majorly affecting not only the patients but also their caregivers. Available pharmacological therapeutic options for depression in PD mainly include selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants; meanwhile, agents acting on dopaminergic pathways used for motor symptoms, such as levodopa, dopaminergic agonists, and monoamine oxidase B (MAO-B) inhibitors, may also provide beneficial antidepressant effects. Recently, there is a growing interest in non-pharmacological interventions, including cognitive behavioral therapy; physical exercise, including dance and mind-body exercises, such as yoga, tai chi, and qigong; acupuncture; therapeutic massage; music therapy; active therapy; repetitive transcranial magnetic stimulation (rTMS); and electroconvulsive therapy (ECT) for refractory cases. However, the optimal treatment approach for PD depression is uncertain, its management may be challenging, and definite guidelines are also lacking. It is still unclear which of these interventions is the most appropriate and for which PD stage under which circumstances. Herein, we aim to provide an updated comprehensive review of both pharmacological and non-pharmacological treatments for depression in PD, focusing on recent clinical trials, systematic reviews, and meta-analyses. Finally, we discuss the pharmacological agents that are currently under investigation at a clinical level, as well as future approaches based on the pathophysiological mechanisms underlying the onset of depression in PD.
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Affiliation(s)
- Efthalia Angelopoulou
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.A.); (E.S.); (A.B.); (D.K.); (S.F.); (C.K.)
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Evangelia Stanitsa
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.A.); (E.S.); (A.B.); (D.K.); (S.F.); (C.K.)
| | - Claire Chrysanthi Karpodini
- Sport and Physical Activity Research Centre, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton WV1 1LY, UK;
| | - Anastasia Bougea
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.A.); (E.S.); (A.B.); (D.K.); (S.F.); (C.K.)
| | - Dionysia Kontaxopoulou
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.A.); (E.S.); (A.B.); (D.K.); (S.F.); (C.K.)
| | - Stella Fragkiadaki
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.A.); (E.S.); (A.B.); (D.K.); (S.F.); (C.K.)
| | - Christos Koros
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.A.); (E.S.); (A.B.); (D.K.); (S.F.); (C.K.)
| | | | - George Fotakopoulos
- Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece;
| | - Yiannis Koutedakis
- Functional Architecture of Mammals in Their Environment Laboratory, Department of Physical Education and Sport Science, University of Thessaly, 38221 Volos, Greece;
| | - Christina Piperi
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Sokratis G. Papageorgiou
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece; (E.A.); (E.S.); (A.B.); (D.K.); (S.F.); (C.K.)
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Ahmad MH, Rizvi MA, Ali M, Mondal AC. Neurobiology of depression in Parkinson's disease: Insights into epidemiology, molecular mechanisms and treatment strategies. Ageing Res Rev 2023; 85:101840. [PMID: 36603690 DOI: 10.1016/j.arr.2022.101840] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 12/25/2022] [Accepted: 12/31/2022] [Indexed: 01/03/2023]
Abstract
Parkinson's disease (PD) is characterized mainly by motor dysfunctions due to the progressive loss of dopaminergic neurons. However, PD patients experience a multitude of debilitating non-motor symptoms, including depression, which may have deleteriously detrimental effects on life. Depression is multifactorial and exhibits a bimodal progression in PD, but its underlying molecular mechanisms are poorly understood. Studies demonstrating the pathophysiology of depression in PD and the specific treatment strategies for depression-like symptoms in PD patients are largely lacking, often underrated, under-recognized and, consequently, inadequately/under-treated. Nevertheless, reports suggest that the incidence of depression is approximately 20-30% of PD patients and may precede the onset of motor symptoms. Diagnosing depression in PD becomes difficult due to the clinical overlap in symptomatology between the two diseases, and the nigrostriatal dysfunction alone is insufficient to explain depressive symptoms in PD. Therefore, the current study provides an overview of the molecular mechanisms underlying the development of depression in PD and new insights into developing current antidepressant strategies to treat depression in PD. This review will identify and understand the molecular pathological mechanisms of depression in PD that will fundamentally help tailoring therapeutic interventions for depressive symptoms in PD.
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Affiliation(s)
- Mir Hilal Ahmad
- Laboratory of Cellular and Molecular Neurobiology, School of Life Sciences, Jawaharlal Nehru University, New Delhi 110067, India; Genome Biology Lab, Department of Biosciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Moshahid Alam Rizvi
- Genome Biology Lab, Department of Biosciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Mansoor Ali
- Cancer Biology Laboratory, School of Life Sciences, Jawaharlal Nehru University, New Delhi 110067, India
| | - Amal Chandra Mondal
- Laboratory of Cellular and Molecular Neurobiology, School of Life Sciences, Jawaharlal Nehru University, New Delhi 110067, India.
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van Wamelen DJ, Rukavina K, Podlewska AM, Chaudhuri KR. Advances in the Pharmacological and Non-pharmacological Management of Non-motor Symptoms in Parkinson's Disease: An Update Since 2017. Curr Neuropharmacol 2023; 21:1786-1805. [PMID: 35293295 PMCID: PMC10514535 DOI: 10.2174/1570159x20666220315163856] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/19/2022] [Accepted: 03/10/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Non-motor symptoms (NMS) are an important and ubiquitous determinant of quality of life in Parkinson's disease (PD). However, robust evidence for their treatment is still a major unmet need. OBJECTIVE This study aimed to provide an updated review on advances in pharmacological, nonpharmacological, and exercise-based interventions for NMS in PD, covering the period since the publication of the MDS Task Force Recommendations. METHODS We performed a literature search to identify pharmacological, non-pharmacological, and exercise-based interventions for NMS in PD. As there are recent reviews on the subject, we have only included studies from the 1st of January 2017 to the 1st of December 2021 and limited our search to randomised and non-randomised (including open-label) clinical trials. RESULTS We discuss new strategies to manage NMS based on data that have become available since 2017, for instance, on the treatment of orthostatic hypotension with droxidopa, several dopaminergic treatment options for insomnia, and a range of non-pharmacological and exercise-based interventions for cognitive and neuropsychiatric symptoms, pain, and insomnia and excessive sleepiness. CONCLUSION Recent evidence suggests that targeted non-pharmacological treatments, as well as some other NMS management options, may have a significant beneficial effect on the quality of life and need to be considered in the pathways of treatment of PD.
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Affiliation(s)
- Daniel J. van Wamelen
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Katarina Rukavina
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Aleksandra M. Podlewska
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - K. Ray Chaudhuri
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
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4
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Tian J, Kang Y, Liu P, Yu H. Effect of Physical Activity on Depression in Patients with Parkinson's Disease: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116849. [PMID: 35682432 PMCID: PMC9180645 DOI: 10.3390/ijerph19116849] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 02/04/2023]
Abstract
Parkinson’s disease (PD) is the second most common neurodegenerative disease worldwide, and approximately 50% of PD patients suffer from depression. We aim to determine the effects of physical activity on depression in PD patients and to provide scientific evidence-based exercise prescriptions for PD patients. A systematic review was conducted by searching PubMed, Embase, Cochrane Library, and PsycInfo until February 2022 for randomized controlled trial (RCT) studies published in English. The primary outcome was a score on a depression scale. A total of 14 RCTs involving 516 patients with PD were included in this study. The results of the meta-analysis showed that physical activity had a moderate and significant improvement in depression in PD patients (SMD = −0.60; 95% CI = −0.79 to −0.41; p < 0.00001). Subgroup analysis indicated that resistance exercise for 60−90 min more than 4 times per week for up to 12 weeks had a significant effect on PD patients who have had the disease for more than 5 years. Meta-regression showed that intervention type, intervention time, intervention frequency, intervention period, age, and disease duration were not sources of heterogeneity. Physical activity may reduce depression in PD patients. However, other larger sample sizes and high-quality studies are needed to validate these effects in the future.
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Affiliation(s)
- Jianing Tian
- Department of Physical Education, Shanghai Jiao Tong University, Shanghai 200240, China; (J.T.); (Y.K.)
| | - Yujie Kang
- Department of Physical Education, Shanghai Jiao Tong University, Shanghai 200240, China; (J.T.); (Y.K.)
| | - Peifeng Liu
- Department of Physical Education, Central South University, Changsha 410083, China;
| | - Hongyan Yu
- Department of Physical Education, Shanghai Jiao Tong University, Shanghai 200240, China; (J.T.); (Y.K.)
- Correspondence:
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5
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Prange S, Klinger H, Laurencin C, Danaila T, Thobois S. Depression in Patients with Parkinson's Disease: Current Understanding of its Neurobiology and Implications for Treatment. Drugs Aging 2022; 39:417-439. [PMID: 35705848 PMCID: PMC9200562 DOI: 10.1007/s40266-022-00942-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 12/11/2022]
Abstract
Depression is one of the most frequent and burdensome non-motor symptoms in Parkinson’s disease (PD), across all stages. Even when its severity is mild, PD depression has a great impact on quality of life for these patients and their caregivers. Accordingly, accurate diagnosis, supported by validated scales, identification of risk factors, and recognition of motor and non-motor symptoms comorbid to depression are critical to understanding the neurobiology of depression, which in turn determines the effectiveness of dopaminergic drugs, antidepressants and non-pharmacological interventions. Recent advances using in vivo functional and structural imaging demonstrate that PD depression is underpinned by dysfunction of limbic networks and monoaminergic systems, depending on the stage of PD and its associated symptoms, including apathy, anxiety, rapid eye movement sleep behavior disorder (RBD), cognitive impairment and dementia. In particular, the evolution of serotonergic, noradrenergic, and dopaminergic dysfunction and abnormalities of limbic circuits across time, involving the anterior cingulate and orbitofrontal cortices, amygdala, thalamus and ventral striatum, help to delineate the variable expression of depression in patients with prodromal, early and advanced PD. Evidence is accumulating to support the use of dual serotonin and noradrenaline reuptake inhibitors (desipramine, nortriptyline, venlafaxine) in patients with PD and moderate to severe depression, while selective serotonin reuptake inhibitors, repetitive transcranial magnetic stimulation and cognitive behavioral therapy may also be considered. In all patients, recent findings advocate that optimization of dopamine replacement therapy and evaluation of deep brain stimulation of the subthalamic nucleus to improve motor symptoms represents an important first step, in addition to physical activity. Overall, this review indicates that increasing understanding of neurobiological changes help to implement a roadmap of tailored interventions for patients with PD and depression, depending on the stage and comorbid symptoms underlying PD subtypes and their prognosis.
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Affiliation(s)
- Stéphane Prange
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France. .,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France. .,Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Hélène Klinger
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France
| | - Chloé Laurencin
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France.,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France
| | - Teodor Danaila
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France.,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France
| | - Stéphane Thobois
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France. .,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France. .,Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Univ Lyon, Université Claude Bernard Lyon 1, Oullins, France.
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6
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Austgen G, Marsh L. Cognitive dysfunction and neuropsychiatric aspects of Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:59-90. [PMID: 35248207 DOI: 10.1016/bs.pbr.2022.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Movement abnormalities, by definition, and cognitive changes, to varying extents, affect every patient with Parkinson's disease (PD) and are attributed to the underlying neurodegenerative disease. Various psychiatric disorders occur in most patients at some point over the course of PD, including in the prodromal phase. Even though psychiatric disturbances tend to aggravate motor and cognitive deficits, they are under-recognized and under-treated, and the role of the underlying neurological disease is often minimized. To provide an integrated approach to understanding neuropsychiatric aspects of PD, this chapter reviews how cognitive changes in PD relate to the common psychiatric disturbances in PD along with the prevalence, phenomenology, pathophysiology, and treatment of each.
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Affiliation(s)
- Gabriela Austgen
- Behavioral Neurology & Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Laura Marsh
- Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Professor, Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences and Department of Neurology, Baylor College of Medicine, Houston, TX, United States.
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7
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Cheng P, Zhang J, Wu Y, Liu W, Zhu J, Chen Z, Zhang J, Guan S, Sun Y, Wang J. 5-HTTLPR polymorphism and depression risk in Parkinson's disease: an updated meta-analysis. Acta Neurol Belg 2021; 121:933-940. [PMID: 32219696 DOI: 10.1007/s13760-020-01342-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/19/2020] [Indexed: 12/13/2022]
Abstract
The relationship between the 5-hydroxytryptamine transporter gene-linked polymorphic region (5-HTTLPR) and depression in Parkinson's disease (PD) has remained controversial. Therefore, we conducted this meta-analysis to evaluate the relationship between 5-HTTLPR polymorphisms and depression in PD. Relevant online databases were searched for cross-sectional, case-control or cohort studies examining relations between 5-HTTLPR polymorphisms (S/L) and the risk of developing depression of PD using a meta-analysis. Odd ratios (ORs) of 5-HTTLPR polymorphisms (S/L allele genotype) were calculated between depression in PD and PD for each study. Five observational studies were identified. Overall ORs for 5-HTTLPR S-Allele genotype was 1.98 (95% CI 0.92-4.26) in the dominant model, 1.43 (95% CI 1.08-1.90) in the recessive model, 2.64 (95% CI 1.01-6.88) in the additive model, independently. The overall ORs of S-Allele genotype was 1.51 (95% CI 0.63-3.64) for the Caucasian subgroup, and 1.44 (95% CI 1.05-1.98) for the non-Caucasian subgroup in the recessive model. This meta-analysis indicates that the 5-HTTLPR genotype (S/S-Allele) is correlated with an increased depression risk in PD, and this highlights the needs for these people to take some effective approaches (if any) in prevention of depression of PD before its onset.
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Affiliation(s)
- Pengfei Cheng
- Department of Neurology, The First Affiliated Hospital of Jiamusi University, 348 Xuefu Street, Xiangyang District, Jiamusi, 154002, Heilongjiang Province, People's Republic of China.
| | - Junxiang Zhang
- Department of Neurology, The First Affiliated Hospital of Jiamusi University, 348 Xuefu Street, Xiangyang District, Jiamusi, 154002, Heilongjiang Province, People's Republic of China
| | - Yu Wu
- Institute of Clinical Research and Translational Medicine, Gansu Provincial Hospital, Lanzhou, People's Republic of China
| | - Wenting Liu
- Department of Neurology, The First Affiliated Hospital of Jiamusi University, 348 Xuefu Street, Xiangyang District, Jiamusi, 154002, Heilongjiang Province, People's Republic of China
| | - Jiaying Zhu
- Department of Neurology, The First Affiliated Hospital of Jiamusi University, 348 Xuefu Street, Xiangyang District, Jiamusi, 154002, Heilongjiang Province, People's Republic of China
| | - Ze Chen
- School of Basic Medicine, Jiamusi University, Jiamusi, People's Republic of China
| | - Jiarui Zhang
- School of Basic Medicine, Jiamusi University, Jiamusi, People's Republic of China
| | - Songwen Guan
- School of Basic Medicine, Jiamusi University, Jiamusi, People's Republic of China
| | - Yiming Sun
- School of Basic Medicine, Jiamusi University, Jiamusi, People's Republic of China
| | - Jingxia Wang
- School of Basic Medicine, Jiamusi University, Jiamusi, People's Republic of China
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Pontone GM, Mills KA. Optimal Treatment of Depression and Anxiety in Parkinson's Disease. Am J Geriatr Psychiatry 2021; 29:530-540. [PMID: 33648830 DOI: 10.1016/j.jagp.2021.02.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 12/21/2022]
Abstract
Depression and anxiety are highly prevalent and have major adverse effects on function and quality of life in Parkinson's disease (PD). Optimal management requires that motor symptoms and psychiatric symptoms be simultaneously addressed. While there is fairly robust evidence for the treatment of motor symptoms, there are no completed randomized controlled trials to guide pharmacological treatment of anxiety in PD and no nonpharmacologic interventions have proven efficacious. Several high-quality trials for depression in PD suggest a number of antidepressants and cognitive behavioral therapy may help, but there is no data on rates of recurrence, comparative efficacy, or augmentation strategies. In order to address the gaps in knowledge, the authors provide a summary of the current evidence for treating depression and anxiety in PD and offer an algorithm that extends beyond the current literature based on clinical experience working in a multidisciplinary specialty center.
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Affiliation(s)
- Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences (GMP), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (GMP, KAM), Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Kelly A Mills
- Department of Neurology (GMP, KAM), Johns Hopkins University School of Medicine, Baltimore, MD
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Abstract
Recent epidemiological evidence indicates that diagnosis of attention-deficit/hyperactivity disorder (ADHD) is associated with increased risk for diseases of the basal ganglia and cerebellum, including Parkinson's disease (PD). The evidence reviewed here indicates that deficits in striatal dopamine are a shared component of the causal chains that produce these disorders. Neuropsychological studies of adult ADHD, prodromal PD, and early-stage PD reveal similar deficits in executive functions, memory, attention, and inhibition that are mediated by similar neural substrates. These and other findings are consistent with the possibility that ADHD may be part of the PD prodrome. The mechanisms that may mediate the association between PD and ADHD include neurotoxic effects of stimulants, other environmental exposures, and Lewy pathology. Understanding the nature of the association between PD and ADHD may provide insight into the etiology and pathogenesis of both disorders. The possible contribution of stimulants to this association may have important clinical and public health implications.
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10
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Neuropsychiatric aspects of Parkinson disease psychopharmacology: Insights from circuit dynamics. HANDBOOK OF CLINICAL NEUROLOGY 2020; 165:83-121. [PMID: 31727232 DOI: 10.1016/b978-0-444-64012-3.00007-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Parkinson disease (PD) is a neurodegenerative disorder with a complex pathophysiology characterized by the progressive loss of dopaminergic neurons within the substantia nigra. Persons with PD experience several motoric and neuropsychiatric symptoms. Neuropsychiatric features of PD include depression, anxiety, psychosis, impulse control disorders, and apathy. In this chapter, we will utilize the National Institutes of Mental Health Research Domain Criteria (RDoC) to frame and integrate observations from two prevailing disease constructions: neurotransmitter anomalies and circuit physiology. When there is available evidence, we posit how unified translational observations may have clinical relevance and postulate importance outside of PD. Finally, we review the limited evidence available for pharmacologic management of these symptoms.
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Wang M, Liao H, Shen Q, Cai S, Zhang H, Xiang Y, Liu S, Wang T, Zi Y, Mao Z, Tan C. Changed Resting-State Brain Signal in Parkinson's Patients With Mild Depression. Front Neurol 2020; 11:28. [PMID: 32082245 PMCID: PMC7005211 DOI: 10.3389/fneur.2020.00028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/09/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Depression is reported to occur 5–10 years early than the onset of motor symptoms in Parkinson (PD) patients. However, markers for early diagnosis of PD in individuals with sub-clinical depression still remain to be identified. Purpose: This study utilized Regional Homogeneity (ReHo) to investigate the alterations in resting state brain activities in Parkinson (PD) patients with different degrees of depression. Methods: Twenty non-depressed PD patients, twenty mild to moderately depressed PD patients, and thirteen severely depressed PD patients were recruited. Hamilton Depression Scale (HDS) and the Beck Depression Inventory (BDI) were assessed depression. Resting-state functional magnetic resonance imaging (rs-MRI) was analyzed with ReHo. Results: PD patients with mild to moderate depression had decreased ReHo in the left dorsal anterior cingulate cortex when compared with PD patients without depression. PD patients with severe depression exhibited increased ReHo in the left inferior prefrontal gyrus and right orbitofrontal area when compared with PD patients with mild to moderate depression. ReHo values in the bilateral supplementary motor area (SMA) in PD patients with severe depression was also increased when compared with PD patients without depression. Conclusions: This study suggests that rs-MRI with ReHo analysis can detect early changes in brain function that associate with depression in PD patients, which could be biomarkers for early diagnosis and treatment of PD related depression.
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Affiliation(s)
- Min Wang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Haiyan Liao
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qin Shen
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Sainan Cai
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hongchun Zhang
- Department of Radiology, The First Affiliated Hospital, University of Science and Technology of China, Changsha, China
| | - Yijuan Xiang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Siyu Liu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Tianyu Wang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuheng Zi
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhenni Mao
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Changlian Tan
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
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12
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Lin H, Cai X, Zhang D, Liu J, Na P, Li W. Functional connectivity markers of depression in advanced Parkinson's disease. NEUROIMAGE-CLINICAL 2019; 25:102130. [PMID: 31869768 PMCID: PMC6931212 DOI: 10.1016/j.nicl.2019.102130] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/23/2019] [Accepted: 12/13/2019] [Indexed: 11/18/2022]
Abstract
Patient-specific 42-ICNs template was created from 156 PD patients’ rs-fMRI data. 6 FC markers significantly contributed to depression discrimination in PD. Classifiers achieved the mean accuracy of 82.4% for depression diagnosis in PD.
Background Depression is a common comorbid condition in Parkinson's disease and a major contributor to poor quality of life. Despite this, depression in PD is under-diagnosed due to overlapping symptoms and difficulties in the assessment of depression in cognitively impaired old patients. Objectives This study is to explore functional connectivity markers of depression in PD patients using resting-state fMRI and help diagnose whether patients have depression or not. Methods We reviewed 156 advanced PD patients (duration > 5 years; 59 depressed ones) and 45 healthy control subjects who underwent a resting-state fMRI scanning. Functional connectivity analysis was employed to characterize intrinsic connectivity networks using group independent component analysis and extract connectivity features. Features were put into an all-relevant feature selection procedure within cross-validation loops, to identify features with significant discriminative power for classification. Random forest classifiers were built for depression diagnosis, on the basis of identified features. Results 42 intrinsic connectivity networks were identified and arranged into subcortical, auditory, somatomotor, visual, cognitive control, default-mode and cerebellar networks. Six features were significantly relevant to classification. They were connectivity within posterior cingulate cortex, within insula, between posterior cingulate cortex and insula/hippocampus+amygdala, between insula and precuneus, and between superior parietal lobule and medial prefrontal cortex. The mean accuracy achieved with classifiers to discriminate depressed patients from the non-depressed was 82.4%. Conclusions Our findings provide preliminary evidence that resting-state functional connectivity can characterize depressed PD patients and help distinguish them from non-depressed ones.
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Affiliation(s)
- Hai Lin
- Department of Functional Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China; Brain Centre, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China; School of Medicine, Shenzhen University, Shenzhen, Guangdong, China
| | - Xiaodong Cai
- Department of Functional Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China; School of Medicine, Shenzhen University, Shenzhen, Guangdong, China
| | - Doudou Zhang
- Department of Functional Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China; School of Medicine, Shenzhen University, Shenzhen, Guangdong, China
| | - Jiali Liu
- Department of Functional Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China; School of Medicine, Shenzhen University, Shenzhen, Guangdong, China
| | - Peng Na
- Department of Functional Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China; Brain Centre, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China; School of Medicine, Shenzhen University, Shenzhen, Guangdong, China
| | - Weiping Li
- Brain Centre, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China; School of Medicine, Shenzhen University, Shenzhen, Guangdong, China.
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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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Lee Y, Oh JS, Chung SJ, Lee JJ, Chung SJ, Moon H, Lee PH, Kim JS, Sohn YH. The presence of depression in de novo Parkinson's disease reflects poor motor compensation. PLoS One 2018; 13:e0203303. [PMID: 30231066 PMCID: PMC6145582 DOI: 10.1371/journal.pone.0203303] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/18/2018] [Indexed: 11/18/2022] Open
Abstract
Depression frequently accompanies Parkinson's disease and often precedes the onset of motor symptoms. This study aimed to evaluate the impact of depression on motor compensation in patients with de novo Parkinson's disease. This retrospective cohort study analyzed data from 474 non-demented patients with de novo Parkinson's disease (mean age, 64.6±9.8 years; 242 men) who underwent both dopamine transporter PET scan and depression assessment using the Beck Depression Inventory at baseline. Patients were classified into tertiles by Beck Depression Inventory score. At baseline, high-tertile group (Beck Depression Inventory score ≥15, n = 157) showed more severe motor deficits and lower cognitive function than low-tertile group (Beck Depression Inventory score ≤7, n = 158, P = 0.034 and P = 0.008, respectively). Greater motor deficits in high-tertile group than low-tertile group remained significant after controlling for dopamine transporter binding in the posterior putamen, as well as other confounding variables. During follow-up of a median duration of 47 months, high-tertile group received higher levodopa-equivalent doses for symptom control than did low-tertile group after controlling for age, gender, and initial motor deficit severity. These results demonstrate that depression in de novo Parkinson's disease is associated with motor deficit severity at baseline and dose of PD medications during follow-up, suggesting that the presence of depression in de novo Parkinson's disease represents poor motor compensation.
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Affiliation(s)
- Yoonju Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jungsu S. Oh
- Department of Nuclear Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Jung Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Su Jin Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Myongji Hospital, Goyang, South Korea
| | - Hyojeong Moon
- Department of Nuclear Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Young H. Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- * E-mail:
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Lian TH, Guo P, Zuo LJ, Hu Y, Yu SY, Liu L, Jin Z, Yu QJ, Wang RD, Li LX, Piao YS, Zhang W. An Investigation on the Clinical Features and Neurochemical Changes in Parkinson's Disease With Depression. Front Psychiatry 2018; 9:723. [PMID: 30713507 PMCID: PMC6346625 DOI: 10.3389/fpsyt.2018.00723] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 12/07/2018] [Indexed: 12/14/2022] Open
Abstract
Objective: To investigate the clinical features and neurochemical changes in Parkinson's disease with depression (PD-D). Methods: A total of 478 PD patients were divided into PD-D and PD patients without depression (PD-ND) groups according to the 24-item Hamilton Depression Rating Scale (HAMD) score. Demographic variables, motor and non-motor symptoms and activities of daily living were evaluated. The independent influencing factors of PD-D were investigated via binary logistic regression analysis. The levels of neurotransmitters in cerebrospinal fluid (CSF) were measured and their correlations with HAMD score were analyzed. Results: The proportion of PD-D was 59.0%, of which 76.95, 20.92, and 2.13% had mild, moderate, and severe depression, respectively. Anxiety/somatization was the most prevalent sub-factor of HAMD in PD-D. The scores of UPDRS III, postural instability/gait difficulty (PIGD) type and the scores of 14-item Hamilton Anxiety Scale (HAMA) and 14-item Chalder Fatigue Scale (FS) were independently associated with PD-D. The levels of dopamine (DA) and 5-hydroxytryptamine (5-HT) were all significantly reduced in PD-D group compared with those in PD-ND group. HAMD scores were negatively correlated with the DA levels in CSF. Conclusions: PD patients have a high proportion of depression, mainly of mild and moderate levels. The profile of depression in PD population is subtly different from that of the general population. Motor symptoms, PIGD type, anxiety and fatigue are the significant influencing factors of PD-D. Compared to 5-HT, DA may play a more important role in PD-D.
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Affiliation(s)
- Teng-Hong Lian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peng Guo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Jun Zuo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Hu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shu-Yang Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li Liu
- Department of Internal Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhao Jin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qiu-Jin Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Rui-Dan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Xia Li
- Department of Internal Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying-Shan Piao
- Center for Movement Disorder, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Zhang
- Center for Cognitive Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Key Laboratory for Neurodegenerative Disorders of the Ministry of Education, Capital Medical University, Beijing, China.,Center of Parkinson's Disease, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory on Parkinson's Disease, Beijing, China
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Zhu J, Lu L, Pan Y, Shen B, Xu S, Hou Y, Zhang X, Zhang L. Depression and associated factors in nondemented Chinese patients with Parkinson’s disease. Clin Neurol Neurosurg 2017; 163:142-148. [DOI: 10.1016/j.clineuro.2017.10.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 07/24/2017] [Accepted: 10/28/2017] [Indexed: 01/01/2023]
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Factor SA, Scullin MK, Freeman A, Bliwise DL, McDonald WM, Goldstein FC. Affective Correlates of Psychosis in Parkinson's Disease. Mov Disord Clin Pract 2016; 4:225-230. [PMID: 28944257 DOI: 10.1002/mdc3.12381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To examine the nature of the association between affective disorders and psychosis in Parkinson's disease (PD). BACKGROUND In PD, psychosis and affective disorders are common and independently impact quality of life and mortality. Both depression and psychosis are correlated with the occurrence of cognitive dysfunction, suggesting that they may share neurobiological substrates. Anxiety has not been examined as a correlate of psychosis. METHODS 144 PD subjects were evaluated with the Schedule for Assessment of Positive Symptoms to assess psychotic features, while depression and anxiety were examined by the Structured Clinical Interview for DSM-IV-TR (SCID) and self-assessment scales Beck Depression Inventory II (BDI-II) and Beck Anxiety Inventory (BAI). Correlational analyses assessed associations between hallucinations and delusions with depression and anxiety. RESULTS A diagnosis of anxiety (SCID) was significantly (p=.015) associated with hallucinations (OR=4.81, CI=1.36-16.99). Severity of anxiety (BAI) significantly predicted (p=.03) the presence of hallucinations (OR=1.08, CI=1.01-1.15) and delusions (OR=1.09, CR=1.01-1.17). Current depression (SCID) was significantly (p=.001) associated with the presence of hallucinations (OR=6.12, CI=2.04-18.39) and delusions (OR=7.14, CI=2.23-22.93). Multiple linear regressions revealed that severity of anxiety remained an independent predictor (p<.05) of both the number of types of hallucinations (t=3.06, p=.003) and delusions (t=2.87, p=.005). Severity of depression was a significant predictor of the total number of delusions (t=2.28, p=.024). CONCLUSIONS This study demonstrates an association between depression and psychosis and, for the first time, an association between anxiety and psychosis. These associations may have implications on pathophysiology and treatment of psychosis in PD.
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Affiliation(s)
| | | | - Alan Freeman
- Emory University School of Medicine: Department of Neurology
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18
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Association of depressive symptoms with circadian blood pressure alterations in Parkinson’s disease. J Neurol 2015; 262:2564-71. [DOI: 10.1007/s00415-015-7887-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/17/2015] [Accepted: 08/19/2015] [Indexed: 12/22/2022]
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Lee M, Ryu YH, Cho WG, Kang YW, Lee SJ, Jeon TJ, Lyoo CH, Kim CH, Kim DG, Lee K, Choi TH, Choi JY. Relationship between dopamine deficit and the expression of depressive behavior resulted from alteration of serotonin system. Synapse 2015; 69:453-60. [DOI: 10.1002/syn.21834] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 05/07/2015] [Accepted: 06/03/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Minkyung Lee
- Department of Nuclear Medicine; Yonsei University College of Medicine, Gangnam Severance Hospital; Seoul Korea
| | - Young Hoon Ryu
- Department of Nuclear Medicine; Yonsei University College of Medicine, Gangnam Severance Hospital; Seoul Korea
| | - Won Gil Cho
- Department of Anatomy; Yonsei University Wonju College of Medicine; Wonju Korea
| | - Yeo Wool Kang
- Department of Anatomy; Yonsei University Wonju College of Medicine; Wonju Korea
| | - Soo Jin Lee
- Department of Anatomy; Yonsei University Wonju College of Medicine; Wonju Korea
| | - Tae Joo Jeon
- Department of Nuclear Medicine; Yonsei University College of Medicine, Gangnam Severance Hospital; Seoul Korea
| | - Chul Hyoung Lyoo
- Department of Neurology; Yonsei University College of Medicine, Gangnam Severance Hospital; Seoul Korea
| | - Chul Hoon Kim
- Department of Pharmacology; Yonsei University College of Medicine; Seoul, Korea
- Brain Korea 21 plus Project for Medical Science; Yonsei University College of Medicine; Seoul Korea
| | - Dong Goo Kim
- Department of Pharmacology; Yonsei University College of Medicine; Seoul, Korea
- Brain Korea 21 plus Project for Medical Science; Yonsei University College of Medicine; Seoul Korea
| | - Kyochul Lee
- Department of Molecular Imaging; Korea Institute of Radiological and Medical Sciences; Seoul 139-706 Korea
| | - Tae Hyun Choi
- Department of Molecular Imaging; Korea Institute of Radiological and Medical Sciences; Seoul 139-706 Korea
| | - Jae Yong Choi
- Department of Nuclear Medicine; Yonsei University College of Medicine, Gangnam Severance Hospital; Seoul Korea
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Bega D, Luo S, Fernandez H, Chou K, Aminoff M, Parashos S, Walker H, Russell DS, Christine CW, Dhall R, Singer C, Bodis-Wollner I, Hamill R, Truong D, Mari Z, Glazmann S, Huang M, Houston E, Simuni T. Impact of Depression on Progression of Impairment and Disability in Early Parkinson's Disease. Mov Disord Clin Pract 2015; 2:371-378. [PMID: 28393083 DOI: 10.1002/mdc3.12205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Depression is one of the most common nonmotor symptoms associated with Parkinson's disease (PD), yet the impact of depression on progression of disease is unclear. OBJECTIVE The aim of this study was to prospectively characterize the relationship between depressive symptoms and measures of disease progression in a large sample of patients with early, medically treated PD. METHODS Baseline and longitudinal Beck Depression Inventory (BDI) scores from participants in the NINDS Exploratory Trials in PD Long Term Study 1 were correlated with changes in multiple measures of disease severity over 5 years. Multivariate analysis of predictors of change in BDI was performed. RESULTS Of 1,741 participants, 746 completed 5-year assessments and were included. Mean age was 62.00 years (standard deviation [SD]: 9.22) and mean disease duration was 1.69 years (SD, 1.16). Mean BDI score was 6.24 (SD, 5.02) at baseline and 8.57 (SD, 6.60) at 5 years. Baseline BDI score was strongly associated with rate of change in all examined measures of disease severity. In multivariate analysis, BDI 5-year change was associated with change in UPDRS Part I (excluding depression item; P < 0.01), 33-item Parkinson's Disease Questionnaire (P < 0.01), EuroQOL Five Dimensional Questionnaire (P = 0.02), and Total Functional Capacity (P < 0.01), but was not associated with motor or cognitive measures. This model explained 68.8% of the variance 5-year change of the BDI score. CONCLUSIONS Worse baseline BDI scores are associated with a decline in multiple measures of disease severity in PD. Worsening of BDI at 5 years was associated with worsening in UPDRS Part I and quality-of-life measures, but not with motor or cognitive measures.
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Affiliation(s)
- Danny Bega
- Northwestern University, Chicago, Illinois, USA
| | - Sheng Luo
- University of Texas Health Science Center, Houston, Texas, USA
| | | | - Kelvin Chou
- University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Aminoff
- University of California San Francisco, San Francisco, California, USA
| | | | - Harrison Walker
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David S Russell
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | | | - Rohit Dhall
- Muhammad Ali Parkinson Center, Phoenix, Arizona, USA
| | | | | | | | - Daniel Truong
- Parkinson and Movement Disorders Institute, Fountain Valley, California, USA
| | - Zoltan Mari
- Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Meilin Huang
- University of Texas Health Science Center, Houston, Texas, USA
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The Natural History of Depression in Parkinson's Disease within 30-Month Follow-Up. PARKINSONS DISEASE 2015; 2015:362892. [PMID: 25722914 PMCID: PMC4333563 DOI: 10.1155/2015/362892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 01/16/2015] [Accepted: 01/16/2015] [Indexed: 11/18/2022]
Abstract
Depression is one of the most common and persistent nonmotor syndromes occurring in 35% of patients diagnosed with PD. However, little information is known about the longitudinal study of its natural history of depression in PD. In this study, we identified 110 patients who are diagnosed with idiopathic PD and recruited them for assessing information about their PD related motor and nonmotor symptoms and rating scales. A follow-up evaluation was performed in 103 patients 30 months later. About 66.7% depressed patients at baseline were still depressed at follow-up, and 24.4% had incident depression among subjects without depression at baseline. Greater decline on MMSE (P = 0.029), higher baseline UPDRS-II (P < 0.001) score, change of UPDRS-II (P = 0.026), and female (P < 0.001) were associated with the worsening of HDRS scores. Higher baseline HDRS score (P < 0.001) and greater decline on MMSE (P = 0.001) were related to the occurrence of depression. In conclusion, cognitive decline is a disease related factor of worsening and the occurrence of depression. Activities of Daily Living (ADL) symptoms in PD and female gender may be crucial factors of increasing depressive symptoms.
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Abstract
Depressive disturbances are common in patients with Parkinson's disease (PD) and influence many other clinical aspects of the disease. In addition to causing inherent emotional distress, depressive disorders negatively impact quality of life, motor and cognitive deficits, functional disability, and other psychiatric comorbidities in patients with PD. Knowledge of the pathophysiology of PD depression remains limited. However, clinical studies demonstrate the efficacy of medications and psychotherapies for PD depression, underscoring the importance of their timely detection and concerted management.
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Abstract
OPINION STATEMENT Anxiety and depression, while very common problems in Parkinson's disease (PD), have not been subject to adequate treatment trials. While a handful of double blind placebo-controlled trials of depression have been published, only a small number of subjects have been enrolled in most of these. There have been no adequate treatment trials of anxiety. Thus, most practitioners base their treatments on what has been published in the general population and their own personal experience. The data suggest that depression is probably treatable in some cases, but there are no data to support any drug treatment of anxiety. Much of the rationale for treating these disorders is based primarily on side effect profiles rather than efficacy and is almost entirely based on anecdotal experience. Although we lack convincing data, we do believe in the pharmacologic treatment of depression and anxiety and choose medications based on side effect profiles, some of which may be useful. We favor the selective serotonin reuptake inhibitors (SSRIs) in general for both depression and anxiety because of their relative freedom from side effects but will often choose mirtazapine if insomnia or weight loss is a problem, clonazepam for anxiety without depression if an SSRI is insufficient or if REM sleep behavior disorder is a problem, or a tricyclic antidepressant if drooling is troubling and the patient is not demented. Alternatively, we use the serotonin and noradrenaline reuptake inhibitor venlafaxine in those who do not tolerate an SSRI. SSRIs cannot be used for anxiety on an as needed basis, whereas short-acting benzodiazepines may be useful for this purpose. Psychosocial treatments of both depression and anxiety have also been under-studied, with probable benefits and a benign adverse effect profile.
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Affiliation(s)
- Atbin Djamshidian
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, 1 Wakefield Street, WC1N1PJ, London, UK,
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Watson GS, Cholerton BA, Gross RG, Weintraub D, Zabetian CP, Trojanowski JQ, Montine TJ, Siderowf A, Leverenz JB. Neuropsychologic assessment in collaborative Parkinson's disease research: a proposal from the National Institute of Neurological Disorders and Stroke Morris K. Udall Centers of Excellence for Parkinson's Disease Research at the University of Pennsylvania and the University of Washington. Alzheimers Dement 2013; 9:609-14. [PMID: 23164549 PMCID: PMC3612566 DOI: 10.1016/j.jalz.2012.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 07/24/2012] [Accepted: 07/24/2012] [Indexed: 11/23/2022]
Abstract
Cognitive impairment (CI) and behavioral disturbances can be the earliest symptoms of Parkinson's disease (PD), ultimately afflict the vast majority of PD patients, and increase caregiver burden. Our two Morris K. Udall Centers of Excellence for Parkinson's Disease Research were supported by the National Institute of Neurological Disorders and Stroke (NINDS) in an effort to recommend a comprehensive yet practical approach to cognitive and behavioral assessment to further collaborative research. We recommend a stepwise approach with two levels of standardized evaluation to establish a common battery, as well as an alternative testing recommendation for severely impaired subjects, and review supplemental tests that may be useful in specific research settings. Our flexible approach may be applied to studies with varying emphasis on cognition and behavior, does not place undue burden on participants or resources, and has a high degree of compatibility with existing test batteries to promote collaboration.
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Affiliation(s)
- G. Stennis Watson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Brenna A. Cholerton
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Rachel G. Gross
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Daniel Weintraub
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Cyrus P. Zabetian
- Geriatric, Veterans Affairs-Puget Sound Health Care System, Seattle WA
- Parkinson’s Disease Research, Education and Clinical Centers, Veterans Affairs-Puget Sound Health Care System, Seattle WA
- Department of Neurology, University of Washington, Seattle, WA
| | - John Q. Trojanowski
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
- Institute on Aging, University of Pennsylvania, Philadelphia, PA
- Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, PA
| | | | - Andrew Siderowf
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - James B. Leverenz
- Mental Illness, Veterans Affairs-Puget Sound Health Care System, Seattle WA
- Parkinson’s Disease Research, Education and Clinical Centers, Veterans Affairs-Puget Sound Health Care System, Seattle WA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- Department of Neurology, University of Washington, Seattle, WA
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Even C, Weintraub D. Is depression in Parkinson's disease (PD) a specific entity? J Affect Disord 2012; 139:103-12. [PMID: 21794923 DOI: 10.1016/j.jad.2011.07.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 07/04/2011] [Accepted: 07/04/2011] [Indexed: 12/29/2022]
Abstract
BACKGROUND Clinical lore and research have suggested for a long time that depression and PD are closely related. We examined the validity of depression associated with PD (dPD) as a specific subtype of depression according to face validity, descriptive validity, construct validity and predictive validity. METHODS The English literature was reviewed after searching the MEDLINE database up to June 2010. RESULTS There appears to be three possible subtypes of comorbid depression: 1) patients who would have been depressed even if they had no PD (nonspecific-casual comorbid dPD), 2) patients who would have been depressed if they had had another disabling medical illness (nonspecific-reactive comorbid dPD) 3) those for which depression is directly related to the underlying pathophysiology of PD (specific comorbid dPD). These latter patients may more often present with particular clinical characteristics (descriptive validity): absence of history of depression or only within 5 years prior to onset of PD, absence of guilty thoughts and self-blame, absence of suicidal behavior, right-sided onset. However, dPD is only partly responsive to dopamine replacement and cannot be solely explained by dopamine deficiency. Other neurotransmitter systems are affected in PD and are involved in the pathophysiology of dPD. Their relative involvement however may differ from that in idiopathic depression (i.e.: lesser involvement of serotonergic systems). LIMITATIONS Therapeutic data are limited to few controlled trials. CONCLUSIONS Further research may allow differential diagnosis between dPD subtypes (i.e.: those who do and do not result from the underlying pathophysiological process of PD) and help inform treatment choice.
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Affiliation(s)
- Christian Even
- Clinique des Maladies Mentales et de l'Encéphale, Centre Hospitalier Sainte-Anne, Paris, France.
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Haas BR, Stewart TH, Zhang J. Premotor biomarkers for Parkinson's disease - a promising direction of research. Transl Neurodegener 2012; 1:11. [PMID: 23211054 PMCID: PMC3514104 DOI: 10.1186/2047-9158-1-11] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 05/31/2012] [Indexed: 12/25/2022] Open
Abstract
The second most serious neurodegenerative disease is Parkinson’s disease (PD). Over the past several decades, a strong body of evidence suggests that PD can begin years before the hallmark clinical motor symptoms appear. Biomarkers for PD are urgently needed to differentiate between neurodegenerative disorders, screen novel therapeutics, and predict eventual clinical PD before the onset of symptoms. Some clinical evaluations and neuroimaging techniques have been developed in the last several years with some success in this area. Moreover, other strategies have been utilized to identify biochemical and genetic markers associated with PD leading to the examination of PD progression and pathogenesis in cerebrospinal fluid, blood, or saliva. Finally, interesting results are surfacing from preliminary studies using known PD-associated genetic mutations to assess potential premotor PD biomarkers. The current review highlights recent advances and underscores areas of potential advancement.
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Affiliation(s)
- Brian R Haas
- Department of Pathology, University of Washington School of Medicine, HMC Box 359635, 325 9th Avenue, Seattle, WA, 98104, USA.
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Jones CA, Wieler M, Carvajal J, Lawrence L, Haennel R. Physical activity in persons with Parkinson disease: A feasibility study. Health (London) 2012. [DOI: 10.4236/health.2012.431173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zahodne LB, Marsiske M, Okun MS, Rodriguez RL, Malaty I, Bowers D. Mood and motor trajectories in Parkinson's disease: multivariate latent growth curve modeling. Neuropsychology 2012; 26:71-80. [PMID: 22142359 PMCID: PMC3296901 DOI: 10.1037/a0025119] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Apathy is a common feature of Parkinson's disease (PD) that can manifest independently of depression, but little is known about its natural progression in medically managed patients. The present study sought to characterize and compare trajectories of apathy, depression, and motor symptoms in PD over 18 months. METHOD Data from a sample of 186 PD patients (mean disease duration of 8.2 years) followed by the University of Florida Movement Disorders Center were obtained from a clinical research database. Scores on the Unified Parkinson's disease Rating Scale (motor portion), Apathy Scale, and Beck Depression Inventory at three time-points (baseline, 6 months, 18 months) were analyzed in a structural equation modeling framework. RESULTS A multivariate growth model controlling for age, sex, education, and disease duration identified linear worsening of both apathy (slope estimate = 0.73; p < .001) and motor symptoms (slope estimate = 1.51; p < .001), and quadratic changes in depression (slope estimate = 1.18; p = .07). All symptoms were positively correlated. Higher education was associated with lower apathy, depression, and motor severity. Advanced age was associated with greater motor and apathy severity. Female sex and longer disease duration were associated with attenuated motor worsening. Antidepressant use was associated only with depression scores. CONCLUSIONS These longitudinal results support the differentiation of apathy and depression in PD. Like motor progression, apathy progression may be linked at least partially to dopaminergic neurodegeneration. Empirically supported treatments for apathy in PD are needed.
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Affiliation(s)
- Laura B Zahodne
- Department of Clinical and Health Psychology, University of Florida, P. O. Box 100165, Gainesville, FL 32610-0165, USA.
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Abstract
Depression occurs in around 35% of patients with Parkinson disease (PD) and is often persistent. Symptoms of depression can be evident in individuals at the time of diagnosis and might develop in the premotor stage of the disease. The underlying mechanisms of depression in PD are not known in detail, but changes in brain structure, signaling by neurotransmitters, and levels of inflammatory and neurotrophic factors are all suggested to contribute to its development. Psychosocial factors and pain could also have roles in depression. Changes in dopaminergic, noradrenergic and serotonergic systems in patients with PD might help to explain the incidence of depression in these individuals. Antidepressants that have dual serotonergic and noradrenergic effects are the drugs of choice for treating depression in PD. However, antiparkinsonian drugs might have beneficial effects not only on the motor symptoms of disease, but also on a patient's mood. Deep brain stimulation can worsen depression in some patients, but a preliminary study has suggested that transcranial magnetic stimulation could improve symptoms of depression. This Review describes the frequency and course of depression in patients with PD. The mechanisms that underlie depression in this disease are also discussed, and the management strategies for these patients are highlighted.
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Srinivasan V, Cardinali DP, Srinivasan US, Kaur C, Brown GM, Spence DW, Hardeland R, Pandi-Perumal SR. Therapeutic potential of melatonin and its analogs in Parkinson's disease: focus on sleep and neuroprotection. Ther Adv Neurol Disord 2011; 4:297-317. [PMID: 22010042 DOI: 10.1177/1756285611406166] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Sleep disorders constitute major nonmotor features of Parkinson's disease (PD) that have a substantial effect on patients' quality of life and can be related to the progression of the neurodegenerative disease. They can also serve as preclinical markers for PD, as it is the case for rapid eye movement (REM)-associated sleep behavior disorder (RBD). Although the etiology of sleep disorders in PD remains undefined, the assessment of the components of the circadian system, including melatonin secretion, could give therapeutically valuable insight on their pathophysiopathology. Melatonin is a regulator of the sleep/wake cycle and also acts as an effective antioxidant and mitochondrial function protector. A reduction in the expression of melatonin MT(1) and MT(2) receptors has been documented in the substantia nigra of PD patients. The efficacy of melatonin for preventing neuronal cell death and for ameliorating PD symptoms has been demonstrated in animal models of PD employing neurotoxins. A small number of controlled trials indicate that melatonin is useful in treating disturbed sleep in PD, in particular RBD. Whether melatonin and the recently developed melatonergic agents (ramelteon, tasimelteon, agomelatine) have therapeutic potential in PD is also discussed.
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Affiliation(s)
- Venkatramanujam Srinivasan
- Sri Sathya Sai Medical Educational and Research Foundation, Prasanthi Nilayam, Plot-40, Kovai Thirunagar, Coimbatore 641014, India
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Becker C, Brobert GP, Johansson S, Jick SS, Meier CR. Risk of incident depression in patients with Parkinson disease in the UK. Eur J Neurol 2010; 18:448-53. [PMID: 20722714 DOI: 10.1111/j.1468-1331.2010.03176.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Non-motor symptoms are not widely recognized in patients with Parkinson disease (PD). We sought to assess the incidence rate as well as the risk of depression in newly diagnosed patients with PD and to compare it to PD-free controls. METHODS We conducted a population-based follow-up study with a nested case-control analysis based on data from the UK-based General Practice Research Database (GPRD). We included PD patients ≥ aged 40 years with a first PD diagnosis between 1994 and 2005, and a matched comparison group free of PD. We assessed incidence rates (IRs) and relative risk estimates (odds ratios [ORs] with 95% confidence intervals [CI]). RESULTS The IR of depression in newly diagnosed PD in the UK community was 26.0 (95% CI 22.9-29.5) per 1000 person-years. The risk of developing depression was increased almost twofold in patients with PD when compared to patients without PD (adj. OR 1.89; 95% CI 1.49-2.40). The increased relative risk was most pronounced in women and in individuals 40-69 years of age. Long-term users of levodopa had an increased depression risk when compared to short-term users. CONCLUSIONS Patients with PD are at an approximately twofold increased risk of being diagnosed with depression compared to the PD-free population.
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Affiliation(s)
- C Becker
- Basel Pharmacoepidemiology Unit, Hospital Pharmacy, University Hospital, Basel, Switzerland
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