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Usnich T, Hauptmann B, Hanssen H, Prasuhn J, Balck A, Borsche M, Tadic V, Klee A, Noblejas-Sanchez G, Vollstedt EJ, Klein C, Brüggemann N, Kasten M. Depressive symptoms in Parkinson's disease are insufficiently but more often treated than in other chronic conditions. NPJ Parkinsons Dis 2023; 9:113. [PMID: 37452071 PMCID: PMC10349053 DOI: 10.1038/s41531-023-00551-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
Depressive symptoms in Parkinson's disease (PD) are multifactorial and are partly linked to the underlying dopaminergic deficit. However, at least a subset of PD patients may exhibit an unspecific depressive reaction to chronic illness. Here, we compared the prevalence and severity of depressive symptoms in PD patients and disease controls (DC). PD patients reported depressive symptoms at similar frequencies as DC but were on antidepressants, especially Mirtazapine, more frequently. Still, in both groups, a high proportion of patients with clinically significant depressive symptoms was not receiving medication. Diagnosis and treatment of depressive symptoms both in PD and DC should be improved.
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Affiliation(s)
- Tatiana Usnich
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Björn Hauptmann
- Neurologisches Zentrum, Segeberger Kliniken Gruppe, Bad Segeberg, Schleswig-Holstein, Germany
| | - Henrike Hanssen
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Jannik Prasuhn
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Alexander Balck
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Max Borsche
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Vera Tadic
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Annika Klee
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | | | | | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Norbert Brüggemann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Meike Kasten
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany.
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Zhang T, Yang R, Pan J, Huang S. Parkinson's Disease Related Depression and Anxiety: A 22-Year Bibliometric Analysis (2000-2022). Neuropsychiatr Dis Treat 2023; 19:1477-1489. [PMID: 37404573 PMCID: PMC10317541 DOI: 10.2147/ndt.s403002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/14/2023] [Indexed: 07/06/2023] Open
Abstract
Background Parkinson's disease (PD) is one of the common neurodegenerative diseases. Depression and anxiety are the most common psychiatric symptoms of PD. It is important to study the potential relationship between PD and depression or anxiety. Aim This study aimed to use bibliometrics to analyze the papers about parkinson's disease related depression and anxiety over the last 22 years, and to characterize the current status of research and predict future hotspots. Methods In the Web of Science Core Collection (WoSCC) from 2000 to 2022, documents are searched according to specific subject words. The selected literature was retrospectively analyzed and mapped using CiteSpace and Vosviewer software. We analyzed countries, institutions, journals, authors, references and keywords. Results A total of 7368 papers were included from 2000 to 2022, and the number of publications has shown an upward trend year by year. Movement Disorder is the journal with the highest number of publications (391 publications, 5.31%) and citations (30,549 times), with the United States (2055 publications, 27.9%) and the University of Toronto (158 publications) being the countries and institutions with the highest number of publications. The high-frequency keywords focused on "quality of life", "deep brain stimulation" and "non-motor symptoms". "Functional connectivity", "gut microbiota" and "inflammation" may be at the forefront of future research. Conclusion Parkinson's disease related depression and anxiety have been increasingly studied over the past 22 years. Functional connectivity, gut microbiota, and inflammation will be the subject of active research hotspots in the future, and these findings may provide new research ideas for researchers.
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Affiliation(s)
- Tong Zhang
- Research and Development Center of Traditional Chinese Medicine, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Rui Yang
- Research and Development Center of Traditional Chinese Medicine, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Juhua Pan
- Research and Development Center of Traditional Chinese Medicine, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Shijing Huang
- Research and Development Center of Traditional Chinese Medicine, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
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Rinaldi C, Landre CB, Volpe MI, Gonçalves RG, Nunes LDS, Darienso D, Cruz AV, Oliveira JD, Rinaldi S, Fontani V, Barcessat AR. Improving Functional Capacity and Quality of Life in Parkinson's Disease Patients through REAC Neuromodulation Treatments for Mood and Behavioral Disorders. J Pers Med 2023; 13:937. [PMID: 37373926 DOI: 10.3390/jpm13060937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Parkinson's disease is a neurological disorder that affects both motor and non-motor functions, including depression, anxiety, and cognitive decline. Currently, it remains a challenge to distinguish the correlation between these aspects and their impact on one another. To try to clarify these reciprocal influences, in this study we have used specific radio electric asymmetric conveyer (REAC) technology neuromodulation treatments for behavioral mood disorders and adjustment disorders. In particular, we employed the neuro-postural optimization (NPO) and neuro-psycho-physical optimization (NPPOs) treatments. The study enrolled randomly 50 subjects of both genders previously diagnosed with Parkinson's disease for at least six months. Prior to and following REAC NPO and NPPOs treatments, we assessed the subjects using functional dysmetria (FD) evaluation, five times sit to stand test (FTSST) for postural stability, and the 12-item Short-Form Health Survey (SF-12) for quality of life (QLF) evaluation. The positive results produced by the REAC NPO and NPPOs neuromodulation treatments, specific for mood and adaptation disorders, on dysfunctional motor disorders, and quality of life confirm how the non-motor components can condition the symptomatology of Parkinsonian motor symptoms. These results also highlight the usefulness of REAC NPO and NPPOs treatments in improving the overall quality of life of these patients.
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Affiliation(s)
- Chiara Rinaldi
- Department of Neuroscience, Psychology, Drug Area, and Child Health (NEUROFARBA), University of Florence, 50121 Florence, Italy
- Department of Regenerative Medicine, Rinaldi Fontani Institute, 50144 Florence, Italy
- Department of Adaptive Neuro Psycho Physio Pathology and Neuro Psycho Physical Optimization, Rinaldi Fontani Institute, 50144 Florence, Italy
| | - Cleuton Braga Landre
- Department of Biological and Health Sciences, Federal University of Amapá-UNIFAP, Macapá 68903-419, Brazil
| | - Maria Izabel Volpe
- Department of Biological and Health Sciences, Federal University of Amapá-UNIFAP, Macapá 68903-419, Brazil
- Graduate Program in Health Sciences-PPGCS, Federal University of Amapá-UNIFAP, Macapá 68903-419, Brazil
| | - Rebeca Góes Gonçalves
- Department of Biological and Health Sciences, Federal University of Amapá-UNIFAP, Macapá 68903-419, Brazil
- Graduate Program in Health Sciences-PPGCS, Federal University of Amapá-UNIFAP, Macapá 68903-419, Brazil
| | - Lucas Dos Santos Nunes
- Department of Biological and Health Sciences, Federal University of Amapá-UNIFAP, Macapá 68903-419, Brazil
- Graduate Program in Health Sciences-PPGCS, Federal University of Amapá-UNIFAP, Macapá 68903-419, Brazil
| | - Danyela Darienso
- Department of Biological and Health Sciences, Federal University of Amapá-UNIFAP, Macapá 68903-419, Brazil
- Graduate Program in Health Sciences-PPGCS, Federal University of Amapá-UNIFAP, Macapá 68903-419, Brazil
| | - Ana Vitoria Cruz
- Department of Biological and Health Sciences, Federal University of Amapá-UNIFAP, Macapá 68903-419, Brazil
- Graduate Program in Health Sciences-PPGCS, Federal University of Amapá-UNIFAP, Macapá 68903-419, Brazil
| | - João Douglas Oliveira
- Department of Biological and Health Sciences, Federal University of Amapá-UNIFAP, Macapá 68903-419, Brazil
| | - Salvatore Rinaldi
- Department of Regenerative Medicine, Rinaldi Fontani Institute, 50144 Florence, Italy
- Department of Adaptive Neuro Psycho Physio Pathology and Neuro Psycho Physical Optimization, Rinaldi Fontani Institute, 50144 Florence, Italy
| | - Vania Fontani
- Department of Regenerative Medicine, Rinaldi Fontani Institute, 50144 Florence, Italy
- Department of Adaptive Neuro Psycho Physio Pathology and Neuro Psycho Physical Optimization, Rinaldi Fontani Institute, 50144 Florence, Italy
| | - Ana Rita Barcessat
- Graduate Program in Health Sciences-PPGCS, Federal University of Amapá-UNIFAP, Macapá 68903-419, Brazil
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
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Artigas NR, Dutra ACL, Soares NM, Pereira GM, Leotti VB, Krimberg JS, Pagnussat ADS, Rieder CRDM. Depressive symptoms and axial motor disorders in individuals with Parkinson's disease: a cross-sectional study. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:1126-1133. [PMID: 36577411 PMCID: PMC9797277 DOI: 10.1055/s-0042-1758444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Depression is an important nonmotor symptom of Parkinson's disease (PD) and has been associated with the motor symptoms in these individuals. OBJECTIVES To determine whether there are relationships between depressive symptoms and abnormalities in axial postural alignment and axial motor deficits, especially postural instability, and trunk rigidity in PD. METHODS In this cross-sectional study, 65 individuals were evaluated using the Beck Depression Inventory-II (BDI-II) for the analysis of depressive symptoms and underwent a postural assessment of head, trunk, and hip sagittal alignment through computerized photogrammetry. The MDS-UPDRS was used to assess clinical aspects of PD, the Trunk Mobility Scale was used to assess axial rigidity, and the MiniBESTest to assess balance. To determine the relationship between depressive symptoms and postural alignment, multiple linear regression analysis was performed. RESULTS The participants with depressive symptoms had more severe motor deficits as well as greater trunk rigidity and worse postural instability (p < 0.05). When the postural angles were compared between men and women using Student's t-test, it was found that men had greater flexion angles of the head (p = 0.003) and trunk (p = 0.017). Using multiple linear regression analysis corrected for the age and sex of the participants, we verified that the anterior trunk inclination was significantly larger in the PD population with depressive symptoms (R2 = 0.453, β = 0.116, and p = 0.045). CONCLUSION PD individuals with depressive symptoms have more severe flexed trunk posture, mainly in older men. Additionally, more severe depressive symptoms are associated with worsening postural instability, trunk rigidity and motor deficits in this population.
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Affiliation(s)
- Nathalie Ribeiro Artigas
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre RS, Brazil.,Address for correspondence Nathalie Ribeiro Artigas
| | - Ana Carolina Leonardi Dutra
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre RS, Brazil.
| | - Nayron Medeiros Soares
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre RS, Brazil.
| | - Gabriela Magalhães Pereira
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre RS, Brazil.
| | - Vanessa Bielefeldt Leotti
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Epidemiologia, Departamento de Estatística, Porto Alegre RS, Brazil.
| | - Julia Schneider Krimberg
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre RS, Brazil.,Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências da Vida e da Saúde, Porto Alegre RS, Brazil.
| | - Aline de Souza Pagnussat
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre RS, Brazil.
| | - Carlos Roberto de Mello Rieder
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre RS, Brazil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Clínica Médica, Divisão de Neurologia, Porto Alegre RS, Brazil.
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Ragimova AA, Petelin DS, Avseytseva TY, Samushia MA, Ivolgin AF. Mental disorders in cervical dystonia – clinical heterogeneity, impact on disease severity and quality of life. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2022. [DOI: 10.14412/2074-2711-2022-6-20-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- A. A. Ragimova
- National Research University “Higher School of Economics”
| | - D. S. Petelin
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - T. Y. Avseytseva
- National Medical Research Center for High Medical Technologies – A.A. Vishnevsky Central Military Clinical Hospital, Ministry of Defense of Russia
| | - M. A. Samushia
- Central State Medical Academy, Office of the President of Russia
| | - A. F. Ivolgin
- National Medical Research Center for High Medical Technologies – A.A. Vishnevsky Central Military Clinical Hospital, Ministry of Defense of Russia
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6
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Perceived social support declines after deep brain stimulation surgery in patients with Parkinson's disease. J Neural Transm (Vienna) 2022; 129:1463-1468. [PMID: 36307657 DOI: 10.1007/s00702-022-02558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/20/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The Social Provisions Scale (SPS) measures a person's perceived social support. We evaluated the perceived social support in Parkinson's disease (PD) patients before and after subthalamic nucleus (STN) deep brain stimulation (DBS) and its impact on clinical outcomes following DBS. METHODS We analyzed 55 PD patients who underwent STN DBS surgery and completed the SPS, PDQ-39, and MDS-UPDRS Parts I-IV before and 6-12 months after surgery. Some patients also completed global cognitive, mood and apathy scales. Caregivers completed the CBI at each visit. Linear regression models and linear mixed models evaluated the association between the SPS baseline score, MDS-UPDRS and PDQ-39 scores, the association between MDS-UPDRS, CBI and the SPS follow-up score, and the association between SPS, global cognition and other psychological variables. RESULTS DBS implantation improved MDS-UPDRS I-IV and PDQ-39 scores. Perceived social support declined after DBS (baseline SPS total 82.55 ± 7.52 vs. follow-up SPS total 78.83 ± 9.02, p = 0.0001). Baseline SPS total score was not significantly associated with the MDS-UPDRS or PDQ-39 scores at follow-up. MDS-UPDRS scores and the CBI at follow-up had no significant association with SPS total score at follow-up. Measures of global cognition, mood and apathy were associated with the SPS before and after DBS, and the association was independent of STN DBS. CONCLUSION After STN DBS, PD patients experienced a decrease in perceived social support, but baseline perceived social support did not impact clinical outcomes. It is important to further identify factors that may contribute to this perception of worsened social support.
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Jellinger KA. The pathobiological basis of depression in Parkinson disease: challenges and outlooks. J Neural Transm (Vienna) 2022; 129:1397-1418. [PMID: 36322206 PMCID: PMC9628588 DOI: 10.1007/s00702-022-02559-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
Depression, with an estimated prevalence of about 40% is a most common neuropsychiatric disorder in Parkinson disease (PD), with a negative impact on quality of life, cognitive impairment and functional disability, yet the underlying neurobiology is poorly understood. Depression in PD (DPD), one of its most common non-motor symptoms, can precede the onset of motor symptoms but can occur at any stage of the disease. Although its diagnosis is based on standard criteria, due to overlap with other symptoms related to PD or to side effects of treatment, depression is frequently underdiagnosed and undertreated. DPD has been related to a variety of pathogenic mechanisms associated with the underlying neurodegenerative process, in particular dysfunction of neurotransmitter systems (dopaminergic, serotonergic and noradrenergic), as well as to disturbances of cortico-limbic, striato-thalamic-prefrontal, mediotemporal-limbic networks, with disruption in the topological organization of functional mood-related, motor and other essential brain network connections due to alterations in the blood-oxygen-level-dependent (BOLD) fluctuations in multiple brain areas. Other hypothetic mechanisms involve neuroinflammation, neuroimmune dysregulation, stress hormones, neurotrophic, toxic or metabolic factors. The pathophysiology and pathogenesis of DPD are multifactorial and complex, and its interactions with genetic factors, age-related changes, cognitive disposition and other co-morbidities awaits further elucidation.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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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: 41] [Impact Index Per Article: 20.5] [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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Plasma neurofilament light chain levels are associated with depressive and anxiety symptoms in Parkinson's disease. Neurol Sci 2022; 43:2839-2843. [PMID: 35088243 DOI: 10.1007/s10072-022-05914-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
The present study aimed to explore the association of plasma neurofilament light chain (NfL) levels with depression and anxiety in Parkinson's disease (PD). This prospective study enrolled 116 patients with PD and 38 healthy controls, and found plasma NfL levels were higher in patients with depression or anxiety than in those without these symptoms. Binary logistic regression identified NfL concentration as an independent predictor of depression and anxiety in PD. In conclusion, elevated plasma NfL may be associated with severity of depression and anxiety in PD patients and may serve as a diagnostic biomarker of PD with moderate to severe depression or anxiety.
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10
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Janssen-Aguilar R, Rojas P, Ruiz-Sánchez E, Rodriguez-Violante M, Alcántara-Flores YM, Crail-Meléndez D, Cervantes-Arriaga A, Sánchez-Escandón Ó, Ruiz-Chow ÁA. Naturalistic Study of Depression Associated with Parkinson's Disease in a National Public Neurological Referral Center in Mexico. Brain Sci 2022; 12:326. [PMID: 35326281 PMCID: PMC8945969 DOI: 10.3390/brainsci12030326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023] Open
Abstract
Major depressive disorder (MDD) is a major health problem in Parkinson's disease (PD) patients. We described the clinical and sociodemographic factors of MDD among patients with PD at a national neurological referral center in Mexico. One hundred patients with PD + MDD were included in the study. All the patients were evaluated during the "ON" treatment phase of PD. Clinical scales for cognition (MMSE and MoCA) and MDD (MADRS) were applied. The mean age was 58.49 ± 11.02 years, and 57% of the sample was male. The most frequent symptom of PD was tremor (67%), and onset was more frequent on the right side (57%). Additionally, 49% of the patients with PD had moderate to severe (M/S) MDD. Selective serotonin reuptake inhibitors were the most frequent antidepressant treatment (69%). The scores of the scales were MADRS 21.33 ± 5.49, MoCA 21.06 ± 4.65, and MMSE 26.67 ± 1.20. The females had lower MMSE scores compared to the males (p = 0.043). The patients with M/S MDD had more rigidity at the beginning of PD (p = 0.005), fewer march alterations (p = 0.023), and a greater prevalence of left-side initial disease (p = 0.037). Rigidity was associated with M/S MDD (OR 3.75 p = 0.013). MDD was slightly more frequent in the males than in the females. The MDD symptoms and cognitive impairment were worse in the female population.
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Affiliation(s)
- Reinhard Janssen-Aguilar
- Department of Psychiatry, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Av. Insurgentes Sur No. 3877, Mexico City 14269, Mexico; (R.J.-A.); (D.C.-M.)
| | - Patricia Rojas
- Laboratory of Neurotoxicology, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Av. Insurgentes Sur No. 3877, Mexico City 14269, Mexico; (P.R.); (E.R.-S.); (Y.M.A.-F.)
| | - Elizabeth Ruiz-Sánchez
- Laboratory of Neurotoxicology, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Av. Insurgentes Sur No. 3877, Mexico City 14269, Mexico; (P.R.); (E.R.-S.); (Y.M.A.-F.)
| | - Mayela Rodriguez-Violante
- Movement Disorders Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Av. Insurgentes Sur No. 3877, Mexico City 14269, Mexico; (M.R.-V.); (A.C.-A.)
| | - Yessica M. Alcántara-Flores
- Laboratory of Neurotoxicology, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Av. Insurgentes Sur No. 3877, Mexico City 14269, Mexico; (P.R.); (E.R.-S.); (Y.M.A.-F.)
| | - Daniel Crail-Meléndez
- Department of Psychiatry, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Av. Insurgentes Sur No. 3877, Mexico City 14269, Mexico; (R.J.-A.); (D.C.-M.)
| | - Amin Cervantes-Arriaga
- Movement Disorders Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Av. Insurgentes Sur No. 3877, Mexico City 14269, Mexico; (M.R.-V.); (A.C.-A.)
| | - Óscar Sánchez-Escandón
- Clinic of Sleep Disorders, Metropolitan Autonomous University, Mexico City 14387, Mexico;
| | - Ángel A. Ruiz-Chow
- Department of Psychiatry, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Av. Insurgentes Sur No. 3877, Mexico City 14269, Mexico; (R.J.-A.); (D.C.-M.)
- Liaison Psychiatry, Medical Center ABC, Av. Carlos Graef Fernández 154, Mexico City 05300, Mexico
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Yao C, Niu L, Fu Y, Zhu X, Yang J, Zhao P, Sun X, Ma Y, Li S, Li J. Cognition, motor symptoms, and glycolipid metabolism in Parkinson's disease with depressive symptoms. J Neural Transm (Vienna) 2021; 129:563-573. [PMID: 34837534 DOI: 10.1007/s00702-021-02437-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/29/2021] [Indexed: 12/29/2022]
Abstract
Depressive symptoms and abnormal glycolipid metabolisms are common in patients with Parkinson's disease (PD), but their relationship has not been fully reported. It is not clear whether glycolipid impairments lead to poor cognitive and motor function, and aggravate depressive symptoms. Therefore, we aimed to explore the relationships between glycolipid variables, cognition, motor and depressive symptoms in PD patients cross-sectionally. Two hundred ten PD patients were recruited. Glycolipid parameters and Uric acid (UA) were measured. Depressive symptoms, cognitive function and motor symptoms were assessed using the Hamilton Depression Rating Scale-17 (HAMD-17), the Montreal Cognitive Assessment (MOCA) and the Movement Disorder Society Unified Parkinson's Disease Rating Scale Part-III (UPDRS-III). Depressive PD patients had significantly worse motor symptoms and higher levels of fasting plasma glucose (FPG) than those in non-depressive patients (F = 24.145, P < 0.001). Further, logistic regression analysis indicated that UPDRS-III (OR = 1.039, 95% CI 1.019-1.057, P = 0.044), FPG (OR = 1.447, 95% CI 1.050-1.994, P = 0.024) were independently associated with depression. In PD patients without depression, UA (β = - 0.068, t = - 2.913, P = 0.005) and cholesterol (CHOL) (β = - 3.941, t = - 2.518, P = 0.014) were independent predictors of the UPDRS-III score; in addition, UPDRS-III score was negatively associated with MOCA score (β = - 0.092, t = - 2.791, P = 0.007). FPG levels and motor symptoms were related to depressive symptoms in PD patients. Further, in non-depressive PD patients, UA and CHOL showed putative biomarkers of motor symptoms.
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Affiliation(s)
- Cong Yao
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, 300222, Tianjin, China
| | - Lichao Niu
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, 300222, Tianjin, China
| | - Yun Fu
- Department of Genetics, College of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China
| | - Xu Zhu
- Department of Genetics, College of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China.,Department of Psychiatry and Psychology, College of Basic Medical Sciences, Tianjin Medical University, 22 Qixiangtai Roads, Heping District, Tianjin, 300070, China
| | - Junfeng Yang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Peng Zhao
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xiaoxiao Sun
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, 300222, Tianjin, China
| | - Yanyan Ma
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, 300222, Tianjin, China
| | - Shen Li
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, 300222, Tianjin, China. .,Department of Psychiatry and Psychology, College of Basic Medical Sciences, Tianjin Medical University, 22 Qixiangtai Roads, Heping District, Tianjin, 300070, China.
| | - Jie Li
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, 300222, Tianjin, China.
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Gyrling T, Ljunggren M, Karlsson S. The impact of dance activities on the health of persons with Parkinson's disease in Sweden. Int J Qual Stud Health Well-being 2021; 16:1992842. [PMID: 34694957 PMCID: PMC8547839 DOI: 10.1080/17482631.2021.1992842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: Parkinson’s disease (PD) is associated with motor and non-motor symptoms that negatively influence the person’s quality of life. To reduce illness and increase quality of life, alternative treatments of PD such as dance might be experienced as beneficial. The aim of this study was to explore experiences of how a dance program in Sweden influences perceived physical, social, and emotional wellbeing in persons with PD. Method: A qualitative method with semi-structured interviews and content analysis was used, and 10 participants with variations in age, gender, and how long they had been diagnosed with the disease were interviewed. Results: The results showed that dancing was experienced as improving health, which implied feeling both calmed and excited, getting better sleep, and being able to move with more focus and freedom. The dance program was experienced as a social context through the importance of community, feelings of togetherness, and being able to compare oneself with others. Experiences of self-support included experiencing increased self-esteem and joy, but also a sense of being confirmed and having structure, which gave meaning to everyday life. Conclusions: To reduce illness and increase quality of life in persons with PD, it is important to investigate alternative treatment methods, and this study shows the importance of participating in a dance program in Sweden for the life situation and health of people with PD.
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Affiliation(s)
- Therese Gyrling
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Magnus Ljunggren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Staffan Karlsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden.,Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
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Schönenberg A, Zipprich HM, Teschner U, Grosskreutz J, Witte OW, Prell T. Impact of subthreshold depression on health-related quality of life in patients with Parkinson's disease based on cognitive status. Health Qual Life Outcomes 2021; 19:107. [PMID: 33766054 PMCID: PMC7993461 DOI: 10.1186/s12955-021-01753-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/18/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In patients with Parkinson's disease (PD), depression has a strong impact on quality of life (QoL). However, little is known about the influence of subthreshold depression (STD) on QoL in PD patients. METHODS A total of 230 hospitalized PD patients with normal and impaired cognitive status were included in this observational study. We collected the following data for analysis: Beck Depression Inventory level, Montreal Cognitive Assessment (MOCA) score, non-motor symptoms questionnaire score, PD questionnaire-39 (PDQ-39) score, Hoehn-Yahr stage, and Movement Disorder Society-sponsored revision of the unified PD rating scale III (MDS-UPDRS III) score. To study the impact of STD on the PDQ-39 summary index (SI) and its domains, we used multivariate analysis of variance and multivariate analysis of covariance. RESULTS In this cohort, 80 (34.8%) patients had STD [44 (32.3%) with high MOCA score (> 21) and 36 (38.3%) with low MOCA score (< 21)]. In PDQ-39 SI, there was a significant effect on depression level. In patients with higher MOCA score, STD was associated with worse PDQ-39 domains emotional well-being and cognition, whereas in patients with lower MOCA score, STD had no significant effect on PDQ-39 SI or its subdomains. CONCLUSION In PD patients, QoL is significantly affected by STD, and thus, more attention in medical care should be focused on treating STD. However, the impact is only observable in PD patients with normal cognitive function. STD patients show more reduced QoL than non-depressed patients, indicating that STD should be treated as a transition zone between normal mood and depression.
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Affiliation(s)
- Aline Schönenberg
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Hannah M Zipprich
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Center for Healthy Ageing, Jena University Hospital, Jena, Germany
| | - Ulrike Teschner
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Julian Grosskreutz
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Center for Healthy Ageing, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Center for Healthy Ageing, Jena University Hospital, Jena, Germany
| | - Tino Prell
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
- Center for Healthy Ageing, Jena University Hospital, Jena, Germany.
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Cao Y, Li G, Xue J, Zhang G, Gao S, Huang Y, Zhu A. Depression and Related Factors in Patients with Parkinson's Disease at High Altitude. Neuropsychiatr Dis Treat 2021; 17:1353-1362. [PMID: 33986595 PMCID: PMC8110268 DOI: 10.2147/ndt.s300596] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/09/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Depression seems to aggravate progression of Parkinson's disease (PD). Hypoxia stress may be one of the pathogenic factors leading to PD. We investigated the characteristics of PD and factors related to Parkinson's disease depression (PDD) at high altitude (mean altitude ≥2300 m). PATIENTS AND METHODS Totally 221 PD patients of three different nationalities (Han, Hui, and Tibetan) were recruited in a high-altitude hospital. Depression was present in 55.6% of them. Patient data were examined, including demographic information, medical history, disease duration and family history. Psychopathological characteristics and motor signs were assessed by the Hamilton Depression scale (HAMD) and scales for motor and non-motor symptoms in the Unified Parkinson's Disease Rating Scale (UPDRS). Progression of PD was evaluated by the modified Hoehn and Yahr (H-Y) staging system. RESULTS Mean age (47.1% men) was 68.25±13.67 years old, with disease duration of 4.18±5.13 years and median H-Y scores 2.07±0.97 points. Among three different nationalities, PD rate was 69.2% in Han nationals, 17.6% in Hui nationals and 13.1% in Tibetans of 221 PD patients. Compared with the non-depressed PD group, female, no-smoking and living alone rates, and dysphagia, pain, H-Y stage, ADL, UPDRS-I, UPDRS-III, HAMA, and PSQI scores were significantly increased in the PDD group, while MMSE scores were significantly decreased (P<0.05 or P<0.01). PD patients of Han and Hui nationalities had increased depression rates compared with Tibetan individuals (P<0.05). Compared with the mild depression group, the moderate and severe depression groups had significantly increased salivation, dysphagia, H-Y stage, UPDRS-I, UPDRS-III, HAMA, and PSQI scores (P<0.05 or P<0.01). Living alone rates and ADL scores were increased in the severe depression group (P<0.05). Logistic regression analysis showed that living alone (OR=19.833, 95% CI: 2.758-142.624, P<0.01), UPDRS-III score (OR=1.079, 95% CI: 1.009-1.153, P<0.05), and PSQI score (OR=1.538, 95% CI: 1.347-1.755, P<0.001) were risk factors for PDD. Male gender (OR=0.292, 95% CI: 0.112-0.763, P<0.05) was a protective factor in PDD. CONCLUSION PDD is associated with gender, ethnicity, loneliness, non-motor symptoms (NMSs), motor symptoms, and disease severity, and depression severity. Living alone, dyskinesia, and sleep disorder are risk factors for PDD at high altitude. A relative protection against depression was observed in the Tibetan population.
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Affiliation(s)
- Yu Cao
- Institute of Geriatric, Qinghai Provincial People's Hospital, Xining, People's Republic of China
| | - Gongfeng Li
- Institute of Geriatric, Qinghai Provincial People's Hospital, Xining, People's Republic of China
| | - Jinsheng Xue
- Foreign Cooperation Office, Chengdu Fifth People's Hospital, Chengdu, People's Republic of China
| | - Guijuan Zhang
- Institute of Geriatric, Qinghai Provincial People's Hospital, Xining, People's Republic of China
| | - Sensen Gao
- Institute of Geriatric, Qinghai Provincial People's Hospital, Xining, People's Republic of China
| | - Yuling Huang
- Institute of Geriatric, Qinghai Provincial People's Hospital, Xining, People's Republic of China
| | - Aiqin Zhu
- Institute of Geriatric, Qinghai Provincial People's Hospital, Xining, People's Republic of China
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15
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Depression in Parkinson's disease: Perspectives from an Australian cohort. J Affect Disord 2020; 277:1038-1044. [PMID: 33065812 DOI: 10.1016/j.jad.2020.09.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/24/2020] [Accepted: 09/08/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Depression is often an under-recognised feature of Parkinson's disease (PD). It is detrimental to physical and interpersonal functioning, negatively impacting a patient's clinical management, quality of life and well-being. We aimed to identify clinical predictors and management implications of depression in Australian PD patients. METHODS 103 PD and 81 Healthy Control (HC) subjects were evaluated using the Beck Depression Inventory (BDI) and other validated PD motor and non-motor symptom (NMS) tools. RESULTS Nearly twice as many PD patients were depressed, (38.9% vs 20.1%, p = 0.009), with a corresponding increase in depression severity on the BDI (11.9; standard deviation (SD) 8.8 vs 5.2; SD 5.5, p<0.001), and an odds ratio of 2.4 (95% confidence interval 1.2 - 4.7). Employment appeared to be a relative protective factor for depression, whilst patients requiring support services seemed to be more vulnerable to depression. Rapid Eye Movement Sleep Behaviour Disorder, dyskinesias, impulse control disorder, higher daily levodopa equivalent dose, increased motor severity, as well as catechol-O-methyltransferase inhibitor and amantadine use, all showed associations with depression (p<0.05). Chronic pain, decreased physical activity, constipation and upper gastrointestinal dysfunction presented with an apparent increase in risk for developing depression and increased depression severity. Other NMS were also found to be associated with PD-related depression. LIMITATIONS Potential selection bias of self-reporting data collection from specialist PD clinics in a single metropolitan area. CONCLUSION Our findings provide novel insight into the prevalence of depression in PD, possible contributory factors and future treatment strategies targeting depression in PD.
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16
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Koutsouras GW, Levine K, Duroseau N, Ciraco C, Chan V, Pergament K, Chan T, Mancini JD, Leder AN, Krishnamachari B. Effects of depression and exercise on health-related quality of life in patients with Parkinson's disease. Chronic Illn 2020; 16:190-200. [PMID: 30185064 DOI: 10.1177/1742395318796166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES There is limited literature describing the effect exercise may have on depression and an individual's health-related quality of life (HRQoL) in Parkinson's Disease (PD). We aim to quantify this effect. METHODS A cross-sectional questionnaire was administered to 60 PD subjects. The Parkinson's Disease Questionnaire-39 (PDQ-39) summary index and the Geriatric Depression Scale-30 were used to quantify HRQoL and depression, respectively. Data were obtained on exercise habits. ANOVA and multivariate linear regression analysis were used to calculate mean differences in HRQoL. RESULTS Depression was consistently related to HRQoL (p < 0.05). Of those who exercised as an adult before PD diagnosis, 49.02% (n = 25) reported depression as compared to 88.89% (n = 8) of those who did not report adult exercise (p = 0.03). Those who exercised frequently as an adult prior to PD diagnosis had a better PDQ-39 Cognitive Index (p = 0.03). Those who were not depressed and were currently exercising had a significantly higher HRQoL than those who were depressed and did not exercise (p < 0.01). DISCUSSION Exercising and depression may interact to affect HRQoL. Thus, coordination of mental health evaluation and exercise regimens in persons with PD may improve HRQoL.
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Affiliation(s)
- George W Koutsouras
- Department of Clinical Sciences, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY, USA
| | - Kimberly Levine
- Department of Clinical Sciences, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY, USA
| | - Nathalie Duroseau
- Department of Clinical Sciences, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY, USA
| | - Christina Ciraco
- Department of Clinical Sciences, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY, USA
| | - Vivian Chan
- Department of Clinical Sciences, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY, USA
| | - Kathleen Pergament
- Department of Clinical Sciences, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY, USA
| | - Thomas Chan
- Department of Clinical Sciences, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY, USA
| | - Jayme D Mancini
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY, USA
| | - Adena N Leder
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY, USA
| | - Bhuma Krishnamachari
- Department of Clinical Sciences, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY, USA
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Nagamine T. Duloxetine, a serotonin and norepinephrine reuptake inhibitor, may be a double-edged sword for patients with advanced Parkinson's disease. Asian J Psychiatr 2020; 50:102031. [PMID: 32272360 DOI: 10.1016/j.ajp.2020.102031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/25/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Takahiko Nagamine
- Department of Psychiatric Internal Medicine, Sunlight Brain Research Center, 4-13-18 Jiyugaoka, Hofu, Yamaguchi, 747-0066, Japan.
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18
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Dogan B, Akyol A, Memis CO, Sair A, Akyildiz U, Sevincok L. The relationship between temperament and depression in Parkinson's disease patients under dopaminergic treatment. Psychogeriatrics 2019; 19:73-79. [PMID: 30141277 DOI: 10.1111/psyg.12366] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/14/2018] [Accepted: 07/18/2018] [Indexed: 12/26/2022]
Abstract
AIM The risk factors for depressive symptoms in patients with Parkinson's disease (PD) under dopaminergic drug treatment are unclear. In this study, we examined whether some temperament traits are related to the presence of comorbid depression in PD patients, independent of the characteristics of illness and drug treatment. METHODS The participants in this study were 74 patients with idiopathic PD who were already treated with stable doses of levodopa or dopamine agonists. Depressive (n = 20) and non-depressive (n = 52) PD patients were assessed by means of the Unified Parkinson's Disease Rating Scale, Beck Depression Inventory, and Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire. The doses of levodopa and dopamine agonists were converted into levodopa equivalent daily dose. RESULTS The duration of treatment in the depressive group was significantly longer than in the non-depressive group (P = 0.03). The depressive patients had significantly higher scores on the Unified Parkinson's Disease Rating Scale than the non-depressive patients. Depressive (P < 0.0001), cyclothymic (P < 0.0001), anxious (P < 0.0001), and irritable (P = 0.02) temperament scores were significantly higher in depressive than in non-depressive patients. Hyperthymia scores were significantly higher in non-depressive patients than in depressive patients (P = 0.01). Logistic regression analysis revealed that depressive temperament traits (P = 0.03) significantly predicted the diagnosis of depression. In contrast, hyperthymic temperament seemed to be associated with the absence of depression (P = 0.006). CONCLUSION Our results indicated that the severity of PD and duration of dopaminergic treatment were not predictive of the development of depression in PD patients. Depressive temperament strongly predicted the development of depression in our sample. Hyperthymic temperament seemed to be associated with patients without depression. We suggest that depressive temperament traits seem to be related to depression, while hyperthymic temperament may have a protective role in the risk of depression in PD patients.
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Affiliation(s)
- Bilge Dogan
- Department of Psychiatry, Adnan Menderes University, Aydin, Turkey
| | - Ali Akyol
- Department of Neurology, Adnan Menderes University, Aydin, Turkey
| | - Cagdas O Memis
- Department of Psychiatry, Adnan Menderes University, Aydin, Turkey
| | - Ahmet Sair
- Department of Neurology, Adnan Menderes University, Aydin, Turkey
| | - Utku Akyildiz
- Department of Neurology, Adnan Menderes University, Aydin, Turkey
| | - Levent Sevincok
- Department of Psychiatry, Adnan Menderes University, Aydin, Turkey
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Achey RL, Yamamoto E, Sexton D, Hammer C, Lee BS, Butler RS, Thompson NR, Nagel SJ, Machado AG, Lobel DA. Prediction of depression and anxiety via patient-assessed tremor severity, not physician-reported motor symptom severity, in patients with Parkinson's disease or essential tremor who have undergone deep brain stimulation. J Neurosurg 2018; 129:1562-1571. [PMID: 29473781 DOI: 10.3171/2017.8.jns1733] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 08/28/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEDeep brain stimulation (DBS) is an effective therapy for movement disorders such as idiopathic Parkinson's disease (PD) and essential tremor (ET). However, some patients who demonstrate benefit on objective motor function tests do not experience postoperative improvement in depression or anxiety, 2 important components of quality of life (QOL). Thus, to examine other possible explanations for the lack of a post-DBS correlation between improved objective motor function and decreased depression or anxiety, the authors investigated whether patient perceptions of motor symptom severity might contribute to disease-associated depression and anxiety.METHODSThe authors performed a retrospective chart review of PD and ET patients who had undergone DBS at the Cleveland Clinic in the period from 2009 to 2013. Patient demographics, diagnosis (PD, ET), motor symptom severity, and QOL measures (Primary Care Evaluation of Mental Disorders 9-item Patient Health Questionnaire [PHQ-9] for depression, Generalized Anxiety Disorder 7-item Scale [GAD-7], and patient-assessed tremor scores) were collected at 4 time points: preoperatively, postoperatively, 1-year follow-up, and 2-year follow-up. Multivariable prediction models with solutions for fixed effects were constructed to assess the correlation of predictor variables with PHQ-9 and GAD-7 scores. Predictor variables included age, sex, visit time, diagnosis (PD vs ET), patient-assessed tremor, physician-reported tremor, Unified Parkinson's Disease Rating Scale part III (UPDRS-III) score, and patient-assessed tremor over time.RESULTSSeventy PD patients and 17 ET patients were included in this analysis. Mean postoperative and 1-year follow-up UPDRS-III and physician-reported tremor scores were significantly decreased compared with preoperative scores (p < 0.0001). Two-year follow-up physician-reported tremor was also significantly decreased from preoperative scores (p < 0.0001). Only a diagnosis of PD (p = 0.0047) and the patient-assessed tremor rating (p < 0.0001) were significantly predictive of depression. A greater time since surgery, in general, significantly decreased anxiety scores (p < 0.0001) except when a worsening of patient-assessed tremor was reported over the same time period (p < 0.0013).CONCLUSIONSPatient-assessed tremor severity alone was predictive of depression in PD and ET following DBS. This finding suggests that a patient's perception of illness plays a greater role in depression than objective physical disability regardless of the time since surgical intervention. In addition, while anxiety may be attenuated by DBS, patient-assessed return of tremor over time can increase anxiety, highlighting the importance of long-term follow-up for behavioral health features in chronic neurological disorders. Together, these data suggest that the patient experience of motor symptoms plays a role in depression and anxiety-a finding that warrants consideration when evaluating, treating, and following movement disorder patients who are candidates for DBS.
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Affiliation(s)
- Rebecca L Achey
- 1Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
| | - Erin Yamamoto
- 1Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
| | - Daniel Sexton
- 1Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
| | - Christine Hammer
- 2Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Bryan S Lee
- 3Department of Neurosurgery, Neurological Institute
| | - Robert S Butler
- 4Department of Quantitative Health Science, Cleveland Clinic
| | | | - Sean J Nagel
- 5Center for Neurological Restoration, Department of Neurosurgery, Neurological Institute
| | - Andre G Machado
- 5Center for Neurological Restoration, Department of Neurosurgery, Neurological Institute
- 6Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio; and
| | - Darlene A Lobel
- 5Center for Neurological Restoration, Department of Neurosurgery, Neurological Institute
- 6Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio; and
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Orsini M, Carolina A, Ferreira ADF, de Assis ACD, Magalhães T, Teixeira S, Bastos VH, Marinho V, Oliveira T, Fiorelli R, Oliveira AB, de Freitas MR. Cognitive impairment in neuromuscular diseases: A systematic review. Neurol Int 2018; 10:7473. [PMID: 30069288 PMCID: PMC6050451 DOI: 10.4081/ni.2018.7473] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/04/2017] [Accepted: 12/12/2017] [Indexed: 12/12/2022] Open
Abstract
Neuromuscular diseases are multifactorial pathologies characterized by extensive muscle fiber damage that leads to the activation of satellite cells and to the exhaustion of their pool, with consequent impairment of neurobiological aspects, such as cognition and motor control. To review the knowledge and obtain a broad view of the cognitive impairment on Neuromuscular Diseases. Cognitive impairment in neuromuscular disease was explored; a literature search up to October 2017 was conducted, including experimental studies, case reports and reviews written in English. Keywords included Cognitive Impairment, Neuromuscular Diseases, Motor Neuron Diseases, Dystrophinopathies and Mitochondrial Disorders. Several cognitive evaluation scales, neuroimaging scans, genetic analysis and laboratory applications in neuromuscular diseases, especially when it comes to the Motor Neuron Diseases, Dystrophinopathies and Mitochondrial Disorders. In addition, organisms model using rats in the genetic analysis and laboratory applications to verify the cognitive and neuromuscular impacts. Several studies indicate that congenital molecular alterations in neuromuscular diseases promote cognitive dysfunctions. Understanding these mechanisms may in the future guide the proper management of the patient, evaluation, establishment of prognosis, choice of treatment and development of innovative interventions such as gene therapy.
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Affiliation(s)
- Marco Orsini
- Master’s Program in Health Applied Sciences, Severino Sombra University, Vasssouras, Rio de Janeiro
- Brain Mapping and Plasticity Laboratory, Federal University of Piauí, Parnaíba
| | | | | | - Anna Carolina Damm de Assis
- Department of Neurology, Federal Fluminense University, Rio de Janeiro
- Department of Neurology, Federal University of São Paulo
| | - Thais Magalhães
- Department of Neurology, Federal Fluminense University, Rio de Janeiro
| | - Silmar Teixeira
- Brain Mapping and Plasticity Laboratory, Federal University of Piauí, Parnaíba
| | - Victor Hugo Bastos
- Brain Mapping and Plasticity Laboratory, Federal University of Piauí, Parnaíba
| | - Victor Marinho
- Brain Mapping and Plasticity Laboratory, Federal University of Piauí, Parnaíba
| | - Thomaz Oliveira
- Brain Mapping and Plasticity Laboratory, Federal University of Piauí, Parnaíba
| | - Rossano Fiorelli
- Master’s Program in Health Applied Sciences, Severino Sombra University, Vasssouras, Rio de Janeiro
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Patterns and Predictors of Depression Treatment among Older Adults with Parkinson's Disease and Depression in Ambulatory Care Settings in the United States. PARKINSONS DISEASE 2018; 2018:3402983. [PMID: 29686832 PMCID: PMC5852869 DOI: 10.1155/2018/3402983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/17/2018] [Indexed: 11/18/2022]
Abstract
Little is known regarding depression treatment patterns and predictors among older adults with comorbid Parkinson's disease and depression (dPD) in the United States (US). The objective of this study was to assess the patterns and predictors of depression treatment among older adults with dPD in the US. We adopted a cross-sectional study design by pooling multiple-year data (2005-2011) from the National Ambulatory Medical Care Survey (NAMCS) and the outpatient department of the National Hospital Ambulatory Medical Care Survey (NHAMCS). The final study sample consisted of visits by older adults with dPD. Depression treatment was defined as antidepressant use with or without psychotherapy. To identify predictors of depression treatment, multivariate logistic regression analysis was conducted adjusting for predisposing, enabling, and need factors. Individuals with dPD and polypharmacy were 74% more likely to receive depression treatment (odds ratio = 1.743, 95% CI 1.376-2.209), while dPD subjects with comorbid chronic conditions were 44% less likely (odds ratio = 0.559, 95% CI 0.396-0.790) to receive depression treatment. Approximately six out of ten older adults with PD and depression received depression treatment. Treatment options for dPD are underutilized in routine clinical practice, and further research should explore how overall medical complexity presents a barrier to depression treatment.
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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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Horn A, Reich M, Vorwerk J, Li N, Wenzel G, Fang Q, Schmitz-Hübsch T, Nickl R, Kupsch A, Volkmann J, Kühn AA, Fox MD. Connectivity Predicts deep brain stimulation outcome in Parkinson disease. Ann Neurol 2017; 82:67-78. [PMID: 28586141 DOI: 10.1002/ana.24974] [Citation(s) in RCA: 428] [Impact Index Per Article: 61.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/02/2017] [Accepted: 06/02/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The benefit of deep brain stimulation (DBS) for Parkinson disease (PD) may depend on connectivity between the stimulation site and other brain regions, but which regions and whether connectivity can predict outcome in patients remain unknown. Here, we identify the structural and functional connectivity profile of effective DBS to the subthalamic nucleus (STN) and test its ability to predict outcome in an independent cohort. METHODS A training dataset of 51 PD patients with STN DBS was combined with publicly available human connectome data (diffusion tractography and resting state functional connectivity) to identify connections reliably associated with clinical improvement (motor score of the Unified Parkinson Disease Rating Scale [UPDRS]). This connectivity profile was then used to predict outcome in an independent cohort of 44 patients from a different center. RESULTS In the training dataset, connectivity between the DBS electrode and a distributed network of brain regions correlated with clinical response including structural connectivity to supplementary motor area and functional anticorrelation to primary motor cortex (p < 0.001). This same connectivity profile predicted response in an independent patient cohort (p < 0.01). Structural and functional connectivity were independent predictors of clinical improvement (p < 0.001) and estimated response in individual patients with an average error of 15% UPDRS improvement. Results were similar using connectome data from normal subjects or a connectome age, sex, and disease matched to our DBS patients. INTERPRETATION Effective STN DBS for PD is associated with a specific connectivity profile that can predict clinical outcome across independent cohorts. This prediction does not require specialized imaging in PD patients themselves. Ann Neurol 2017;82:67-78.
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Affiliation(s)
- Andreas Horn
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.,Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité-Universitätsmedizin, Berlin, Germany
| | - Martin Reich
- Department of Neurology, Würzburg University Hospital, Würzburg, Germany
| | - Johannes Vorwerk
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
| | - Ningfei Li
- Institute of Software Engineering and Theoretical Computer Science, Neural Information Processing Group, Berlin Technical University, Berlin, Germany
| | - Gregor Wenzel
- Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité-Universitätsmedizin, Berlin, Germany
| | - Qianqian Fang
- Department of Bioengineering, Northeastern University, Boston, MA
| | - Tanja Schmitz-Hübsch
- Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité-Universitätsmedizin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin, Berlin, Germany
| | - Robert Nickl
- Department of Neurosurgery, Würzburg University Hospital, Würzburg, Germany
| | - Andreas Kupsch
- Clinic of Neurology and Stereotactic Neurosurgery, Otto von Guericke University, Magdeburg, Germany.,Neurology Moves, Berlin, Germany
| | - Jens Volkmann
- Department of Neurology, Würzburg University Hospital, Würzburg, Germany
| | - Andrea A Kühn
- Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité-Universitätsmedizin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin, Berlin, Germany
| | - Michael D Fox
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
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Lawrence BJ, Gasson N, Kane R, Bucks RS, Loftus AM. Activities of daily living, depression, and quality of life in Parkinson's disease. PLoS One 2014; 9:e102294. [PMID: 25025280 PMCID: PMC4099301 DOI: 10.1371/journal.pone.0102294] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 06/17/2014] [Indexed: 12/13/2022] Open
Abstract
This study examined whether activities of daily living (ADL) mediate the relationship between depression and health-related quality of life (HR-QOL) in people with Parkinson's disease (PD). A cross-sectional, correlational research design examined data from 174 participants who completed the Geriatric Depression Scale (GDS-15), Parkinson's Disease Questionnaire-39 (PDQ-39), and Unified Parkinson's Disease Rating Scale-section 2 (UPDRS-section 2 [ADL]). Multiple Regression Analysis (MRA) was used to examine the mediator model. Depression and ADL significantly (p<.001) predicted HR-QOL, and depression significantly (p<.001) predicted ADL. Whilst ADL did not impact on the relationship between depression and HR-QOL, there was a significant (p<.001) indirect effect of depression on HR-QOL via ADL, suggesting both direct and indirect (via ADL) effects of depression on HR-QOL. The magnitude of this effect was moderate (R2 = .13). People with PD who report depression also experience greater difficulty completing ADL, which impacts upon their HR-QOL. It is recommended that clinicians adopt a multidisciplinary approach to care by combining pharmacological treatments with psycho/occupational therapy, thereby alleviating the heterogeneous impact of motor and non-motor symptoms on HR-QOL in people with PD.
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Affiliation(s)
- Blake J. Lawrence
- Curtin Neuroscience Laboratory, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
- * E-mail:
| | - Natalie Gasson
- Curtin Neuroscience Laboratory, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
- Parkinson's Centre (ParkC), Curtin University, Perth, Western Australia, Australia
| | - Robert Kane
- Curtin Neuroscience Laboratory, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Romola S. Bucks
- Parkinson's Centre (ParkC), Curtin University, Perth, Western Australia, Australia
- School of Psychology, University of Western Australia, Perth, Western Australia, Australia
| | - Andrea M. Loftus
- Curtin Neuroscience Laboratory, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
- Parkinson's Centre (ParkC), Curtin University, Perth, Western Australia, Australia
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Lewis C, Annett LE, Davenport S, Hall AA, Lovatt P. Mood changes following social dance sessions in people with Parkinson's disease. J Health Psychol 2014; 21:483-92. [PMID: 24752558 DOI: 10.1177/1359105314529681] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Dance interventions have physical benefits for the elderly, especially those with Parkinson's disease. This study assessed the psychological benefits of dance. A total of 37 participants, with either Parkinson's disease (n= 22) or age-matched controls (n= 15) completed mood questionnaires before and after a 10-week dance intervention. An overall reduction in total mood disturbance and a specific reduction in anger were observed. In addition, less fatigue was found for those initially scoring higher in depression. This suggests that dance can provide psychological benefits for both people with Parkinson's disease and the elderly, with findings suggesting that this is an avenue to be explored further.
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Lee J, Choi M, Jung D, Sohn YH, Hong J. A Structural Model of Health-Related Quality of Life in Parkinson's Disease Patients. West J Nurs Res 2014; 37:1062-80. [PMID: 24718037 DOI: 10.1177/0193945914528588] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Disability-adjusted life expectancy is focused on more than just extending life span; thus, health-related quality of life (HRQOL) has emerged as an important issue for elderly patients with chronic disease. The number of patients with Parkinson's disease (PD) is predicted to grow along with the aging population, so it is essential to identify the predictors of HRQOL. This study utilized structural equation modeling (SEM) to predict the HRQOL of patients with PD. Participants (N = 217) were patients diagnosed with PD (M age = 66.01). Demographic and disease-related characteristics, sleep quality, pain, depression, and HRQOL were investigated via a structured questionnaire. Participants' functional factors were measured using physical function evaluations. The hypothetical model verified disease-related factors, depression, and pain as direct factors that significantly predicted HRQOL of patients with PD (Goodness of Fit Index = 0.93 and Comparative Fit Index = 0.96). These findings are useful for developing comprehensive interventions to improve the HRQOL of patients with PD.
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Affiliation(s)
- JuHee Lee
- College of Nursing, Yonsei University, Seoul, Korea
| | - MoonKi Choi
- College of Nursing, Yonsei University, Seoul, Korea
| | - Dukyoo Jung
- Division of Nursing Science, Ewha Womans University, Seoul, Korea
| | - Young H Sohn
- Department of Neurology, College of Medicine, Yonsei University, Seoul, Korea
| | - JinYong Hong
- Department of Neurology, Wonju College of Medicine, Yonsei University, Wonju, Korea
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Mhatre PV, Vilares I, Stibb SM, Albert MV, Pickering L, Marciniak CM, Kording K, Toledo S. Wii Fit balance board playing improves balance and gait in Parkinson disease. PM R 2013; 5:769-77. [PMID: 23770422 DOI: 10.1016/j.pmrj.2013.05.019] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 05/06/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the effect of exercise training by using the Nintendo Wii Fit video game and balance board system on balance and gait in adults with Parkinson disease (PD). DESIGN A prospective interventional cohort study. SETTING An outpatient group exercise class. PARTICIPANTS Ten subjects with PD, Hoehn and Yahr stages 2.5 or 3, with a mean age of 67.1 years; 4 men, 6 women. INTERVENTIONS The subjects participated in supervised group exercise sessions 3 times per week for 8 weeks by practicing 3 different Wii balance board games (marble tracking, skiing, and bubble rafting) adjusted for their individualized function level. The subjects trained for 10 minutes per game, a total of 30 minutes training per session. MAIN OUTCOME MEASUREMENTS Pre-and postexercise training, a physical therapist evaluated subjects' function by using the Berg Balance Scale, Dynamic Gait Index, and Sharpened Romberg with eyes open and closed. Postural sway was assessed at rest and with tracking tasks by using the Wii balance board. The subjects rated their confidence in balance by using the Activities-specific Balance Confidence scale and depression on the Geriatric Depression Scale. RESULTS Balance as measured by the Berg Balance Scale improved significantly, with an increase of 3.3 points (P = .016). The Dynamic Gait Index improved as well (mean increase, 2.8; P = .004), as did postural sway measured with the balance board (decreased variance in stance with eyes open by 31%; P = .049). Although the Sharpened Romberg with eyes closed increased by 6.85 points and with eyes opened by 3.3 points, improvements neared significance only for eyes closed (P = .07 versus P = .188). There were no significant changes on patient ratings for the Activities-specific Balance Confidence (mean decrease, -1%; P = .922) or the Geriatric Depression Scale (mean increase, 2.2; P = .188). CONCLUSIONS An 8-week exercise training class by using the Wii Fit balance board improved selective measures of balance and gait in adults with PD. However, no significant changes were seen in mood or confidence regarding balance.
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Affiliation(s)
- Priya V Mhatre
- Rehabilitation Institute of Chicago, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL(∗)
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Zielonka D, Marinus J, Roos RA, De Michele G, Di Donato S, Putter H, Marcinkowski J, Squitieri F, Bentivoglio AR, Landwehrmeyer GB. The influence of gender on phenotype and disease progression in patients with Huntington's disease. Parkinsonism Relat Disord 2013; 19:192-7. [DOI: 10.1016/j.parkreldis.2012.09.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 09/25/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
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Piccinni A, Marazziti D, Veltri A, Ceravolo R, Ramacciotti C, Carlini M, Del Debbio A, Schiavi E, Bonuccelli U, Dell'Osso L. Depressive symptoms in Parkinson's disease. Compr Psychiatry 2012; 53:727-31. [PMID: 22209634 DOI: 10.1016/j.comppsych.2011.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 11/02/2011] [Accepted: 11/08/2011] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE We aimed to investigate the relationship between the presence and severity of depression and the degree of motor and functional disability in Parkinson's disease (PD). METHODS One hundred twenty-two outpatients with PD were enrolled in a neurology department: 65 satisfied the Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition criteria for major depression, and 57 did not (PD-C). Depressive symptoms were assessed by means of the Hamilton Rating Scale for Depression (HRSD), and the PD severity was assessed according to the Hoehn and Yahr System. Activities of daily living and motor symptoms were measured by the Unified PD Rating Scale (UPDRS), parts II and III. RESULTS Twenty-nine patients had a mild depression (HRSD total score ranging between 8 and 17), 30 had a moderate depression (HRSD total score ranging between 18 and 24), and 6 had a severe depression (HRSD total score, ≥25). By comparing the 3 groups of patients, it emerged that those with a severe depression showed significantly higher scores at the UPDRS II, UPDRS III, and HY scales than did PD-C or patients with a mild depression. Moreover, patients with a moderate depression scored significantly higher on the UPDRS II, UPDRS III, and HY scales than did PD-C or those with a mild depression. CONCLUSIONS Our findings suggest that depression and motor symptoms/well-being are highly intertwined in patients with PD.
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Affiliation(s)
- Armando Piccinni
- Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnologies, University of Pisa, Via Roma 67, 56126 Pisa, Italy.
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Paumier KL, Siderowf AD, Auinger P, Oakes D, Madhavan L, Espay AJ, Revilla FJ, Collier TJ. Tricyclic antidepressants delay the need for dopaminergic therapy in early Parkinson's disease. Mov Disord 2012; 27:880-7. [PMID: 22555881 DOI: 10.1002/mds.24978] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 02/01/2012] [Accepted: 02/26/2012] [Indexed: 12/13/2022] Open
Abstract
This study examined whether antidepressants delay the need for dopaminergic therapy or change the degree of motor impairment and disability in a population of early Parkinson's disease (PD) patients. Preclinical studies have indicated that antidepressants modulate signaling pathways involved in cell survival and plasticity, suggesting they may serve to both treat PD-associated depression and slow disease progression. A patient-level meta-analysis included 2064 patients from the treatment and placebo arms of the following trials: FS1, FS-TOO, ELLDOPA, QE2, TEMPO, and PRECEPT. Depression severity was determined at baseline, and antidepressant use was reported in a medication log each visit. Kaplan-Meier curves and time-dependent Cox proportional hazards models determined associations between depression severity and antidepressant use with the primary outcome, time to initiation of dopaminergic therapy. ANCOVAs determined associations with the secondary outcome, degree of motor impairment and disability, reported as annualized change in UPDRS scores from baseline to final visit. When controlling for baseline depression, the initiation of dopaminergic therapy was delayed for subjects taking tricyclic antidepressants compared with those not taking antidepressants. No significant differences were found in UPDRS scores for subjects taking antidepressants compared with those not taking antidepressants. Tricyclic antidepressants are associated with a delay in reaching the end point of need to start dopaminergic therapy. The lack of change in overall UPDRS scores suggests the delay was not attributable to symptomatic effects.
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Affiliation(s)
- Katrina L Paumier
- Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
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Do co-morbidities and cognition impact functional change and discharge needs in Parkinson disease? Am J Phys Med Rehabil 2011; 90:272-80. [PMID: 21765244 DOI: 10.1097/phm.0b013e31820b15a2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess the impact of cognition, baseline motor function, and co-morbid medical conditions on functional change, discharge destination, and discharge needs in patients admitted to acute rehabilitation for Parkinson-related impairments. DESIGN This retrospective chart review study evaluated the records of patients admitted to acute rehabilitation over a 5-yr period with a primary impairment category of parkinsonism. Functional status was measured at admission and discharge; 3-mo follow-up function was also collected in a sample of discharged patients. RESULTS Eighty-nine patients (mean age, 74.26 yrs) were admitted over the 5-yr time frame. A more complicated Medicare tier diagnosis (tier 2) was associated with lower total and motor score Functional Independence Measure gains compared with tier 3 (P = 0.009 and P = 0.016, respectively). Cognitive scores at admission were not related to need for caregivers upon discharge. Overall Functional Independence Measure gain (adjusted R(2) = 0.073, P = 0.006) and Functional Independence Measure gain efficiency (adjusted R(2) = 0.142, P < 0.001) inversely correlated with age. At the 3-mo follow-up, a random sample (38%) of patients contacted postdischarge demonstrated continued improvements. CONCLUSIONS Significant improvement may be seen after acute rehabilitation in patients with Parkinson disease, irrespective of cognitive impairment. More complicated medical tier diagnoses result in less Functional Independence Measure gain, and older individuals with Parkinson disease are more likely to show less functional change. However, functional improvements are still statistically significant.
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Stress, depression and Parkinson's disease. Exp Neurol 2011; 233:79-86. [PMID: 22001159 DOI: 10.1016/j.expneurol.2011.09.035] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 09/16/2011] [Accepted: 09/30/2011] [Indexed: 12/13/2022]
Abstract
In this review, we focus on the relationship among Parkinson's disease (PD), stress and depression. Parkinson's disease patients have a high risk of developing depression, and it is possible that stress contributes to the development of both pathologies. Stress dysfunction may have a role in the etiology of preclinical non-motor symptoms of PD (such as depression) and, later in the course of the disease, may worsen motor symptoms. However, relatively few studies have examined stress or depression and the injured nigrostriatal system. This review discusses the effects of stress on neurodegeneration and depression, and their association with the symptoms and progression of PD.
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van der Hoek TC, Bus BAA, Matui P, van der Marck MA, Esselink RA, Tendolkar I. Prevalence of depression in Parkinson's disease: effects of disease stage, motor subtype and gender. J Neurol Sci 2011; 310:220-4. [PMID: 21802694 DOI: 10.1016/j.jns.2011.07.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 06/22/2011] [Accepted: 07/05/2011] [Indexed: 12/29/2022]
Abstract
Depression is one of the most common non-motor symptoms of Parkinson's disease (PD) with a large negative impact on the quality of life. Factors such as disease stage, subtype of PD and gender might play an important role in the prevalence of depression, but a large study investigating all these factors in a within-subject design is lacking. Therefore we studied a homogeneous group of 256 Dutch PD patients (60% men, mean age=65.12 (±9.6) years). In total, 36.3% of the subjects had a BDI-score indicative for a minor depression, while 12.9% had a major depression. Notably, only 8.6% of the minor depressed patients and 30.3% of the major depressed patients were taking antidepressants. A higher prevalence of depression was observed in the later stages of the disease. However, this finding was absent in a smaller subsample after correction for cognitive impairment. Our data did not show a difference in the prevalence of depression between the motor subtypes and showed a trend towards higher prevalence of depression in the tremor dominant group. There was no significant difference in the prevalence of depression between men and women. We will discuss the relevance of these results in relation to the findings of other studies.
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Affiliation(s)
- Take C van der Hoek
- Radboud University Nijmegen Medical Centre, Department of Psychiatry, Nijmegen, The Netherlands.
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Dissanayaka NN, O'Sullivan JD, Silburn PA, Mellick GD. Assessment methods and factors associated with depression in Parkinson's disease. J Neurol Sci 2011; 310:208-10. [PMID: 21764079 DOI: 10.1016/j.jns.2011.06.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 05/25/2011] [Accepted: 06/17/2011] [Indexed: 01/25/2023]
Abstract
Depression is a common problem experienced by patients with Parkinson's disease (PD). Identifying depression in PD is difficult and the determinants of depression in PD are complex and debatable. Here we review our recent studies which have (i) examined the validity of current depression rating scales in PD, (ii) introduced a self-reported and validated strategy to identify a lifetime history of depression in PD, and (iii) investigated genetic and non-genetic factors associated with depression in the context of PD. Our research showed PD-specific cut-off values suitable to use for the Hamilton Depression Scales (HAMD and HDI) and the Geriatric Depression Scale (GDS-15) when dichotomising patients with and without a current depression. Using the GDS-15 specific cut-off scores and a number of self-reported questions that screen for a lifetime history of depression, we developed a novel method to dichotomise PD patients according to current depression or a past history of depression. This method was applied in a large-scale study examining the factors associated with depression in PD. We clarified that the severity of PD is positively related to depression. We also showed that a number of other clinical factors including a longer duration of PD, a younger PD onset age, frequent falls, a history of anxiety disorder and memory problems were associated with depression in PD. In addition to these clinical factors, we observed associations between depression, and lower education levels, a history of smoking and a regular use of non-aspirin bases NSAIDs or analgesics. No associations were found between depression in PD and common genetic variations examined across the serotonin and dopamine transporter genes. Our studies provide a focus for future intervention strategies.
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Dissanayaka NNW, Sellbach A, Silburn PA, O'Sullivan JD, Marsh R, Mellick GD. Factors associated with depression in Parkinson's disease. J Affect Disord 2011; 132:82-8. [PMID: 21356559 DOI: 10.1016/j.jad.2011.01.021] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 01/31/2011] [Accepted: 01/31/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Depression is common in Parkinson's disease (PD) and contributes significantly to a reduced quality of life in PD patients. The determinants of depression in PD are complex and poorly understood. We investigated the factors associated with depression in PD. METHODS PD patients were recruited from Neurology clinics. A validated method was used to screen for a lifetime history of depression. 'Depressed' patients were identified by a score of >6 in the Geriatric Depression Scale (GDS-15) or by having had prescribed treatment for depression. 'Never depressed' patients were recognised by a score of <5 in the GDS-15 with no signs of a history of depression. A newly developed and validated questionnaire was used to collect other information. RESULTS Depression was identified in 66% of the 639 PD patients who met the inclusion criteria. Depression was associated with an increased severity of illness as evidenced by higher Unified PD Rating Scale scores and a higher Hoehn and Yahr stage. Other clinical factors associated with disease severity were also more frequently observed in depressed patients. Similar to findings in non-PD samples, depressed PD patients were more likely to have a lower education level, a history of smoking and to regularly use non-aspirin based NSAIDs or analgesics. Comorbidities such as anxiety, memory problems, hallucinations, sleep disturbances and postural hypotension were more common in depressed PD patients. LIMITATIONS To avoid patient exhaustion of over-surveying, some factors within the psychological domain were not examined. CONCLUSION Our results provide a focus for future intervention strategies.
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Silver DE, Buck PO. Determining the Efficacy of Rasagiline in Reducing Bradykinesia Among Parkinson's Disease Patients: A Review. Int J Neurosci 2011; 121:485-9. [DOI: 10.3109/00207454.2011.582240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ceravolo R, Rossi C, Kiferle L, Bonuccelli U. Nonmotor symptoms in Parkinson’s disease: the dark side of the moon. FUTURE NEUROLOGY 2010. [DOI: 10.2217/fnl.10.69] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Nonmotor symptoms may appear during the course of Parkinson’s disease, complicating the advanced phase in particular, but are also common in the premotor phase of Parkinson’s disease. The appearance of nonmotor manifestations represents a milestone, determining a worse prognosis and lower quality of life; however, they are often misdiagnosed and untreated. The spectrum of nonmotor symptoms encompasses mood disorders, psychosis, dementia, sleep disorders, impulse-control disorders and autonomic dysfunctions. This article describes these nonmotor symptoms and their management.
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Affiliation(s)
- Roberto Ceravolo
- Department of Neurosciences, Section of Neurology, University of Pisa, via Roma 67, 56126 Pisa, Italy
| | - Carlo Rossi
- Department of Neurosciences, Section of Neurology, University of Pisa, via Roma 67, 56126 Pisa, Italy
| | - Lorenzo Kiferle
- Department of Neurosciences, Section of Neurology, University of Pisa, via Roma 67, 56126 Pisa, Italy
| | - Ubaldo Bonuccelli
- Department of Neurosciences, Section of Neurology, University of Pisa, via Roma 67, 56126 Pisa, Italy
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Langlieb AM, Guico-Pabia CJ. Beyond symptomatic improvement:assessing real-world outcomes in patients with major depressive disorder. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2010; 12. [PMID: 20694113 DOI: 10.4088/pcc.09r00826blu] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 08/04/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To quantify the negative impact that major depressive disorder (MDD) has on quality of life, disability, and work, family, and overall psychosocial functioning. Available scales that assess these areas of impairment as they relate to patients with MDD are described. DATA SOURCES PUBMED SEARCHES WERE CONDUCTED USING THE FOLLOWING TERMS: (MDD OR major depressive disorder) AND (absenteeism OR absente*); AND (quality of life OR QOL); AND (psychosocial function*); AND (presente* OR presenteeism); AND (health care cost* OR [health care] cost*); AND (health outcome*); AND (functional outcome*); AND (family life); AND (disabil* OR disability); AND (work function*); AND (unemployment OR unemploy*). The literature search was conducted in July 2008 and was restricted to English language articles. There were no limits set on the dates of the search. STUDY SELECTION Two hundred twenty potential articles were identified. Among these studies, 48 presented primary data directly demonstrating the effect of MDD on quality of life, disability, and work, family, and overall psychosocial functioning. DATA EXTRACTION Primary data were compiled from these studies and are summarily described. Available scales that assess quality of life, disability, and work, family, and overall psychosocial functioning are also described. DATA SYNTHESIS MDD was found to be associated with significant disability and declines in functioning and quality of life. The Sheehan Disability Scale, the 36-item Short-Form Health Survey, and the Work Limitations Questionnaire were the most commonly used scales according to this review of the literature, but the majority of studies used direct and indirect disability measures, such as health care and other disability-related costs. CONCLUSIONS In addition to assessing symptomatic outcomes, physicians should routinely assess their depressed patients on "real-world" outcomes. The development of a concise functional outcome measure specific to MDD is necessary for busy clinical practices.
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Affiliation(s)
- Alan M Langlieb
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland and Pfizer Inc, formerly Wyeth Research, Collegeville, Pennsylvania.
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Sharma AN, Elased KM, Garrett TL, Lucot JB. Neurobehavioral deficits in db/db diabetic mice. Physiol Behav 2010; 101:381-8. [PMID: 20637218 DOI: 10.1016/j.physbeh.2010.07.002] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 07/07/2010] [Accepted: 07/08/2010] [Indexed: 01/02/2023]
Abstract
Recent clinical studies indicate neurobehavioral disturbances in type-2 diabetics. However, there is paucity of preclinical research to support this concept. The validity of db/db mouse as an animal model to study type-2 diabetes and related complications is known. The present study was designed to investigate comprehensively the db/db mouse behavior as preclinical evidence of type-2 diabetes related major neurobehavioral complications. We tested juvenile (5-6weeks) and adult (10-11weeks) db/db mice for behavioral depression in forced swim test (FST), psychosis-like symptoms using pre-pulse inhibition (PPI) test, anxiety behavior employing elevated plus maze (EPM) test, locomotor behavior and thigmotaxis using open field test and working memory deficits in Y-maze test. Both juvenile and adult group db/db mice displayed behavioral despair with increased immobility time in FST. There was an age-dependent progression of psychosis-like symptoms with disrupted PPI in adult db/db mice. In the EPM test, db/db mice were less anxious as observed by increased percent open arms time and entries. They were also hypo-locomotive as evident by a decrease in their basic and fine movements. There was no impairment of working memory in the Y-maze test in db/db mice. This is the first report of depression, psychosis-like symptoms and anxiolytic behavior of db/db mouse strain. It is tempting to speculate that this mouse strain can serve as useful preclinical model to study type-2 diabetes related neurobehavioral complications.
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Affiliation(s)
- Ajaykumar N Sharma
- Wright State University, Boonshoft School of Medicine, Department of Pharmacology and Toxicology, Dayton, OH 45435, USA
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Werneck ALDS, Rosso AL, Vincent MB. The use of an antagonist 5-HT2a/c for depression and motor function in Parkinson' disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 67:407-12. [PMID: 19623435 DOI: 10.1590/s0004-282x2009000300007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Accepted: 04/02/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To test the ability of a 5HT2a/c (trazodone) antagonist, to improve depression and motor function in Parkinson' disease (PD). METHOD Twenty PD patients with and without depression were randomly assigned to receive trazodone (group 1) or not (group 2). They were evaluated through UPDRS and Hamilton Depression Rating Scale (HAM-D). RESULTS For the UPDRS the mean score of group 2 was 33.1 +/- 19.7 and 37.1 +/- 18.0 at the end. For the group 1, the corresponding scores were 31.4 +/- 11.3 and 25.9 +/- 13.7. The variations in the Mann-Whitney test were 0.734 at the initial moment and 0.208 at the final moment. The variation in the comparison of the initial moment with the final moment was 0.005 providing statistical significance. For the HAM-D, the mean score went up 4 points in group 2, contrary to a 5.5 points decrease in group 1. CONCLUSION Data analysis shows that this agent significantly improves depression, but the motor function improved only in the depressed patients. Because of the known anti-dopaminergic property of the 5-HT2c receptors, a possible approach for depression in PD could be the use of 5-HT2c antagonists, similarly to the use of atypical neuroleptics in case of psychotic symptoms.
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Nation DA, Katzen HL, Papapetropoulos S, Scanlon BK, Levin BE. Subthreshold depression in Parkinson's disease. Int J Geriatr Psychiatry 2009; 24:937-43. [PMID: 19212967 PMCID: PMC2729808 DOI: 10.1002/gps.2199] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE It is estimated that 40% of patients with Parkinson's disease (PD) are clinically depressed, however, little is known about the frequency and associated features of subthreshold depression in PD. The current study sought to determine the prevalence of subthreshold depression (sD) and to further characterize the associated features in a sample of 111 nondemented patients with moderate to severe PD. METHODS Patients were classified into the following groups: diagnostic depression (DD), subthreshold depression (sD), or nondepressed (ND) by applying the Diagnostic and Statistical Manual, 4th edn criteria for depression and previously reported criteria for sD to items from the Beck Depression Inventory, 2nd edn. These groups were compared on clinical and demographic variables. The symptom profile of the sD group is also described. RESULTS Fifty participants (45.0%) were classified as ND, 32 (28.8%) as sD, and 29 (26.1%) as DD. Patients with sD were younger (approximately 5 yrs) than nondepressed patients, but did not differ in disease stage or any other demographic variables. Patients with sD tended to endorse mood symptoms that overlap with PD, including fatigue, sleep difficulties, appetite dysfunction, and concentration difficulties. These symptoms were also endorsed with high frequency by the other groups. CONCLUSIONS These findings suggest that sD is not uncommon in PD and may be more prevalent among younger patients. The finding that sD patients report mood symptoms that overlap with the PD symptomatology suggests that these two entities share common features and may be difficult to disentangle.
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Affiliation(s)
- Daniel A. Nation
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | | | - Blake K. Scanlon
- Department of Psychology, University of Miami, Coral Gables, FL, USA,Department of Neurology, University of Miami, Coral Gables, FL, USA
| | - Bonnie E. Levin
- Department of Psychology, University of Miami, Coral Gables, FL, USA,Department of Neurology, University of Miami, Coral Gables, FL, USA,Correspondence to: Dr B. E. Levin, Clinical Research Building, 1120 NW, 14th Street, rm 1337, Miami, FL 33136, USA. E-mail:
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Abstract
Depression is common in patients with neurologic disorders such as Alzheimer disease, stroke, Parkinson disease, and multiple sclerosis. Diagnosing depression in the context of neurologic disease is challenging, given the overlap between many signs and symptoms of depression with those of the neurologic disorders. Cognitive impairment further complicates diagnostic evaluation. The etiology of depression in these patients is not well understood and variously has been attributed to emotional reaction to the diagnosis or disability associated with the neurologic condition, the anatomical and/or neurochemical outcomes of neurodegeneration, and the influence of other disease factors. Beyond the inherent burden depression places on patients and caregivers, it increases cognitive and functional disability and, depending on the neurologic disorder, poorer treatment adherence and recovery, earlier institutionalization, and increased suicide risk. Few controlled antidepressant trials are available to guide treatment. In the absence of validated diagnostic guidelines for depression in each neurologic condition, clinicians are urged to remain vigilant for this treatable comorbidity. Although more controlled trials clearly are needed, existing studies suggest that depression in patients with neurologic disorders responds to antidepressant medication and, in some disorders, to psychotherapeutic approaches. Investigating the neuroanatomical and neurochemical correlates of depression comorbid with neurologic conditions also may clarify depression etiology and treatment in the general population.
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Affiliation(s)
- Murray A Raskind
- Mental Health Service, VA Puget Sound Health Care System Mental Illness Research, University of Washington, Seattle, Washington 98108, USA.
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Koerts J, Leenders KL, Koning M, Bouma A, van Beilen M. The assessment of depression in Parkinson's disease. Eur J Neurol 2008; 15:487-92. [PMID: 18355310 DOI: 10.1111/j.1468-1331.2008.02101.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Motor symptoms form the hallmark of Parkinson's Disease (PD), although features like depression are often present. Depression rating scales [e.g. Montgomery-Asberg Depression Rating Scale (MADRS)] used in PD measure affective, cognitive and somatic symptoms. An important clinical question is which items of the MADRS are likely to be influenced by PD symptoms. METHODS Depression was assessed in 43 PD patients who scored below the cut-off of the MADRS and who differed widely in motor severity. RESULTS Parkinson's Disease patients scored relatively highest on Concentration difficulties, Reduced sleep and Inner tension. Reduced sleep, Lassitude and Suicidal thoughts were associated with motor severity and specifically with Bradykinesia, Rigidity and Axial impairment, however not with Tremor. To avoid a possible influence on our results of coincidentally included PD patients with a depression, all associations between somatic MADRS items and motor severity were corrected for the influence of affective symptoms of depression. All associations remained significant. DISCUSSION In conclusion, the items Reduced sleep and Lassitude of the MADRS are likely to be influenced by motor symptoms. The high score on Concentration difficulties is suggested to be a reflection of cognitive dysfunction in PD. Thus, when assessing depression in PD, using a depression rating scale like the MADRS, adjusted cut-off scores are required.
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Affiliation(s)
- J Koerts
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Truong DD, Bhidayasiri R, Wolters E. Management of non-motor symptoms in advanced Parkinson disease. J Neurol Sci 2008; 266:216-28. [PMID: 17804018 DOI: 10.1016/j.jns.2007.08.015] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Progress in pharmacology has markedly improved the treatment of early Parkinson's disease. The management of advanced Parkinson's symptoms, however, remains a challenge. These symptoms are divided into motor and non-motor symptoms. Non-motor symptoms may appear early or late in the disease and sometimes even before the onset of the first motor symptoms confirming the diagnosis. The spectrum of non-motor symptoms encompasses autonomic dysfunctions, sleep disorders, mood disorders, impulse control disorders, cognitive dysfunction, dementia, paranoia and hallucinations. They are often less appreciated than motor symptoms but are important sources of disability for many PD patients. This review describes these non-motor symptoms and their managements.
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Affiliation(s)
- Daniel D Truong
- The Parkinson's and Movement Disorder Institute, 9940 Talbert Avenue, Fountain Valley, CA 92708, USA.
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Ehrt U, Brønnick K, De Deyn PP, Emre M, Tekin S, Lane R, Aarsland D. Subthreshold depression in patients with Parkinson's disease and dementia--clinical and demographic correlates. Int J Geriatr Psychiatry 2007; 22:980-5. [PMID: 17393542 DOI: 10.1002/gps.1774] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND About 40% of the patients with Parkinson's disease (PD) have depressive symptoms, either major depression (MD) or subthreshold depression. Depression was found to be associated with age and age at onset of PD, female gender, more severe parkinsonism, in particular with left-sided and akinetic-rigid symptoms, more functional impairment and cognitive impairment.However, the findings are inconsistent and partly contradictory and most of the studies focused on major depression in PD without dementia. The aim of this study was to examine the relationship between subthreshold depression and other clinical features in 538 PD patients with dementia but without MD drawn from a randomized, placebo-controlled multicentre trial of rivastigmine in PD. RESULTS One hundred and sixteen patients (21%) had subthreshold depression. Depression was associated with a younger age and age at onset and female gender, but not with severity of parkinsonism, cognition or activities of daily living or laterality of motor symptoms. However, in male patients, an association between depression and left-sided parkinsonism was found. CONCLUSION In contrast to previous findings in PD patients with major depression but without dementia, we found no relationship between subthreshold depression and other clinical symptoms in patients with PDD.
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Affiliation(s)
- Uwe Ehrt
- Norwegian Centre for Movement Disorders, Stavanger University Hospital, Norway.
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Cheng Y, Liu C, Mao C, Qian J, Liu K, Ke G. Social support plays a role in depression in Parkinson's disease: a cross-section study in a Chinese cohort. Parkinsonism Relat Disord 2007; 14:43-5. [PMID: 17616476 DOI: 10.1016/j.parkreldis.2007.05.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 05/24/2007] [Accepted: 05/25/2007] [Indexed: 10/23/2022]
Abstract
To investigate the association between social support and depression in Parkinson's disease (PD), 121 PD patients were enrolled in our study. Interview of questionnaires and neurological examinations, including Hamilton Depression Rating Scale, Chinese Social Support Rating Scale (SSRS), Hoehn and Yahr Stage, Schwab and England Scale (SE) and unified PD Rating Scale (UPDRS) were performed. Increased level of UPDRS and lowered social support were associated with depression in PD patients. Stepwise regression analysis showed that objective social support, UPDRS part 1 and duration of disease manifested significant correlation to patients' depression degree. Therefore, social support plays an important role in depression in PD.
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Affiliation(s)
- Yanbo Cheng
- Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, China
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Ravina B, Camicioli R, Como PG, Marsh L, Jankovic J, Weintraub D, Elm J. The impact of depressive symptoms in early Parkinson disease. Neurology 2007; 69:342-7. [PMID: 17581943 PMCID: PMC2031220 DOI: 10.1212/01.wnl.0000268695.63392.10] [Citation(s) in RCA: 195] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Depressive disorders may affect up to 50% of patients with Parkinson disease (PD) and are associated with increased disability and reduced quality of life. No previous study has systematically examined the impact of depressive symptoms in early, untreated PD. METHODS We administered the 15-item Geriatric Depression Scale (GDS-15) as part of two NIH-sponsored phase II clinical trials in PD, enrolling 413 early, untreated PD subjects. We used linear mixed models to examine the relationship of depressive symptoms, measured by the GDS-15, with motor function and activities of daily living (ADLs), as measured by the Unified PD Rating Scale (UPDRS). A time-dependent Cox model was used to examine the effect of demographic and clinical outcome measures as predictors of investigator-determined time to need for symptomatic therapy for PD. RESULTS A total of 114 (27.6%) subjects screened positive for depression during the average 14.6 months of follow-up. Forty percent of these subjects were neither treated with antidepressants nor referred for further psychiatric evaluation. Depression, as assessed by the GDS-15, was a significant predictor of more impairment in ADLs (p < 0.0001) and increased need for symptomatic therapy of PD (hazard ratio = 1.86; 95% CI 1.29, 2.68). CONCLUSIONS Clinically important depressive symptoms are common in early Parkinson disease (PD), but are often not treated. Depressive symptoms are an important contributor to disability and the decision to start symptomatic therapy for motor-related impairment in early PD, highlighting the broad importance of identifying and treating depression in this population.
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Affiliation(s)
- B Ravina
- Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
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Rommelfanger KS, Weinshenker D. Norepinephrine: The redheaded stepchild of Parkinson's disease. Biochem Pharmacol 2007; 74:177-90. [PMID: 17416354 DOI: 10.1016/j.bcp.2007.01.036] [Citation(s) in RCA: 180] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Revised: 01/27/2007] [Accepted: 01/29/2007] [Indexed: 01/12/2023]
Abstract
Parkinson's disease (PD) affects approximately 1% of the world's aging population. Despite its prevalence and rigorous research in both humans and animal models, the etiology remains unknown. PD is most often characterized by the degeneration of dopamine (DA) neurons in the substantia nigra pars compacta (SNc), and models of PD generally attempt to mimic this deficit. However, PD is a true multisystem disorder marked by a profound but less appreciated loss of cells in the locus coeruleus (LC), which contains the major group of noradrenergic neurons in the brain. Historic and more recent experiments exploring the role of norepinephrine (NE) in PD will be analyzed in this review. First, we examine the evidence that NE is neuroprotective and that LC degeneration sensitizes DA neurons to damage. The second part of this review focuses on the potential contribution of NE loss to the behavioral symptoms associated with PD. We propose that LC loss represents a crucial turning point in PD progression and that pharmacotherapies aimed at restoring NE have important therapeutic potential.
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Affiliation(s)
- K S Rommelfanger
- Department of Human Genetics, Emory University, Atlanta, GA 30322, United States
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Miller KM, Okun MS, Fernandez HF, Jacobson CE, Rodriguez RL, Bowers D. Depression symptoms in movement disorders: Comparing Parkinson's disease, dystonia, and essential tremor. Mov Disord 2007; 22:666-72. [PMID: 17266084 DOI: 10.1002/mds.21376] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Depression is common in Parkinson's disease (PD) and affects 30 to 50% of all patients. In contrast to the wealth of research on depression in PD, little is known about the occurrence of depression in other movement disorders. The primary objective of the current study was to determine whether the high prevalence of depression symptoms seen in PD is also found in other movement disorders, by directly comparing rates of specific depression symptoms and depression severity across PD, dystonia, and essential tremor (ET). Three hundred and fifty-four patients with PD, 83 patients with dystonia, and 53 patients with ET completed the Beck Depression Inventory (BDI). We found no significant between-groups differences for depression severity, frequency, or endorsement of specific depression symptoms. Forty-eight percent of PD patients, 37.3% of dystonia patients, and 34% of ET patients were found to be at least mildly depressed (BDI score of 10 or higher). The most commonly endorsed symptoms were fatigability, difficulty with work, anhedonia, and sleep disturbance. Clinicians should be aware that depression is a frequent problem in dystonia and ET, in addition to PD, and inquire about depression symptoms in these patients so that they can be appropriately treated.
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Affiliation(s)
- Kimberly M Miller
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32608, USA.
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