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Azizifar N, Mohaddes G, Keyhanmanesh R, Athari SZ, Alimohammadi S, Farajdokht F. Intranasal AdipoRon Mitigated Anxiety and Depression-Like Behaviors in 6-OHDA-Induced Parkinson 's Disease Rat Model: Going Beyond Motor Symptoms. Neurochem Res 2024; 49:3030-3042. [PMID: 39096412 DOI: 10.1007/s11064-024-04223-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/02/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024]
Abstract
Depression and anxiety are prevalent neuropsychiatric conditions among patients with Parkinson's disease (PD), which may manifest prior to motor symptoms. As levodopa, a prominent treatment for PD motor symptoms, provides few benefits for mood-related abnormalities, tackling non-motor symptoms is particularly important. AdipoRon (Ad), an adiponectin agonist, has demonstrated neuroprotective effects by suppressing neuroinflammatory responses and activating the AMPK/Sirt-1 signaling pathway. This study looked at the potential advantages and underlying mechanisms of intranasal Ad in a rat model of PD induced by 6-hydroxydopamine (6-OHDA). We found that Ad at doses of 1 and 10 µg for 21 days exhibited anxiolytic- and antidepressant effects in the open field (OF) test, elevated plus maze (EPM), sucrose splash test, and forced swimming test in a PD model caused by a unilateral 6-OHDA injection into the medial forebrain bundle (MFB). The Ad also lowered the levels of corticosterone in the blood, decreased inflammasome components (NLRP3, caspase 1, and IL-1β), and increased Sirt-1 protein levels in the prefrontal cortex (PFC) of PD rats. We conclude that Ad ameliorates anxious and depressive-like behaviors in the PD rat model through stimulating the AMPK/Sirt-1 signaling and blocking the NLRP3 inflammasome pathways in the PFC.
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Affiliation(s)
- Negin Azizifar
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Gisou Mohaddes
- Department of Biomedical Education, College of Osteopathic Medicine, California Health Sciences University, Clovis, CA, USA
| | - Rana Keyhanmanesh
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Zanyar Athari
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soraya Alimohammadi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fereshteh Farajdokht
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Qin Y, Li J, Quan W, Song J, Xu J, Chen J. Risk of Parkinson's disease and depression severity in different populations: A two-sample Mendelian randomization analysis. Brain Behav 2024; 14:e3642. [PMID: 39219304 PMCID: PMC11366827 DOI: 10.1002/brb3.3642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/25/2024] [Accepted: 07/12/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Depression is widely recognized as a common non-motor symptom of Parkinson's disease (PD). Across different studies, the reported prevalence of depression in PD varies widely, ranging from 2.7% to 90%, but it is unclear whether this association is due to genetic or acquired factors. Whether there is a causal relationship remains unknown. The aim of this study was to use a two-sample Mendelian randomization (MR) approach to investigate the causal effect of PD on depression. METHODS Analyses were conducted separately for individuals of European and East Asian ancestry using publicly available summary data from genome-wide association studies. Depression was divided into two categories: ever depressed for a whole week and major depressive disorder (MDD). PD data were used as the exposure and were obtained from the International Parkinson's Disease Genomics Consortium and the BioBank Japan PheWeb, while depression data were used as the outcome and were obtained from the ntegrative Epidemiology Unit (IEU) Open GWAS Project(A public GWAS database) and the Psychiatric Genomics Consortium. The influence of PD on depression was assessed using inverse variance weighted (IVW), weighted median, MR-Egger, and weighted mode methods. Heterogeneity and pleiotropy were tested, and the results were validated using FinnGen GWAS data from version R9. RESULTS In individuals of European ancestry, there was a causal relationship between PD and ever depressed for a whole week (IVW method, odds ratio [OR] = 0.990; 95% CI, 0.984-0.996; p = .002), but no causal relationship was observed between PD and MDD (IVW method, OR = 0.974; 95% CI, 0.942-1.009; p = .141). In individuals of East Asian ancestry, no causal relationship was observed between PD and ever depressed for a whole week (IVW method, OR = 1.001; 95% CI, 0.829-1.209; p = .990) and between PD and MDD (IVW method, OR = 1.017; 95% CI, 0.982-1.052; p = .342). The results of the three additional analysis methods were similar to those of the IVW method, and there was no heterogeneity according to Cochran's Q-test. There was no evidence of pleiotropy based on MR-Egger intercept test and MR-PRESSO. The FinnGen validation dataset supported these findings. The results are stable and reliable. CONCLUSION The observed increase in depression among PD patients could potentially be attributed to modifiable acquired factors. Consequently, there is an urgent need to strengthen the management of PD patients in order to prevent the development of depression in the future.
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Affiliation(s)
- Yidan Qin
- Department of NeurologyChina‐Japan Union Hospital of Jilin UniversityChangchunChina
| | - Jia Li
- Department of NeurologyChina‐Japan Union Hospital of Jilin UniversityChangchunChina
| | - Wei Quan
- Department of NeurologyChina‐Japan Union Hospital of Jilin UniversityChangchunChina
| | - Jia Song
- Department of NeurologyChina‐Japan Union Hospital of Jilin UniversityChangchunChina
| | - Jing Xu
- Department of NeurologyChina‐Japan Union Hospital of Jilin UniversityChangchunChina
| | - Jiajun Chen
- Department of NeurologyChina‐Japan Union Hospital of Jilin UniversityChangchunChina
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3
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Weise D, Claus I, Dresel C, Kalbe E, Liepelt-Scarfone I, Lorenzl S, Redecker C, Urban PP. Multidisciplinary care in Parkinson's disease. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02807-w. [PMID: 39039238 DOI: 10.1007/s00702-024-02807-w] [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: 06/21/2024] [Accepted: 07/07/2024] [Indexed: 07/24/2024]
Abstract
Parkinson's Disease (PD) is a multifaceted and progressive disorder characterized by a diverse range of motor and non-motor symptoms. The complexity of PD necessitates a multidisciplinary approach to manage both motor symptoms, such as bradykinesia, gait disturbances and falls, and non-motor symptoms, including cognitive dysfunction, sleep disturbances, and mood disorders, which significantly affect patients' quality of life. Pharmacotherapy, particularly dopaminergic replacement therapy, has advanced to alleviate many symptoms. However, these medications can also induce side effects or aggravate symptoms like hallucinations or orthostatic dysfunction, highlighting the need for comprehensive patient management. The optimal care for PD patients involves a team of specialists, including neurologists, physical and occupational therapists, speech-language pathologists, psychologists, and other medical professionals, to address the complex and individualized needs of each patient. Here, we illustrate the necessity of such a multidisciplinary approach in four illustrative PD cases with different disease stages and motor and non-motor complications. The patients were treated in different treatment settings (specialized outpatient clinic, day clinic, inpatient care including neurorehabilitation). The biggest challenge lies in organizing and implementing such comprehensive care effectively across different clinical settings.
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Affiliation(s)
- David Weise
- Department of Neurology, Asklepios Fachklinikum Stadtroda, Stadtroda, Germany.
- Department of Neurology, University of Leipzig, Leipzig, Germany.
| | - Inga Claus
- Department of Neurology with Institute of Translational Neurology, University Hospital of Münster, 48149, Münster, Germany
| | - Christian Dresel
- Department of Neurology, Section for Movement Disorders and Neurostimulation, Neuroimaging Center Mainz, Universitätsmedizin Mainz, Mainz, Germany
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne and Medical Faculty, University of Cologne, Cologne, Germany
| | - Inga Liepelt-Scarfone
- German Center for Neurodegenerative Diseases (DZNE) and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, IB-Hochschule, Tübingen, Stuttgart, Germany
| | - Stefan Lorenzl
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
- Department of Neurology, Department of Palliative Care, Hospital Agatharied, Hausham, Germany
- Clinic of Palliative Care, Ludwig Maximilians University, Munich, Germany
| | - Christoph Redecker
- Department of Neurology, Klinikum Lippe Lemgo, Rintelner Str. 85, D-32657, Lemgo, Germany
| | - Peter P Urban
- Department of Neurology, Asklepios Klinik Barmbek, Hamburg, Germany
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4
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Gao R, Zhao P, Yan K. Selective Serotonin Reuptake Inhibitors for the Treatment of Depression in Parkinson's Disease: A Systematic Review and Meta-Analysis. Clin Drug Investig 2024; 44:459-469. [PMID: 38960993 DOI: 10.1007/s40261-024-01378-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Although selective serotonin reuptake inhibitors (SSRIs) are usually considered safe to use in patients with Parkinson's disease (PD), there are mixed data about their effectiveness, and only a few investigations have led to a total improvement of depressive symptoms in patients with PD. OBJECTIVES We aimed to conduct a comprehensive systematic review and meta-analysis of all studies that investigated the effectiveness of SSRIs in treating depression in the context of PD. METHODS From its commencement to June 2024, the databases of MEDLINE via PubMed, Scopus, Embase, and Google Scholar were electronically searched for the relevant papers. All full-text journal articles assessing the effectiveness of SSRIs in treating depression in patients with PD were included. The tool developed by the Cochrane Collaboration was utilized to evaluate the bias risk. Data were analyzed utilizing a pair-wise comparison meta-analysis using the standardized mean difference. RESULTS A total of 19 articles and 22 separate interventions were included. We found that SSRI treatment attenuated depression in patients with PD (1.242 standardized mean difference, 95% confidence interval 0.956, 1.529, p < 0.001). The general heterogeneity of the studies was medium (ϰ2 = 72.818, T2 = 0.317, df = 21, I2 = 71.15%, p < 0.001). The funnel plot was reasonably symmetrical. However, three studies were trimmed to the left of the mean. Begg's test (p = 0.080), Egger's test (p = 0.121), and funnel plot showed no significant risk of publication bias. The meta-regression showed that the treatment effect increased as a function of paroxetine treatment duration (slope p = 0.001) but decreased as a function of sertraline treatment duration (slope p = 0.019). CONCLUSIONS There are few controlled antidepressant trials on the PD population, even though patients with PD frequently experience depression and use antidepressants. Clinical studies that are larger and better structured are needed in the future to determine if antidepressants are useful for treating patients with PD with depression.
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Affiliation(s)
- Renjie Gao
- Department of Graduate School, Shandong First Medical University (Shandong Academy of Medical Science), Jinan, 250117, Shandong, China
| | - Panpan Zhao
- Internal Medicine, People's Hospital of Sishui County, Sishui, 273200, Shandong, China
| | - Kai Yan
- Internal Medicine, People's Hospital of Sishui County, Sishui, 273200, Shandong, China.
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5
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Zhang A, Song Z, Di A, Zhou Z, Zheng L, Zhuang L. Acupuncture for the Treatment of Neuropsychiatric Symptoms in Parkinson's Disease: A Systematic Review and Meta-Analysis. Complement Ther Med 2024; 80:103020. [PMID: 38185400 DOI: 10.1016/j.ctim.2024.103020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/06/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPSs) of Parkinson's disease (PD) have received increasing attention, but effective treatment options remain limited. Acupuncture may have clinical benefits for NPSs in PD patients, but high-quality evidence supporting this possibility still needs to be discovered. Therefore, we conducted a meta-analysis to evaluate the effect of acupuncture treatment on NPSs in PD patients. METHODS Randomized controlled trials (RCTs) of acupuncture treatment for PD retrieved from the following electronic databases: PubMed, Embase, Cochrane Library, Web of Science, and Scopus, were used to evaluate NPSs of PD patients. The Cochrane Intervention System Evaluation Manual assessed the methodological quality. RESULTS A total of 13 RCTs involving 719 patients were included. The results showed that compared with medication alone or sham acupuncture, acupuncture improved sleep quality in PD patients, with Parkinson's Disease Sleep Scale (PDSS) [standardized mean difference (SMD)= 0.48, 95% confidence interval (CI)= 0.242 to 0.793, P = 0.001]. The I scores and total scores on Unified Parkinson's Disease Rating Scale (UPDRS) indicated acupuncture treatment was effective (SMD=-0.66, 95%CI=-0.66 to -0.18, P = 0.042; SMD=-0.77, 95%CI=-1.31 to -0.23, P = 0.005). Results of the Epworth Sleepiness Scale (ESS) and Parkinson's Disease Questionnaire-39 (PDQ-39) showed no statistically significant differences (SMD=-0.27, 95%CI=-0.08 to 0.62, P = 0.128; SMD=-0.20, 95%CI=-0.42 to 0.01, P = 0.554). Anxiety and depression research had no significant differences due to the excessive inter-study bias. CONCLUSION Acupuncture treatment can improve sleep quality, psychological and behavioral alterations, and the overall condition of PD patients. However, the study revealed no significant positive intervention effects on anxiety, depression, and quality of life, underscoring the necessity for continued research to elucidate these domains' intricacies and develop productive therapeutic approaches.
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Affiliation(s)
- Anxin Zhang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Zefeng Song
- Medical Department, Dalian University of Technology, Dalian 116024, China
| | - Anqi Di
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Zelin Zhou
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Liang Zheng
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Lixing Zhuang
- Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
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6
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Zhou T, Wei B, Hu Y, Zhou X, Cai X, Shi X. Causal association between atopic dermatitis and Parkinson's disease: A bidirectional Mendelian randomization study. Brain Behav 2024; 14:e3468. [PMID: 38468488 PMCID: PMC10928334 DOI: 10.1002/brb3.3468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Atopic dermatitis is one of the most common skin disorders. Evidence has suggested an association between skin disorders, such as atopic dermatitis, and Parkinson's disease (PD). However, whether atopic dermatitis has a causal effect on PD remains unknown. METHODS The study aimed to determine whether their association between atopic dermatitis and PD is causal, using a bidirectional two-sample Mendelian randomization method. Genetic variants from the public genome-wide association studies for atopic dermatitis (n = 10788 cases and 30047 controls) were selected to evaluate their causal effects on the risk of PD (33,674 cases and 449,056 controls). The inverse variance weighted (IVW) method was used as the primary analysis. RESULTS The IVW results indicated that atopic dermatitis was associated with decreased risk of PD {fixed effects: odds ratio [OR] [95% confidence interval (CI)]: .905 [.832-.986], p = .022; OR [95% CI]: .905 [.827-.991], p = .032}. However, we failed to detect the causal effects of PD on risk of atopic dermatitis in the reverse causation analysis. CONCLUSION This study indicated causal association of genetically proxied atopic dermatitis with the risk of PD. Future studies are warranted to explore the underlying mechanism and investigate the targeting effect of atopic dermatitis on PD.
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Affiliation(s)
- Taofeng Zhou
- Department of NeurologyYijishan Hospital, Wannan Medical CollegeWuhuChina
| | - Baohao Wei
- Department of NeurologyYijishan Hospital, Wannan Medical CollegeWuhuChina
| | - Yachun Hu
- Department of NeurologyThe Affiliated Brain Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Xiaoming Zhou
- Department of NeurologyThe Affiliated Brain Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Xiaoying Cai
- Department of AnesthesiologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Xiaolei Shi
- Geriatric Neuroscience CenterThe Affiliated Brain Hospital of Guangzhou Medical UniversityGuangzhouChina
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental DisordersGuangzhouChina
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of ChinaGuangzhou Medical UniversityGuangzhouChina
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7
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Hinkle JT, Mills KA, Morrow CB, Pontone GM. Anxiety Change After Dopamine Therapy in Parkinson Disease is Independent of Motor Improvement. Am J Geriatr Psychiatry 2024; 32:220-229. [PMID: 37867011 PMCID: PMC10846408 DOI: 10.1016/j.jagp.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Several anxiety syndromes have been associated with Parkinson disease (PD), but their interactions with dopamine replacement therapy (DRT) and motor function dynamics are not completely understood. We sought to delineate how DRT impacts anxiety phenomenology in PD and whether these changes are dissociable from improved motoric function. METHODS We compared anxiety responses to DRT in two cohorts: 1) a study of 200 PD participants who completed neuropsychiatric assessments before and after taking their dopaminergic medications ("On-Off"); 2) participants in the Parkinson's Progression Markers Initiative (PPMI) de novo PD cohort who completed the State-Trait Anxiety Inventory (STAI) at the time of DRT initiation and a subsequent study visit (n = 113, mean 8-month interval). RESULTS Among On-Off participants transitioning acutely to the On-state, scores on the Hamilton anxiety rating scale decreased by 37% (t = 14.8, df = 199, p <0.0001). Among PPMI participants, STAI-state scores decreased by 10.4% following DRT initiation (t = 4.5, df = 112, p <0.0001). Item-level anxiety changes exhibited weak and nonsignificant correlations (Spearman ρ: -0.24 to 0.33) with objective MDS-UPDRS motor improvements in both immediate and sustained dopamine replacement contexts. CONCLUSION Dopamine repletion effected immediate relief of anxiety in an On-Off state comparison. A similar benefit was observed in the longitudinal PPMI cohort by comparing anxiety before and after DRT initiation, suggesting DRT confers sustained anxiolytic effects in early PD. The weak correlations between improvements to anxiety and motor function on both timescales support the view that these changes are not mediated by improved motor function.
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Affiliation(s)
- Jared T Hinkle
- Medical Scientist Training Program (JTH), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Behavioral Sciences (JTH, CBM), Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Kelly A Mills
- Department of Neurology (KAM, GMP), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher B Morrow
- Department of Psychiatry and Behavioral Sciences (JTH, CBM), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences (JTH, CBM), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (KAM, GMP), Johns Hopkins University School of Medicine, Baltimore, MD
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van Wegen EEH, van Balkom TD, Hirsch MA, Rutten S, van den Heuvel OA. Non-Pharmacological Interventions for Depression and Anxiety in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024; 14:S135-S146. [PMID: 38607762 PMCID: PMC11380297 DOI: 10.3233/jpd-230228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Non-pharmacological interventions, including cognitive-behavioral therapy (CBT), non-invasive brain stimulation (NIBS), electroconvulsive therapy (ECT), light therapy (LT), and physical rehabilitation/exercise, have shown promise as effective approaches to treat symptoms of depression and anxiety in individuals with Parkinson's disease (PD). In this narrative literature overview, we discuss the state-of-the-art regarding these treatment options and address future perspectives for clinical practice and research. Non-pharmacological interventions hold promise to treat depression and anxiety in PD. There is meta-analytic evidence for the efficacy of CBT, NIBS, ECT, LT, and exercise on improving depressive symptoms. For the treatment of anxiety symptoms, CBT shows large effects but scientific evidence of other non-pharmacological interventions is limited. Importantly, these treatments are safe interventions with no or mild side-effects. More research is needed to tailor treatment to the individuals' needs and combined interventions may provide synergistic effects.We conclude that non-pharmacological interventions should be considered as alternative or augmentative treatments to pharmacological and neurosurgical approaches for the treatment of depression and anxiety in individuals with PD.
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Affiliation(s)
- Erwin E H van Wegen
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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| | - Tim D van Balkom
- Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention, Neurodegeneration, Amsterdam, The Netherlands
| | - Mark A Hirsch
- Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Atrium Health Carolinas Rehabilitation, Charlotte, NC, USA
- Department of Orthopedic Surgery and Rehabilitation, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sonja Rutten
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention, Neurodegeneration, Amsterdam, The Netherlands
| | - Odile A van den Heuvel
- Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention, Neurodegeneration, Amsterdam, The Netherlands
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Roper A, Pacas Fronza G, Dobkin RD, Beaudreau SA, Mitchell LK, Pachana NA, Thangavelu K, Dissanayaka NN. A Systematic Review of Psychotherapy Approaches for Anxiety in Parkinson's Disease. Clin Gerontol 2024; 47:188-214. [PMID: 35634720 DOI: 10.1080/07317115.2022.2074814] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Anxiety is common in Parkinson's disease (PD), negatively impacting daily functioning and quality of life in PD patients and their families. This systematic review evaluates the effectiveness of different psychotherapeutic approaches for reducing anxiety in PD and provides recommendations for clinical practise. METHODS Following PRISMA guidelines, 36 studies were included and risk of bias was evaluated. RESULTS We identified cognitive behavioral therapy (CBT), mindfulness-based therapies, acceptance and commitment therapy, and psychodrama psychotherapies. There is good evidence-base for anxiety reduction using CBT approaches, but with mixed results for mindfulness-based therapies. Other therapeutic approaches were under researched. Most randomized control trials examined anxiety as a secondary measure. There was a paucity of interventions for anxiety subtypes. Secondarily, studies revealed the consistent exclusion of PD patients with cognitive concerns, an importance of care partner involvement, and a growing interest in remote delivery of psychotherapy interventions. CONCLUSIONS Person-centered anxiety interventions tailored for PD patients, including those with cognitive concerns, and trials exploring modalities other than CBT, warrant future investigations. CLINICAL IMPLICATIONS Practitioners should consider PD-specific anxiety symptoms and cognitive concerns when treating anxiety. Key distinctions between therapeutic modalities, therapy settings and delivery methods should guide treatment planning.
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Affiliation(s)
- Amy Roper
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Gabriela Pacas Fronza
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Roseanne D Dobkin
- Department of Psychiatry, Rutgers University, Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Sherry A Beaudreau
- School of Psychology, The University of Queensland, Brisbane, Australia
- Sierra Pacific Mental Illness Research, Education, and Clinical Centers (MIRECC), Palo Alto Veterans Administration Health Care System & Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | | | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Karthick Thangavelu
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, Australia
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10
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Subramanian I, Pushparatnam K, McDaniels B, Mathur S, Post B, Schrag A. Delivering the diagnosis of Parkinson's disease- setting the stage with hope and compassion. Parkinsonism Relat Disord 2024; 118:105926. [PMID: 38129230 DOI: 10.1016/j.parkreldis.2023.105926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Indu Subramanian
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA; Parkinson's Disease Research, Education, and Clinical Center (PADRECC), Veterans Administration Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | | | - Bradley McDaniels
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, USA
| | | | - Bart Post
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Anette Schrag
- UCL Queen Square Institute of Neurology, University College London, London, UK.
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Lovegrove CJ, Sturkenboom IH, Marsden J, Bannigan K. Concept Mapping to Define Components for an Occupation-Based Intervention for Parkinson's Disease and Anxiety. JOURNAL OF PARKINSON'S DISEASE 2024; 14:181-195. [PMID: 38160365 PMCID: PMC10836548 DOI: 10.3233/jpd-230150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Anxiety, a common symptom of Parkinson's disease (PD), results in reduced life quality, reduced participation in meaningful roles and daily activities, and increased health burden. There are no evidence-based interventions to reduce the impact of anxiety in PD on participation. OBJECTIVE This study aimed to identify the key components required for the co-production of an occupation- and community-based intervention for people with PD-related anxiety. METHODS A participatory mixed-methods research study was conducted using online Group Concept Mapping methodology that included five stages: brainstorming, idea synthesis, sorting activity, rating activity, and analysis. A cluster map, pattern match, and 'go-zone' charts were created through multivariate statistical analysis based on participants' responses. The stages were guided by questions generated by the research team working with stakeholders. RESULTS Eighty-three people participated, with 64 taking part in more than one activity. Participants included people with PD (n = 72), care partners (n = 6), and occupational therapists (n = 5). The final map contained 119 statements with eight clusters (stress value 0.252): exercise, lifestyle changes, self-help, coping, access to information, professional help, peers and groups, support from others. Significant agreement existed between the importance and feasibility rating activities (r = -0.07). 'Go-zone' charts highlighted the priority statements for intervention development. CONCLUSIONS This novel participatory study highlighted priority components that provide starting points for future development of an occupation- and community-based intervention for people with PD-related anxiety.
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Affiliation(s)
- Christopher J. Lovegrove
- School of Health Professions, Faculty of Health & Human Sciences, University of Plymouth, Plymouth, UK
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Ingrid H.W.M. Sturkenboom
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jonathan Marsden
- School of Health Professions, Faculty of Health & Human Sciences, University of Plymouth, Plymouth, UK
| | - Katrina Bannigan
- Department of Occupational Therapy, and Human Nutrition and Dietetics, School of health Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
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12
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Morrow CB, Hinkle JT, Seemiller J, Mills KA, Pontone GM. Examining the link between impulse control disorder and antidepressant use in Parkinson's disease. Parkinsonism Relat Disord 2023; 117:105918. [PMID: 37922636 PMCID: PMC10842227 DOI: 10.1016/j.parkreldis.2023.105918] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Impulse control disorders (ICD) in Parkinson's disease (PD) and hypomanic episodes of bipolar disorder show overlapping symptoms, suggesting a shared neurobiology. To explore this, the following hypotheses are tested: (1) larger changes in affective symptoms from OFF to ON medication states will be associated with ICD, (2) antidepressant exposure will be associated with larger OFF to ON affective symptom changes, and (3) antidepressant exposure will be associated with ICD. METHODS 200 participants (mean age 65, 61 % male) were evaluated in "off" and "on" dopamine states. Affective symptoms were captured using the Hamilton Anxiety and Depression Rating Scales. Differences in clinical outcomes were compared using two-sample Wilcoxon rank-sum tests and Pearson χ2 tests. We performed multivariable logistic regression to assess the association of antidepressant exposure on ICD. RESULTS Participants with an ICD had higher anxiety and depressive scores in "on" and "off" states and larger changes in depressive symptoms from OFF to ON states compared to those without an ICD. Participants on antidepressants had higher anxiety scores in "on" and "off" states, higher depressive scores in the "off" state, and larger changes in anxiety symptoms from OFF to ON states than those not on an antidepressant. Antidepressant use was associated with a higher odds of an ICD (OR 2.3, CI [1.0-4.5], p-value 0.04). CONCLUSIONS Affective symptom severity in "on" and "off" dopamine states is associated with ICD. Antidepressant therapy may be associated with ICD. Future prospective studies clarifying temporal associations between antidepressant initiation and ICD emergence are needed.
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Affiliation(s)
- Christopher B Morrow
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA.
| | - Jared T Hinkle
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | - Joseph Seemiller
- Department of Neurology, Johns Hopkins University School of Medicine, USA
| | - Kelly A Mills
- Department of Neurology, Johns Hopkins University School of Medicine, USA
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
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13
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DeMarco EC, Zhang Z, Robinson H, Hinyard L. Anxiety in Parkinson's Patients: What's Timing Got to Do with It? J Geriatr Psychiatry Neurol 2023; 36:496-504. [PMID: 37839809 DOI: 10.1177/08919887231163293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background: Parkinson's Disease (PD) affects over 10 million people worldwide. Many PD patients experience comorbid anxiety disorders, which have been correlated with reduced quality of life and can manifest at any time during the course of PD, including prior to motor symptom onset. Purpose: Prior work has demonstrated that patients diagnosed with depression following a PD diagnosis are less likely to receive depression treatment, but no such study has been conducted for anxiety. Research Design: A cross-sectional analysis of secondary electronhic health record data was conducted. Study Sample: Data was obtained through Optum® de-identified Electronic Health Record dataset, using ICD-9 and ICD-10 diagnosis codes to determine PD status and comparing index date of anxiety and PD diagnoses to classify patients by relative time of diagnosis. Data Analysis: Multivariate logistic regression was performed to assess factors associated with receipt of mental health treatment. Results: Of PD patients with anxiety, 52% documented a diagnosis of anxiety prior to PD. Overall, 69% documented some treatment, with 79% of those diagnosed with anxiety prior to PD receiving some treatment compared to 59% of those diagnosed with anxiety on or after PD (P < 0.001). Conclusion: Patients with PD and subsequent anxiety diagnoses are less likely to receive treatment. Further study could explore reasons for variations in mental health care within the context of an existing PD diagnosis.
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Affiliation(s)
- Elisabeth C DeMarco
- Department of Health & Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA
- Advanced HEAlth Data (AHEAD) Institute, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Zidong Zhang
- Department of Health & Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA
- Advanced HEAlth Data (AHEAD) Institute, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Hunter Robinson
- Department of Health & Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA
- Advanced HEAlth Data (AHEAD) Institute, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Leslie Hinyard
- Department of Health & Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA
- Advanced HEAlth Data (AHEAD) Institute, Saint Louis University School of Medicine, St. Louis, MO, USA
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14
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Ning H, Zhou H, Yang N, Ren J, Wang H, Liu W, Zhao Y. Effect of Zishen pingchan granules combined with pramipexole on serum BDNF, IL-1β, IL-6, CRP, TNF-α levels in depressed patients with Parkinson's disease: Results of a randomized, double-blind, controlled study. Exp Gerontol 2023; 182:112295. [PMID: 37734668 DOI: 10.1016/j.exger.2023.112295] [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: 08/05/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Depression is a common comorbidity in Parkinson's Disease (PD) and treatment of depression can significantly support PD management. Zishen pingchan granules (ZPG), a traditional Chinese herbal formula, may help ameliorate depressive symptoms in PD patients. However, the molecular mechanisms underlying the effects of ZPG remain unclear. This study aimed to investigate the impact of ZPG on serum levels of brain-derived neurotrophic factor (BDNF), interleukin-1β (IL-1β), interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α) in PD patients with depression. METHODS Eighty PD patients treated with pramipexole but still experiencing mild to moderate depression symptoms were randomly allocated to a group receiving 12-week ZPG treatment (n = 40) or placebo (n = 40). The Hamilton Depression Scale 17 items (HAM-D-17) was utilized to evaluate changes in depressive symptoms from baseline over 12 weeks, while the Unified Parkinson's Disease Rating Scales (UPDRS) part 3 was employed to assess changes in motor symptoms over the same duration. Serum levels of BDNF, IL-1β, IL-6, CRP, and TNF-α were measured at baseline and post-treatment. RESULTS Seventy-one participants completed the study. Following treatment, both groups showed significantly reduced HAMD scores. The placebo group demonstrated a decrease in BDNF levels, while the ZPG group showed an increase in IL-6 levels post-treatment. In the examination of the group-time interaction, the ZPG group exhibited a greater decrease in HAMD scores and increase in IL-6 levels compared to the placebo group. Conversely, the placebo group showed a greater decrease in BDNF levels compared to the ZPG group. However, no significant group differences were observed in UPDRS part 3 change scores or serum levels of IL-1β, CRP, or TNF-α change from baseline. CONCLUSION ZPG may potentially ameliorate depressive symptoms in PD patients, with the potential mechanism involving mitigation of reductions in serum BDNF level and an increase in IL-6 level.
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Affiliation(s)
- Houxu Ning
- Department of Neurology, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China; Department of Chinese Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Zhou
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ning Yang
- Department of Chinese Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jingru Ren
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Haidong Wang
- Department of Chinese Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Weiguo Liu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
| | - Yang Zhao
- Department of Neurology, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China.
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Stocchi F, Angelo Antonini, Barone P, Bellelli G, Fagiolini A, Ferini Strambi L, Sorbi S, Padovani A. Exploring depression in Parkinson's disease: an Italian Delphi Consensus on phenomenology, diagnosis, and management. Neurol Sci 2023; 44:3123-3131. [PMID: 37100925 PMCID: PMC10415449 DOI: 10.1007/s10072-023-06740-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/05/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Depression is a prodromic and a frequent non-motor symptom of Parkinson's disease, associated to reduced quality of life and poor outcomes. The diagnosis of depression in parkinsonian patients represents a challenge due to the overlapping of symptoms typical of the two conditions. METHODS A Delphi panel survey was performed to reach a consensus amongst different Italian specialists on four main topics: the neuropathological correlates of depression, main clinical aspects, diagnosis, and management of depression in Parkinson's disease. RESULTS AND CONCLUSION Experts have recognized that depression is an established risk factor of PD and that its anatomic substrate is related to the neuropathological abnormalities typical of the disease. Multimodal and SSRI antidepressant have been confirmed as a valid therapeutic option in the treatment of depression in PD. Tolerability, safety profile, and potential efficacy on broad spectrum of symptoms of depression including cognitive symptoms and anhedonia should be considered when selecting an antidepressant and the choice should be tailored on the patients' characteristics.
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Affiliation(s)
- Fabrizio Stocchi
- University San Raffaele Rome and IRCCS San Raffaele, Rome, Italy.
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Center for Neurodegenerative Diseases (CENSE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Paolo Barone
- Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Salerno, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, 20126, Milan, Italy
- Acute Geriatric Unit, IRCCS San Gerardo, 20900, Monza, Italy
| | - Andrea Fagiolini
- Department of Molecular and Developmental Medicine, University of Siena, School of Medicine, Siena, Italy
| | - Luigi Ferini Strambi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology-Sleep Disorders Centre, Milan, Italy
- Vita-Salute" San Raffaele University, Milan, Italy
| | - Sandro Sorbi
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
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16
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Jiang LL, Wu YL, Mo Y, Gou L, Chen ML, Wang Y, Zang QM, Jiang DQ. The effects of paroxetine therapy on depressive symptom and motor function in the treatment of depression with Parkinson's disease: A meta-analysis. Medicine (Baltimore) 2023; 102:e34687. [PMID: 37653795 PMCID: PMC10470685 DOI: 10.1097/md.0000000000034687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 06/23/2023] [Accepted: 07/20/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Paroxetine therapy has been used for treatment of patients with depression and Parkinson's disease (dPD) in many clinical studies, but, the effects of paroxetine in dPD patients are not completely understood. The aim of this study was to systematically evaluate the effects of paroxetine therapy on depressive symptom and motor function in the treatment of dPD, in order to confer a reference for clinical practice. METHODS Randomized controlled trials (RCTs) of paroxetine for dPD published up to October, 2022 were retrieved. Standardised mean difference (SMD), odds ratio (OR), and 95% confidence interval (CI) were calculated and heterogeneity was measured with the I2 test. The outcomes of interest were as follows: the efficacy, Hamilton depression rating scale score, unified Parkinson's disease rating scale score, Hamilton anxiety rating scale score or adverse events. RESULTS Thirty-four RCTs with 2819 participants were included. Compared with control group, the pooled effects of paroxetine therapy on depression were (22 trials; OR 3.62, 95% CI 2.63 to 4.98, P < .00001) for antidepressant response (25 trials; SMD -2.14, 95% CI -2.73 to -1.56, P < .00001) for Hamilton depression rating scale score, the pooled effects of paroxetine therapy on motor function were (10 trials; OR 4.63, 95% CI 3.15 to 6.79, P < .00001) for anti-PD efficacy (18 trials; SMD -2.02, 95% CI -2.48 to -1.55, P < .00001) for total unified Parkinson's disease rating scale score. The Hamilton anxiety rating scale score showed significant decrease in the paroxetine treatment group compared to control group (10 trials; SMD -1.93, 95% CI -2.65 to -1.22, P < .00001). In addition, paroxetine therapy reduced the number of any adverse events obviously in dPD patients (twenty trials; OR 0.42, 95% CI 0.31 to 0.57, P < .00001). CONCLUSIONS Paroxetine therapy has clinical benefits for improvement of depressive symptom and motor function in dPD patients, moreover, it is of high drug safety. Further well-designed, multi-center RCTs needed to identify these findings.
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Affiliation(s)
- Li-Lin Jiang
- Department of Biology and Pharmacy, Guangxi Key Laboratory of Agricultural Resources Chemistry and Biotechnology, Yulin Normal University, Yulin, China
| | - Yu-Lin Wu
- Department of Biology and Pharmacy, Guangxi Key Laboratory of Agricultural Resources Chemistry and Biotechnology, Yulin Normal University, Yulin, China
| | - Ye Mo
- Department of Biology and Pharmacy, Guangxi Key Laboratory of Agricultural Resources Chemistry and Biotechnology, Yulin Normal University, Yulin, China
| | - Ling Gou
- Department of Biology and Pharmacy, Guangxi Key Laboratory of Agricultural Resources Chemistry and Biotechnology, Yulin Normal University, Yulin, China
| | - Mei-Ling Chen
- Department of Biology and Pharmacy, Guangxi Key Laboratory of Agricultural Resources Chemistry and Biotechnology, Yulin Normal University, Yulin, China
| | - Yan Wang
- Department of Pharmacy, Guangdong Province Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, China
| | - Qing-Min Zang
- Department of Biology and Pharmacy, Guangxi Key Laboratory of Agricultural Resources Chemistry and Biotechnology, Yulin Normal University, Yulin, China
| | - De-Qi Jiang
- Department of Biology and Pharmacy, Guangxi Key Laboratory of Agricultural Resources Chemistry and Biotechnology, Yulin Normal University, Yulin, China
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17
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Yang X, He X, Xu S, Zhang Y, Mo C, Lai Y, Song Y, Yan Z, Ai P, Qian Y, Xiao Q. Effect of Lacticaseibacillus paracasei strain Shirota supplementation on clinical responses and gut microbiome in Parkinson's disease. Food Funct 2023; 14:6828-6839. [PMID: 37470081 DOI: 10.1039/d3fo00728f] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disease characterized by motor issues and a range of non-motor symptoms. Microbial therapy may be a useful approach for the treatment of PD. However, comprehensive analyses of the impact of probiotic supplementation on motor and non-motor symptoms are still lacking and the mechanisms whereby the treatment works remain unclear. This study investigated Lacticaseibacillus paracasei strain Shirota (LcS) supplementation on clinical responses, gut microbiota and faecal metabolites in PD patients. Patients (n = 128) were randomised to receive either probiotics (LcS-fermented milk, containing 1 × 1010 living LcS cells) or placebo for 12 weeks. All participants were examined and the basic clinical features were recorded using questionnaires. Fecal and blood samples were collected at the baseline and after 12 weeks for further omics analysis. We found that LcS intervention significantly alleviated patients' constipation-related symptoms and non-motor symptoms. We found no significant shifts in the composition of gut microbiota or faecal metabolites. Several taxa were differentially abundant between the groups, especially with regard to LcS intake, which increased the abundance of the genus Lacticaseibacillus in the probiotic group compared with those at the baseline and in the placebo group. The faecal concentration of L-tyrosine was significantly decreased and the plasma concentration of L-tyrosine was increased in the probiotic group compared with the placebo group. Our study demonstrated that although supplementation with LcS did not induce major changes in the global gut microbiome, the probiotic had favorable effects in managing constipation and other non-motor symptoms in PD patients. This study was registered at the Chinese Clinical Trial Registry: ChiCTR1800016795.
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Affiliation(s)
- Xiaodong Yang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
| | - Xiaoqin He
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
| | - Shaoqing Xu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
| | - Yi Zhang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
| | - Chengjun Mo
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
| | - Yiqiu Lai
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
| | - Yanyan Song
- Department of Biostatistics, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Zheng Yan
- Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, PR China
| | - Penghui Ai
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
| | - Yiwei Qian
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
| | - Qin Xiao
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
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18
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Blundell EK, Grover LE, Stott J, Schrag A. The experience of Anxiety for people with Parkinson's disease. NPJ Parkinsons Dis 2023; 9:75. [PMID: 37198166 DOI: 10.1038/s41531-023-00512-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/13/2023] [Indexed: 05/19/2023] Open
Abstract
Anxiety is a common non-motor symptom of Parkinson's disease (PD) associated with increased disability and reduced quality of life. However, anxiety is poorly understood, underdiagnosed, and undertreated. To date, little research has explored how anxiety is experienced by patients themselves. This study explored the experience of anxiety for people with Parkinson's (PWP) to inform future research and interventions. Semi-structured interviews with 22 PWP (aged 43-80, 50% female) were conducted and analysed using inductive thematic analysis. Four main themes were extracted: conceptualising anxiety; anxiety and the body; anxiety and social identity; and coping with anxiety. Sub-themes revealed inconsistent perceptions: anxiety was in body and mind, part of disease and human nature, part of self-identity and a threat to it. The symptoms described were diverse. Many perceived their anxiety as more incapacitating than motor symptoms or capable of amplifying them, and described that anxiety restricted their lifestyle. All perceived anxiety as connected to PD, and ultimately persistent: dominant aspirations were coping and acceptance rather than cures, with medications strongly resisted. Findings highlight the complexity and high importance of anxiety for PWP. Implications for therapeutic approaches are discussed.
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Affiliation(s)
- Emma K Blundell
- Department of Clinical and Movement Neurosciences, University College London, London, UK
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Laura E Grover
- Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Joshua Stott
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, University College London, London, UK.
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19
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Jiang X, Zhang L, Liu H, Su H, Jiang J, Qiang C, Wang Q, Qu X, Sun W, Bi H. Efficacy of non-pharmacological interventions on depressive symptoms in patients with Parkinson's disease: a study protocol for a systematic review and network meta-analysis. BMJ Open 2023; 13:e068019. [PMID: 37130665 PMCID: PMC10163538 DOI: 10.1136/bmjopen-2022-068019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION Depression is the most dominant non-motor symptom of Parkinson's disease (PD), with a prevalence of up to 50%, and can lead to a range of psychiatric and psychological problems that can affect quality of life and overall functioning. While several randomised controlled trials (RCTs) have tested the effect of certain non-pharmacological interventions on the outcome of PD depression symptoms, the comparative benefits and harms of these remain unclear. We will conduct a systematic review and network meta-analysis to compare the efficacy and safety of different non-pharmacological interventions for patients with PD depression. METHODS AND ANALYSIS We will search PubMed, Web of Science, Cochrane, Embase, Google Scholar, the Chinese National Knowledge Infrastructure, the Chinese Biomedical Literature Database, WanFang Data and the Chongqing VIP Database from their inception date to June 2022. The studies will be limited to results published in English or Chinese. The primary outcomes will be the changes in the depressive symptoms, while secondary outcomes will include adverse effects and the quality of life. Two researchers will screen those documents that meet the inclusion criteria, extracting data according to the preset table and evaluating the methodological quality of the included studies using the Cochrane Risk of Bias 2.0 Tool. The STATA and ADDIS statistical software will be used to conduct a systematic review and network meta-analysis. A traditional pairwise meta-analysis and a network meta-analysis will be performed to compare the efficacy and safety of different non-pharmacological interventions, ensuring the robustness of the findings. The Grading of Recommendations Assessment, Development and Evaluation system will be used to assess the overall quality of the body of evidence associated with the main results. The publication bias assessment will be conducted using comparison-adjusted funnel plots. ETHICS AND DISSEMINATION All the data for this study will be extracted from published RCTs. As a literature-based systematic review, this study does not require ethical approval. The results will be disseminated through peer-reviewed journals and national/international conference presentations. PROSPERO REGISTRATION NUMBER CRD42022347772.
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Affiliation(s)
- Xiaoyu Jiang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Linlin Zhang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Huifen Liu
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Hang Su
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jiahui Jiang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Chen Qiang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Qing Wang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xinjie Qu
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Wenyu Sun
- Department of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, Shandong, China
| | - Hongyan Bi
- Department of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, Shandong, China
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20
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Hayley S, Vahid-Ansari F, Sun H, Albert PR. Mood disturbances in Parkinson's disease: From prodromal origins to application of animal models. Neurobiol Dis 2023; 181:106115. [PMID: 37037299 DOI: 10.1016/j.nbd.2023.106115] [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: 08/26/2022] [Revised: 03/09/2023] [Accepted: 04/05/2023] [Indexed: 04/12/2023] Open
Abstract
Parkinson's disease (PD) is a complex illness with a constellation of environmental insults and genetic vulnerabilities being implicated. Strikingly, many studies only focus on the cardinal motor symptoms of the disease and fail to appreciate the major non-motor features which typically occur early in the disease process and are debilitating. Common comorbid psychiatric features, notably clinical depression, as well as anxiety and sleep disorders are thought to emerge before the onset of prominent motor deficits. In this review, we will delve into the prodromal stage of PD and how early neuropsychiatric pathology might unfold, followed by later motor disturbances. It is also of interest to discuss how animal models of PD capture the complexity of the illness, including depressive-like characteristics along with motor impairment. It remains to be determined how the underlying PD disease processes contributes to such comorbidity. But some of the environmental toxicants and microbial pathogens implicated in PD might instigate pro-inflammatory effects favoring α-synuclein accumulation and damage to brainstem neurons fueling the evolution of mood disturbances. We posit that comprehensive animal-based research approaches are needed to capture the complexity and time-dependent nature of the primary and co-morbid symptoms. This will allow for the possibility of early intervention with more novel and targeted treatments that fit with not only individual patient variability, but also with changes that occur over time with the evolution of the disease.
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Affiliation(s)
- S Hayley
- Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, Ontario K1S 5B6, Ottawa Hospital Research Institute (Neuroscience), University of Ottawa, Canada.
| | - F Vahid-Ansari
- Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, Ontario K1S 5B6, Ottawa Hospital Research Institute (Neuroscience), University of Ottawa, Canada
| | - H Sun
- Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, Ontario K1S 5B6, Ottawa Hospital Research Institute (Neuroscience), University of Ottawa, Canada
| | - P R Albert
- Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, Ontario K1S 5B6, Ottawa Hospital Research Institute (Neuroscience), University of Ottawa, Canada
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21
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Current Treatments and New, Tentative Therapies for Parkinson’s Disease. Pharmaceutics 2023; 15:pharmaceutics15030770. [PMID: 36986631 PMCID: PMC10051786 DOI: 10.3390/pharmaceutics15030770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
Parkinson’s disease (PD) is a neurodegenerative pathology, the origin of which is associated with the death of neuronal cells involved in the production of dopamine. The prevalence of PD has increased exponentially. The aim of this review was to describe the novel treatments for PD that are currently under investigation and study and the possible therapeutic targets. The pathophysiology of this disease is based on the formation of alpha-synuclein folds that generate Lewy bodies, which are cytotoxic and reduce dopamine levels. Most pharmacological treatments for PD target alpha-synuclein to reduce the symptoms. These include treatments aimed at reducing the accumulation of alpha-synuclein (epigallocatechin), reducing its clearance via immunotherapy, inhibiting LRRK2, and upregulating cerebrosidase (ambroxol). Parkinson’s disease continues to be a pathology of unknown origin that generates a significant social cost for the patients who suffer from it. Although there is still no definitive cure for this disease at present, there are numerous treatments available aimed at reducing the symptomatology of PD in addition to other therapeutic alternatives that are still under investigation. However, the therapeutic approach to this pathology should include a combination of pharmacological and non-pharmacological strategies to maximise outcomes and improve symptomatological control in these patients. It is therefore necessary to delve deeper into the pathophysiology of the disease in order to improve these treatments and therefore the quality of life of the patients.
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Liu D, Zhang Q, Zhao Z, Chen M, Hou Y, Wang G, Shen H, Zhu H, Ji Y, Ruan L, Lou Z. Benzodiazepine-Receptor Agonist Utilization in Outpatients with Anxiety Disorder: A Retrospective Study Based on Electronic Healthcare Data from a Large General Tertiary Hospital. Healthcare (Basel) 2023; 11:healthcare11040554. [PMID: 36833088 PMCID: PMC9956167 DOI: 10.3390/healthcare11040554] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
Benzodiazepine-receptor agonists (BZRAs), including benzodiazepines (BZDs) and drugs related to BZDs (Z-drugs), are commonly used for anxiety, but often have side effects. We retrospectively investigated the utilization and prescription characteristics of BZRAs for patients with anxiety disorders in a large tertiary care general hospital between 2018 and 2021, based on electronic healthcare records. We also examined the pattern of simultaneous consumption of multiple BZRA drugs, and the diseases coexisting with anxiety that are associated with this. The numbers of patients and BZRA prescriptions increased over the 4 years. Moreover, 7195 prescriptions from 694 patients contained two or more BZRAs, of which 78.08% contained both BZDs and Z-drugs, 19.78% contained multiple BZDs, and 2.14% contained multiple Z-drugs. For anxiety patients with concomitant Alzheimer's disease or Parkinson's disease, and dyslipidemia, they were more likely to consume multiple BZRAs simultaneously, whereas patients with concomitant insomnia, depression, hypertension, diabetes, or tumors were less likely to consume multiple BZRAs (all p < 0.05). Furthermore, older patients who consume multiple BZRAs simultaneously may have higher probabilities of long-term drug use. Better interventions supporting standardized BZD utilization may be needed to minimize the side effects of inappropriate BZRA administration.
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Affiliation(s)
- Denong Liu
- School of Medicine, Ningbo University, Ningbo 315211, China
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
| | - Qingyu Zhang
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
| | - Zhijia Zhao
- School of Medicine, Ningbo University, Ningbo 315211, China
| | - Mengjia Chen
- Department of Pharmacy, Ningbo Yinzhou No.2 Hospital, Ningbo 315199, China
| | - Yanbin Hou
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
| | - Guanjun Wang
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
| | - Haowei Shen
- School of Medicine, Ningbo University, Ningbo 315211, China
| | - Huaqiang Zhu
- Department of Pharmaceutical Engineering, Zhejiang Pharmaceutical University, Ningbo 315199, China
| | - Yunxin Ji
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
| | - Liemin Ruan
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
- Correspondence: (L.R.); (Z.L.)
| | - Zhongze Lou
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
- Zhejiang Key Laboratory of Precision Medicine for Atherosclerotic Diseases, Central Laboratory of the Medical Research Center, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
- Correspondence: (L.R.); (Z.L.)
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23
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DeMarco EC, Zhang Z, Al-Hakeem H, Hinyard L. Depression After Parkinson's Disease: Treated Differently or Not At All? J Geriatr Psychiatry Neurol 2023; 36:39-51. [PMID: 35382620 DOI: 10.1177/08919887221090217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Depression is a common, potentially debilitating non-motor symptom of Parkinson's disease which may manifest at any time and can respond to treatment. Although depression is a known primary mediator of health-related quality of life, it is currently unknown whether the timing of depression diagnosis relative to PD diagnosis affects receipt of depression treatment. Electronic health record data were examined to explore differences in depression treatment among patients diagnosed with depression before or after PD diagnosis. Compared to PD patients diagnosed with depression prior to PD, those diagnosed with depression following PD are less likely to receive any treatment, either pharmacologic or non-pharmacologic, indicating a temporal association between the time of PD diagnosis and receipt of depression treatment. This highlights a potentially substantial treatment gap, despite the existence of efficacious treatment. Diagnosis with PD appears to alter depression treatment and further research is warranted to determine potential causes and effective interventions.
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Affiliation(s)
- Elisabeth C DeMarco
- Department of Health & Clinical Outcomes Research, 12274Saint Louis University School of Medicine, Saint Louis, MO, USA.,Advanced HEAlth Data (AHEAD) Institute, 12274Saint Louis University, Saint Louis, MO, USA
| | - Zidong Zhang
- Department of Health & Clinical Outcomes Research, 12274Saint Louis University School of Medicine, Saint Louis, MO, USA.,Advanced HEAlth Data (AHEAD) Institute, 12274Saint Louis University, Saint Louis, MO, USA
| | - Haider Al-Hakeem
- 12274Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Leslie Hinyard
- Department of Health & Clinical Outcomes Research, 12274Saint Louis University School of Medicine, Saint Louis, MO, USA.,Advanced HEAlth Data (AHEAD) Institute, 12274Saint Louis University, Saint Louis, MO, USA
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Carey G, Viard R, Lopes R, Kuchcinski G, Defebvre L, Leentjens AF, Dujardin K. Anxiety in Parkinson's Disease Is Associated with Changes in Brain Structural Connectivity. JOURNAL OF PARKINSON'S DISEASE 2023; 13:989-998. [PMID: 37599537 PMCID: PMC10578283 DOI: 10.3233/jpd-230035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Anxiety in Parkinson's disease (PD) has been associated with grey matter changes and functional changes in anxiety-related neuronal circuits. So far, no study has analyzed white matter (WM) changes in patients with PD and anxiety. OBJECTIVE The aim of this study was to identify WM changes by comparing PD patients with and without anxiety, using diffusion-tensor imaging (DTI). METHODS 108 non-demented PD patients with (n = 31) and without (n = 77) anxiety as defined by their score on the Parkinson Anxiety Scale participated. DTI was used to determine the fractional anisotropy (FA) and mean diffusivity (MD) in specific tracts within anxiety-related neuronal circuits. Mean FA and MD were compared between groups and correlated with the severity of anxiety adjusted by sex, center, Hoehn & Yahr stage, levodopa equivalent daily dosage, and Hamilton depression rating scale. RESULTS Compared to patients without anxiety, PD patients with anxiety showed lower FA within the striato-orbitofrontal, striato-cingulate, cingulate-limbic, and caudate-thalamic tracts; higher FA within the striato-limbic and accumbens-thalamic tracts; higher MD within the striato-thalamic tract and lower MD within the striato-limbic tract. CONCLUSIONS Anxiety in PD is associated with microstructural alterations in anxiety-related neuronal circuits within the WM. This result reinforces the view that PD-related anxiety is linked to structural alteration within the anxiety-related brain circuits.
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Affiliation(s)
- Guillaume Carey
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
- School for Mental Health and Neurosciences (MHeNS), Maastricht University, Maastricht, The Netherlands
- Department of Neurology and Movement Disorders, Lille University Medical Centre, Lille, France
| | - Romain Viard
- Univ Lille, UMS 2014 – US 41 – PLBS – Plateformes Lilloises en Biologie & Santé, Lille, France
| | - Renaud Lopes
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
- Univ Lille, UMS 2014 – US 41 – PLBS – Plateformes Lilloises en Biologie & Santé, Lille, France
| | - Gregory Kuchcinski
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
- Univ Lille, UMS 2014 – US 41 – PLBS – Plateformes Lilloises en Biologie & Santé, Lille, France
- Department of Neuroradiology, Lille University Medical Centre, Lille, France
| | - Luc Defebvre
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
- Department of Neurology and Movement Disorders, Lille University Medical Centre, Lille, France
| | - Albert F.G. Leentjens
- School for Mental Health and Neurosciences (MHeNS), Maastricht University, Maastricht, The Netherlands
- Department of Psychiatry, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Kathy Dujardin
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
- Department of Neurology and Movement Disorders, Lille University Medical Centre, Lille, France
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25
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Carrozzino D, Christensen KS, Patierno C, Siri C, Zecchinelli A, Pezzoli G, Cosci F. The Hopkins Symptom Checklist (SCL-90-R): A Patient-Reported Outcome Measure in Parkinson's Disease. J Geriatr Psychiatry Neurol 2022; 35:689-697. [PMID: 34971324 DOI: 10.1177/08919887211060020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This is the first study applying Clinimetric Patient-Reported Outcome Measures (CLIPROM) criteria to evaluate the construct validity, sensitivity, and clinical utility of the SCL-90-R in patients with Parkinson's disease (PD). Methods: A Rasch analysis was conducted using a sample of 488 PD outpatients. Results: Testing for dimensionality revealed that less than 5% of t-tests were significant, indicating that the SCL-90-R subscales entailed the property of construct validity. As to the total score, a Person Separation Reliability Index of .96 was found. Conclusions: The SCL-90-R total score is a sensitive screening measure that can be used not only to differentiate healthy stress reactions from symptoms of psychological distress but also to detect PD patients with an increased risk for psychiatric complications. As to the subscales, the brief versions that did not include misfitting items should be used to assess the severity of specific symptoms of psychological distress affecting PD patients.
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Affiliation(s)
- Danilo Carrozzino
- Department of Psychology "Renzo Canestrari", 9296University of Bologna, Bologna, Italy
| | - Kaj Sparle Christensen
- Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, 1006Aarhus University, Aarhus, Denmark
| | - Chiara Patierno
- Department of Psychology "Renzo Canestrari", 9296University of Bologna, Bologna, Italy
| | - Chiara Siri
- Rehabilitation Unit, 89497Moriggia Pelascini Hospital, Como, Italy
| | | | - Gianni Pezzoli
- 18605Parkinson Institute, Pini-CTO, Milan, Italy.,Fondazione Grigioni per Il Morbo di Parkinson, Milan, Italy
| | - Fiammetta Cosci
- Department of Health Sciences, 9300University of Florence, Florence, Italy.,Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
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26
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Dissanayaka NN, Forbes EJ, Perepezko K, Leentjens AFG, Dobkin RD, Dujardin K, Pontone GM. Phenomenology of Atypical Anxiety Disorders in Parkinson's Disease: A Systematic Review. Am J Geriatr Psychiatry 2022; 30:1026-1050. [PMID: 35305884 DOI: 10.1016/j.jagp.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Anxiety is a prominent concern in Parkinson's disease (PD) that negatively impacts quality of life, increases functional disability, and complicates clinical management. Atypical presentations of anxiety are under-recognized and inadequately treated in patients with PD, compromising global PD care. METHODS This systematic review focuses on the prevalence, symptomology and clinical correlates of atypical presentations of PD-related anxiety following PRISMA guidelines. RESULTS Of the 60 studies meeting inclusion criteria, 14 focused on 'Anxiety Not Otherwise Specified (NOS)' or equivalent, 31 reported on fluctuating anxiety symptoms, and 22 reported on 'Fear of Falling (FOF)'. Anxiety NOS accounted for a weighted mean prevalence of 14.9%, fluctuating anxiety for 34.19%, and FOF for 51.5%. These latter two exceeded the average reported overall prevalence rate of 31% for anxiety disorders in PD. We identified a diverse array of anxiety symptoms related to motor and non-motor symptoms of PD, to complications of PD medication (such as "on" and "off" fluctuations, or both), and, to a lesser extent, to cognitive symptoms. CONCLUSION Atypical anxiety is common, clinically relevant, and heterogeneous in nature. A better understanding of the phenomenology, clinical course, and pathophysiology of varied forms of atypical anxiety in PD is needed to improve recognition, advance therapeutic development and ultimately optimize quality of life in PD.
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Affiliation(s)
- Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine (NND, EJF), The University of Queensland, Brisbane, Australia; School of Psychology (NND, EJF), University of Queensland, Brisbane, Australia; Department of Neurology (NND), Royal Brisbane & Women's Hospital, Brisbane, Australia.
| | - Elana J Forbes
- UQ Centre for Clinical Research, Faculty of Medicine (NND, EJF), The University of Queensland, Brisbane, Australia; School of Psychology (NND, EJF), University of Queensland, Brisbane, Australia
| | - Kate Perepezko
- Department of Mental Health (KP), Johns Hopkins University Blomberg School of Public Health, Baltimore, USA
| | - Albert F G Leentjens
- Department of Psychiatry (AFGL), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Roseanne D Dobkin
- Department of Psychiatry (RDD), Rutgers University, Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Kathy Dujardin
- Department of Neurology and Movement Disorders (KD), University Lille, Lille, France
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences (GMP), Johns Hopkins University School of Medicine, Baltimore, USA; Department of Neurology (GMP), Johns Hopkins University School of Medicine, Baltimore, USA
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27
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Schmauß M. [Depression and Parkinson's Disease]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2022; 90:145-146. [PMID: 35443281 DOI: 10.1055/a-1683-1840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Depression und Parkinson-Syndrom treten häufig gemeinsam auf 1. Depressive Episoden tragen signifikant zur
Morbidität der Parkinson-Erkrankung und damit auch zur Inanspruchnahme der
Angehörigen bei. Bei Verwendung moderner Klassifikationssysteme gibt die
Mehrzahl der Autoren Prävalenzraten von bis zu 50% an 2. Diese Komorbidität wird immer noch zu
selten diagnostiziert und viel zu selten behandelt 1. Hierbei ist zu berücksichtigen, dass depressive Syndrome
nicht nur als Reaktion auf die Parkinson-Erkrankung zu interpretieren sind, da sie
häufig bereits in der präsymptomatischen Phase der
Parkinson-Erkrankung zu beobachten sind und auch bei deutlicher Besserung der
Parkinson-Symptomatik unter entsprechender Medikation häufig sistieren.
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Austgen G, Marsh L. Cognitive dysfunction and neuropsychiatric aspects of Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:59-90. [PMID: 35248207 DOI: 10.1016/bs.pbr.2022.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Movement abnormalities, by definition, and cognitive changes, to varying extents, affect every patient with Parkinson's disease (PD) and are attributed to the underlying neurodegenerative disease. Various psychiatric disorders occur in most patients at some point over the course of PD, including in the prodromal phase. Even though psychiatric disturbances tend to aggravate motor and cognitive deficits, they are under-recognized and under-treated, and the role of the underlying neurological disease is often minimized. To provide an integrated approach to understanding neuropsychiatric aspects of PD, this chapter reviews how cognitive changes in PD relate to the common psychiatric disturbances in PD along with the prevalence, phenomenology, pathophysiology, and treatment of each.
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Affiliation(s)
- Gabriela Austgen
- Behavioral Neurology & Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Laura Marsh
- Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Professor, Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences and Department of Neurology, Baylor College of Medicine, Houston, TX, United States.
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29
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Treatment Options for Motor and Non-Motor Symptoms of Parkinson's Disease. Biomolecules 2021; 11:biom11040612. [PMID: 33924103 PMCID: PMC8074325 DOI: 10.3390/biom11040612] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/29/2021] [Accepted: 04/15/2021] [Indexed: 12/11/2022] Open
Abstract
Parkinson’s disease (PD) usually presents in older adults and typically has both motor and non-motor dysfunctions. PD is a progressive neurodegenerative disorder resulting from dopaminergic neuronal cell loss in the mid-brain substantia nigra pars compacta region. Outlined here is an integrative medicine and health strategy that highlights five treatment options for people with Parkinson’s (PwP): rehabilitate, therapy, restorative, maintenance, and surgery. Rehabilitating begins following the diagnosis and throughout any additional treatment processes, especially vis-à-vis consulting with physical, occupational, and/or speech pathology therapist(s). Therapy uses daily administration of either the dopamine precursor levodopa (with carbidopa) or a dopamine agonist, compounds that preserve residual dopamine, and other specific motor/non-motor-related compounds. Restorative uses strenuous aerobic exercise programs that can be neuroprotective. Maintenance uses complementary and alternative medicine substances that potentially support and protect the brain microenvironment. Finally, surgery, including deep brain stimulation, is pursued when PwP fail to respond positively to other treatment options. There is currently no cure for PD. In conclusion, the best strategy for treating PD is to hope to slow disorder progression and strive to achieve stability with neuroprotection. The ultimate goal of any management program is to improve the quality-of-life for a person with Parkinson’s disease.
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