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Schade RN, Etheridge CB, Kenney LE, Ratajska AM, Rodriguez K, Lopez FV, Gertler J, Ray A, Santos L, Hess C, Bowers D. Greater Apathy Associated With Selective Serotonin Reuptake Inhibitor Use in Parkinson's Disease. J Geriatr Psychiatry Neurol 2024:8919887241254471. [PMID: 38780969 DOI: 10.1177/08919887241254471] [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: 05/25/2024]
Abstract
OBJECTIVE Apathy, a motivational disorder, is common in Parkinson's disease (PD) and often misdiagnosed as depression. Use of selective serotonin reuptake inhibitors (SSRIs) has been associated with increased apathy in adolescents and adults with depression. Based on observations that serotonin may downregulate dopaminergic systems, we examined the relationship between apathy and SSRI use in individuals with PD. METHODS Medications, mood/motivation scales, and clinical data were collected from a convenience sample of 400 individuals with PD. Depression and apathy were measured using the Beck Depression Inventory-II (BDI-Il) and the Apathy Scale (AS). Antidepressant medications were grouped by mechanism type. RESULTS Of the 400 PD patients, 26% were on SSRIs. On standard mood/motivation scales, 38% of the sample exceeded clinical cut-offs for apathy and 28% for depression. Results of hierarchical regression analyses revealed that SSRIs were the only antidepressant that were significantly associated with higher apathy scores (β = .1, P = .02). Less education (β = -.1, P = .01) worse cognition (β = -.1, P = .01), and greater depressive symptoms (β = .5, P < .001) were also significant predictors of apathy. CONCLUSION These findings suggest that use of SSRIs, but not other antidepressants, is associated with greater apathy in PD. Given the interactive relationship between serotonin and dopamine, the current findings highlight the importance of considering apathy when determining which antidepressants to prescribe to individuals with PD. Similarly, switching a SSRI for an alternative antidepressant in individuals with PD who are apathetic may be a potential treatment for apathy that needs further study.
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Affiliation(s)
- Rachel N Schade
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Connor B Etheridge
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Lauren E Kenney
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Adrianna M Ratajska
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Katie Rodriguez
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Francesca V Lopez
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Joshua Gertler
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Alyssa Ray
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Lauren Santos
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Christopher Hess
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
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Lanctôt KL, Ismail Z, Bawa KK, Cummings JL, Husain M, Mortby ME, Robert P. Distinguishing apathy from depression: A review differentiating the behavioral, neuroanatomic, and treatment-related aspects of apathy from depression in neurocognitive disorders. Int J Geriatr Psychiatry 2023; 38:e5882. [PMID: 36739588 PMCID: PMC10107127 DOI: 10.1002/gps.5882] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/17/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVES This narrative review describes the clinical features of apathy and depression in individuals with neurocognitive disorders (NCDs), with the goal of differentiating the two syndromes on the basis of clinical presentation, diagnostic criteria, neuropathological features, and contrasting responses to treatments. METHODS Literature was identified using PubMed, with search terms to capture medical conditions of interest; additional references were also included based on our collective experience and knowledge of the literature. RESULTS Evidence from current literature supports the distinction between the two disorders; apathy and depression occur with varying prevalence in individuals with NCDs, pose different risks of progression to dementia, and have distinct, if overlapping, neurobiological underpinnings. Although apathy is a distinct neuropsychiatric syndrome, distinguishing apathy from depression can be challenging, as both conditions may occur concurrently and share several overlapping features. Apathy is associated with unfavorable outcomes, especially those with neurodegenerative etiologies (e.g., Alzheimer's disease) and is associated with an increased burden for both patients and caregivers. Diagnosing apathy is important not only to serve as the basis for appropriate treatment, but also for the development of novel targeted interventions for this condition. Although there are currently no approved pharmacologic treatments for apathy, the research described in this review supports apathy as a distinct neuropsychiatric condition that warrants specific treatments aimed at alleviating patient disability. CONCLUSIONS Despite differences between these disorders, both apathy and depression pose significant challenges to patients, their families, and caregivers; better diagnostics are needed to develop more tailored treatment and support.
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Affiliation(s)
- Krista L. Lanctôt
- Departments of Psychiatry and of Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
- Neuropsychopharmacology Research GroupHurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Bernick Chair in Geriatric PsychopharmacologySunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health SciencesHotchkiss Brain InstituteO'Brien Institute of Public HealthUniversity of CalgaryCalgaryAlbertaCanada
| | - Kritleen K. Bawa
- Departments of Psychiatry and of Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
- Neuropsychopharmacology Research GroupHurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Jeffrey L. Cummings
- Department of Brain HealthChambers‐Grundy Center for Transformative NeuroscienceSchool of Integrated Health SciencesUniversity of Nevada Las Vegas (UNLV)Las VegasNevadaUSA
| | - Masud Husain
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - Moyra E. Mortby
- School of PsychologyUniversity of New South WalesSydneyNew South WalesAustralia
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
| | - Philippe Robert
- Cognition Behaviour Technology LabUniversity Côte d'Azur (UCA)NiceFrance
- Centre MémoireLe Centre Hospitalier Universitaire de NiceNiceFrance
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3
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Bogdan A, Fabre R, Desmidt T, Golebiowski J, Topin J, Bethus I, Hanon O, Boutoleau-Bretonniere C, Wagemann N, Annweiler C, Ousset PJ, Godefroy O, Rouch I, Paccalin M, Sukhorukova M, Gabelle A, Robert G, David R. Different Trajectories of Apathy and Depression Among Subjective Cognitive Impairment Individuals with or without Conversion to Dementia: Results from the Memento Cohort in France. J Alzheimers Dis 2023; 95:415-426. [PMID: 37545236 DOI: 10.3233/jad-230162] [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] [Indexed: 08/08/2023]
Abstract
BACKGROUND Apathy and depression are two early behavioral symptoms in Alzheimer's disease (AD) and related disorders that often occur prior to the onset of cognitive decline and memory disturbances. Both have been associated with an increased risk of conversion to dementia, with a distinct neuropathology. OBJECTIVE The assessment of the trajectories of apathy and depression and their independent impact on dementia conversion. METHODS Apathy and Depression were measured using the Neuropsychiatric Inventory for caregiver (NPI) and clinician (NPI-C), among the nondemented individuals reporting subjective cognitive decline (SCD) at baseline. They were followed up over a 60-month period. Some converted to dementia, according to the methodology carried out by the French Memento Cohort. RESULTS Among individuals with SCD (n = 2,323), the levels of apathy and depression were low and did not evolve significantly over the 60-month period, despite a trend in apathy increasing as of month 24. Regarding SCD individuals who converted to dementia within the 60-month period (n = 27), the prevalence of depression remained globally steady, while the levels of apathy increased over time. CONCLUSION Apathy and depression have different trajectories among individuals with SCD and apathy alone is more likely-compared to depression-to be associated with conversion to dementia.
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Affiliation(s)
- Anamaria Bogdan
- Cote d'Azur University, Nice University Hospital, Department of Old Age Psychiatry, Nice, France
| | - Roxane Fabre
- Nice University Hospital, Department of Public Health, Nice, France
| | | | | | - Jérémie Topin
- Côte D'Azur University, Chemistry Institute of Nice, France
| | - Ingrid Bethus
- Côte d'Azur University, IPMC (Institut de Pharmacologie Moléculaire et cellulaire), Sophia Antipolis, France
| | - Olivier Hanon
- Université Paris Cité - EA4468 APHP-Hôpitaux Universitaires Paris Centre - Service de Gériatrie- hôpital Broca, Paris, France
| | | | | | | | - Pierre-Jean Ousset
- Toulouse Clinical Research Center, Toulouse University Hospital, Toulouse, France
| | - Olivier Godefroy
- Department of Neurology, Amiens University Hospital, Amiens, France
| | - Isabelle Rouch
- Memory Clinic (CMRR) Saint Etienne, INSERM U1219, Bordeaux, France
| | - Marc Paccalin
- Department of Geriatry, Memory Clinic (CMRR), CIC U1402, Poitiers University Hospital, Poitiers, France
| | | | - Audrey Gabelle
- Memory Clinic (CMRR), Montpellier University Hospital, Montpellier, France
| | | | - Renaud David
- Cote d'Azur University, Nice University Hospital, Department of Old Age Psychiatry, Nice, France
- NICE BRAIN non-profitorganization for research on brain, Nice, France
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4
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Batail JM, Corouge I, Combès B, Conan C, Guillery-Sollier M, Vérin M, Sauleau P, Le Jeune F, Gauvrit JY, Robert G, Barillot C, Ferre JC, Drapier D. Apathy in depression: An arterial spin labeling perfusion MRI study. J Psychiatr Res 2023; 157:7-16. [PMID: 36427413 DOI: 10.1016/j.jpsychires.2022.11.015] [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] [Received: 12/08/2021] [Revised: 07/28/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Apathy, as defined as a deficit in goal-directed behaviors, is a critical clinical dimension in depression associated with chronic impairment. Little is known about its cerebral perfusion specificities in depression. To explore neurovascular mechanisms underpinning apathy in depression by pseudo-continuous arterial spin labeling (pCASL) magnetic resonance imaging (MRI). METHODS Perfusion imaging analysis was performed on 90 depressed patients included in a prospective study between November 2014 and February 2017. Imaging data included anatomical 3D T1-weighted and perfusion pCASL sequences. A multiple regression analysis relating the quantified cerebral blood flow (CBF) in different regions of interest defined from the FreeSurfer atlas, to the Apathy Evaluation Scale (AES) total score was conducted. RESULTS After confound adjustment (demographics, disease and clinical characteristics) and correction for multiple comparisons, we observed a strong negative relationship between the CBF in the left anterior cingulate cortex (ACC) and the AES score (standardized beta = -0.74, corrected p value = 0.0008). CONCLUSION Our results emphasized the left ACC as a key region involved in apathy severity in a population of depressed participants. Perfusion correlates of apathy in depression evidenced in this study may contribute to characterize different phenotypes of depression.
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Affiliation(s)
- J M Batail
- Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, F-35703, Rennes, France; Univ Rennes, Inria, CNRS, IRISA, INSERM, Empenn U1228 ERL, F-35042, Rennes, France; Univ Rennes, "Comportement et noyaux gris centraux" Research Unit (EA 4712), F-35000, Rennes, France.
| | - I Corouge
- Univ Rennes, Inria, CNRS, IRISA, INSERM, Empenn U1228 ERL, F-35042, Rennes, France
| | - B Combès
- Univ Rennes, Inria, CNRS, IRISA, INSERM, Empenn U1228 ERL, F-35042, Rennes, France
| | - C Conan
- Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, F-35703, Rennes, France
| | - M Guillery-Sollier
- Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, F-35703, Rennes, France; Univ Rennes, "Comportement et noyaux gris centraux" Research Unit (EA 4712), F-35000, Rennes, France; Univ Rennes, LP3C (Laboratoire de Psychologie: Cognition, Comportement, Communication) - EA 1285, CC5000, Rennes, France
| | - M Vérin
- Univ Rennes, "Comportement et noyaux gris centraux" Research Unit (EA 4712), F-35000, Rennes, France; CHU Rennes, Department of Neurology, F-35033, Rennes, France
| | - P Sauleau
- Univ Rennes, "Comportement et noyaux gris centraux" Research Unit (EA 4712), F-35000, Rennes, France; CHU Rennes, Department of Neurophysiology, F-35033, Rennes, France
| | - F Le Jeune
- Univ Rennes, "Comportement et noyaux gris centraux" Research Unit (EA 4712), F-35000, Rennes, France; Centre Eugène Marquis, Department of Nuclear Medicine, F-35062, Rennes, France
| | - J Y Gauvrit
- Univ Rennes, Inria, CNRS, IRISA, INSERM, Empenn U1228 ERL, F-35042, Rennes, France; CHU Rennes, Department of Radiology, F-35033, Rennes, France
| | - G Robert
- Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, F-35703, Rennes, France; Univ Rennes, Inria, CNRS, IRISA, INSERM, Empenn U1228 ERL, F-35042, Rennes, France; Univ Rennes, "Comportement et noyaux gris centraux" Research Unit (EA 4712), F-35000, Rennes, France
| | - C Barillot
- Univ Rennes, Inria, CNRS, IRISA, INSERM, Empenn U1228 ERL, F-35042, Rennes, France
| | - J C Ferre
- Univ Rennes, Inria, CNRS, IRISA, INSERM, Empenn U1228 ERL, F-35042, Rennes, France; CHU Rennes, Department of Radiology, F-35033, Rennes, France
| | - D Drapier
- Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, F-35703, Rennes, France; Univ Rennes, "Comportement et noyaux gris centraux" Research Unit (EA 4712), F-35000, Rennes, France
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5
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Bareeqa SB, Samar SS, Kamal S, Masood Y, Allahyar, Ahmed SI, Hayat G. Prodromal depression and subsequent risk of developing Parkinson's disease: a systematic review with meta-analysis. Neurodegener Dis Manag 2022; 12:155-164. [PMID: 35512296 DOI: 10.2217/nmt-2022-0001] [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] [Indexed: 12/19/2022] Open
Abstract
Aim: Parkinson's disease (PD) is a progressive neurological disorder that predominately affects dopaminergic neurons. We believe that this pooling of data will help to better understand the prodromal nature of depression in PD. Materials & methods: We conducted this study in accordance with PRISMA guidelines 2020. Fifteen eligible articles were shortlisted for final analysis. Risk of bias assessment was also conducted Results: The random-effect model revealed that the risk of subsequent Parkinson's disease in patients with prodromal depression was twice as likely (OR, 2.04; 95% CI, 1.02-4.08) as compared with a healthy population. Conclusion: Our meta-analysis concluded that the subsequent risk of PD is significantly higher in patients with depression as compared with healthy individuals.
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Affiliation(s)
| | - Syeda Sana Samar
- Medical Student, Jinnah Sindh Medical University, Karachi, Sindh, 75510, Pakistan
| | - Sufiyan Kamal
- Medical Student, Jinnah Sindh Medical University, Karachi, Sindh, 75510, Pakistan
| | - Yasir Masood
- Washington University in Saint Louis, MO 63130, USA
| | - Allahyar
- Bolan Medical Complex Hospital, Quetta, Balochistan, 87300, Pakistan
| | - Syed Ijlal Ahmed
- Department of Neurology, Neurology Resident, Saint Louis University, MO 63103, USA
| | - Ghazala Hayat
- Department of Neurology, Professor of Neurology, Saint Louis University, MO 63103, USA
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6
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Pieperhoff P, Südmeyer M, Dinkelbach L, Hartmann CJ, Ferrea S, Moldovan AS, Minnerop M, Diaz-Pier S, Schnitzler A, Amunts K. Regional changes of brain structure during progression of idiopathic Parkinson’s disease – a longitudinal study using deformation based morphometry. Cortex 2022; 151:188-210. [DOI: 10.1016/j.cortex.2022.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/04/2022] [Accepted: 03/12/2022] [Indexed: 12/14/2022]
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7
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Li XN, Hao DP, Qu MJ, Zhang M, Ma AB, Pan XD, Ma AJ. Development and Validation of a Plasma FAM19A5 and MRI-Based Radiomics Model for Prediction of Parkinson's Disease and Parkinson's Disease With Depression. Front Neurosci 2022; 15:795539. [PMID: 34975391 PMCID: PMC8718551 DOI: 10.3389/fnins.2021.795539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/26/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Prediction and early diagnosis of Parkinson’s disease (PD) and Parkinson’s disease with depression (PDD) are essential for the clinical management of PD. Objectives: The present study aimed to develop a plasma Family with sequence similarity 19, member A5 (FAM19A5) and MRI-based radiomics nomogram to predict PD and PDD. Methods: The study involved 176 PD patients and 181 healthy controls (HC). Sandwich enzyme-linked immunosorbent assay (ELISA) was used to measure FAM19A5 concentration in the plasma samples collected from all participants. For enrolled subjects, MRI data were collected from 164 individuals (82 in the PD group and 82 in the HC group). The bilateral amygdala, head of the caudate nucleus, putamen, and substantia nigra, and red nucleus were manually labeled on the MR images. Radiomics features of the labeled regions were extracted. Further, machine learning methods were applied to shrink the feature size and build a predictive radiomics signature. The resulting radiomics signature was combined with plasma FAM19A5 concentration and other risk factors to establish logistic regression models for the prediction of PD and PDD. Results: The plasma FAM19A5 levels (2.456 ± 0.517) were recorded to be significantly higher in the PD group as compared to the HC group (2.23 ± 0.457) (P < 0.001). Importantly, the plasma FAM19A5 levels were also significantly higher in the PDD subgroup (2.577 ± 0.408) as compared to the non-depressive subgroup (2.406 ± 0.549) (P = 0.045 < 0.05). The model based on the combination of plasma FAM19A5 and radiomics signature showed excellent predictive validity for PD and PDD, with AUCs of 0.913 (95% CI: 0.861–0.955) and 0.937 (95% CI: 0.845–0.970), respectively. Conclusion: Altogether, the present study reported the development of nomograms incorporating radiomics signature, plasma FAM19A5, and clinical risk factors, which might serve as potential tools for early prediction of PD and PDD in clinical settings.
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Affiliation(s)
- Xue-Ning Li
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Da-Peng Hao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mei-Jie Qu
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Meng Zhang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - An-Bang Ma
- Shanghai Xunshi Technology Co., Ltd., Shanghai, China
| | - Xu-Dong Pan
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.,Institute of Cerebrovascular, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ai-Jun Ma
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.,Institute of Cerebrovascular, The Affiliated Hospital of Qingdao University, Qingdao, China
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8
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Won JH, Youn J, Park H. Enhanced neuroimaging genetics using multi-view non-negative matrix factorization with sparsity and prior knowledge. Med Image Anal 2022; 77:102378. [DOI: 10.1016/j.media.2022.102378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/29/2021] [Accepted: 01/26/2022] [Indexed: 11/28/2022]
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9
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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] [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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10
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Costanza A, Amerio A, Aguglia A, Escelsior A, Serafini G, Berardelli I, Pompili M, Amore M. When Sick Brain and Hopelessness Meet: Some Aspects of Suicidality in the Neurological Patient. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2021; 19:257-263. [PMID: 32525785 PMCID: PMC7569280 DOI: 10.2174/1871527319666200611130804] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/13/2020] [Accepted: 08/18/2020] [Indexed: 12/11/2022]
Abstract
Neurological diseases expose individuals to a higher risk of suicidal ideation and suicidal behavior, including completed suicides and suicide attempts. They also represent a paradigmatic arena to study the etiopathogenic mechanisms underlying suicidality because they are emblematic of the heterogeneity and complexity of mutual interrelationships characterizing this issue. On the one hand, neurological diseases imply strictly biological impairments that are postulated to be the basis of vulnerability to suicide or result in the need for treatments for which a suicidal risk has been hypothesized. On the other hand, they question some subjective experiences of neurological patients, up to near existential positions. Often, in fact, they are accompanied by severe hopelessness. The latter may originate in, particularly for the most severe neurological diseases, the absence of curative treatments, unpredictable disease progression that leads to acute relapses or chronicity, a decrease in autonomy or selfidentity, progressive social isolation, a sense of becoming useless, and perception of feeling stigmatized. This may ultimately cause a slip into experiencing an absurd condition. At the confluence of neurobiology and hopelessness, frequent psychiatric comorbidities may play a primary role. To conclude, neurological patients require special attention from clinicians in form of openly verbalizing and exploring the suicidal thematic, inquiring about protective and risk factors, and promptly initiating both a psychopharmacological treatment and, where possible, psychological support.
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Affiliation(s)
- Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland.,Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Mood Disorders Program, Tufts Medical Center, Boston, MA, USA
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Escelsior
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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11
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Ou R, Lin J, Liu K, Jiang Z, Wei Q, Hou Y, Zhang L, Cao B, Zhao B, Song W, Shang H. Evolution of Apathy in Early Parkinson's Disease: A 4-Years Prospective Cohort Study. Front Aging Neurosci 2021; 12:620762. [PMID: 33633560 PMCID: PMC7901914 DOI: 10.3389/fnagi.2020.620762] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/22/2020] [Indexed: 02/05/2023] Open
Abstract
Objective: We investigated the prevalence, evolution, associated factors, and risk factors of apathy in a cohort of patients with early-stage Parkinson's disease (PD), who underwent a 4-years prospective follow-up. Methods: This study included 188 patients with PD (baseline disease duration <3 years) who underwent an annual evaluation using the Lille Apathy Rating Scale (LARS). Based on the cut-off value of -21 observed on the LARS, patients were categorized as PD with and without apathy. The generalized estimating equations (GEE) model was utilized to determine the factors associated with apathy, and the Cox proportional-hazards regression model was used to determine the predictors of apathy. Results: Apathy increased from a baseline rate of 18.6-28.8% after 4 years; notably, this rate was not persistent across patients' visits. The LARS score was independently associated with the male sex (B 8.131, p = 0.009), low Frontal Assessment Battery (FAB) scores (B 0.567, p = 0.011), low attention scores on the Montreal Cognitive Assessment (MOCA) test (B 0.217, p = 0.026), high Hamilton Depression Rating Scale (HDRS) scores (B 1.362, p < 0.001), high Unified Parkinson's Disease Rating Scale (UPDRS) part III scores (B 1.147, p < 0.001), and prolonged follow-up time (B 1.785, p = 0.048). A high HDRS score was the only predictor of apathy in PD [hazard ratio (HR) 1.043, p = 0.026]. Conclusions: The risk of apathy is higher in men with progressive PD accompanied by disease-specific motor and non-motor symptoms. Depression during early-stage PD is a primary risk factor for apathy in PD.
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Affiliation(s)
- Ruwei Ou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Junyu Lin
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Kuncheng Liu
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Zheng Jiang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Qianqian Wei
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yanbing Hou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Lingyu Zhang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Bei Cao
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Bi Zhao
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Song
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Huifang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
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12
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Underlying Mechanisms of Psychological Interventions in Magnetic Resonance Imaging and Image-Guided Radiology Procedures. Top Magn Reson Imaging 2020; 29:157-163. [PMID: 32568978 DOI: 10.1097/rmr.0000000000000239] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Positive patient care and healthcare facility outcomes are associated with using various psychological interventions during magnetic resonance imaging and interventional radiology procedures. Interventions such as hypnosis, relaxation, guided imagery, and empathic communication can improve anxiety, pain, and hemodynamic stability during procedures, as well as improve claustrophobia and anxiety during magnetic resonance imaging. Little is understood as to the potential underlying mechanisms of how these interventions operate and contribute to positive outcomes. Thus, this article seeks to address that question by integrating autonomic nervous system functioning, neuropsychological concepts, and common factors theory of psychotherapy as potential underlying mechanisms. Opportunities for future directions in the field are also included.
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13
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Robert P, Manera V, Derreumaux A, Ferrandez Y Montesino M, Leone E, Fabre R, Bourgeois J. Efficacy of a Web App for Cognitive Training (MeMo) Regarding Cognitive and Behavioral Performance in People With Neurocognitive Disorders: Randomized Controlled Trial. J Med Internet Res 2020; 22:e17167. [PMID: 32159519 PMCID: PMC7097721 DOI: 10.2196/17167] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/16/2020] [Accepted: 02/04/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cognitive and behavioral symptoms are the clinical hallmarks of neurocognitive disorders. Cognitive training may be offered to reduce the risks of cognitive decline and dementia and to reduce behavioral symptoms, such as apathy. Information and communication technology approaches, including serious games, can be useful in improving the playful aspect of computerized cognitive training and providing motivating solutions in elderly patients. OBJECTIVE The objective of this study was to assess the effectiveness of employing the MeMo (Memory Motivation) Web app with regard to cognitive and behavioral symptoms in patients with neurocognitive disorders. METHODS MeMo is a Web app that can be used on any Web browser (computer or tablet). The training activities proposed in MeMo are divided into the following two parts: memory and mental flexibility/attention. The study included 46 individuals (mean age 79.4 years) with a diagnosis of neurocognitive disorders at the Institut Claude Pompidou Memory Center in Nice. This randomized controlled study compared the evolution of cognition and behavior between patients not using MeMo (control group) and patients using MeMo (MeMo group) for 12 weeks (four sessions per week). Patients underwent memory and attention tests, as well as an apathy assessment at baseline, week 12 (end of the training period), and week 24 (12 weeks after the end of the training sessions). In addition, to assess the impact of high and low game uses, the MeMo group was divided into patients who used MeMo according to the instructions (about once every 2 days; active MeMo group) and those who used it less (nonactive MeMo group). RESULTS When comparing cognitive and behavioral scores among baseline, week 12, and week 24, mixed model analysis for each cognitive and behavioral score indicated no significant interaction between testing time and group. On comparing the active MeMo group (n=9) and nonactive MeMo group (n=13), there were significant differences in two attention tests (Trial Making Test A [P=.045] and correct Digit Symbol Substitution Test items [P=.045]) and in the Apathy Inventory (AI) (P=.02). Mixed analysis (time: baseline, week 12, and week 24 × number of active days) indicated only one significant interaction for the AI score (P=.01), with a significant increase in apathy in the nonactive MeMo group. CONCLUSIONS This study indicates that the cognitive and behavioral efficacies of MeMo, a Web-based training app, can be observed only with regular use of the app. Improvements were observed in attention and motivation. TRIAL REGISTRATION ClinicalTrials.gov NCT04142801; https://clinicaltrials.gov/ct2/show/NCT04142801.
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Affiliation(s)
- Philippe Robert
- Cognition Behaviour Technology Lab, Université Côte d'Azur, Nice, France.,Association Innovation Alzheimer, Nice, France.,Centre Memoire, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Valeria Manera
- Cognition Behaviour Technology Lab, Université Côte d'Azur, Nice, France.,Association Innovation Alzheimer, Nice, France
| | - Alexandre Derreumaux
- Association Innovation Alzheimer, Nice, France.,Centre Memoire, Centre Hospitalier Universitaire de Nice, Nice, France
| | | | - Elsa Leone
- Centre Memoire, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Roxane Fabre
- Departement de Santé Publique, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Jeremy Bourgeois
- Centre Memoire, Centre Hospitalier Universitaire de Nice, Nice, France
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14
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Bogdan A, Manera V, Koenig A, David R. Pharmacologic Approaches for the Management of Apathy in Neurodegenerative Disorders. Front Pharmacol 2020; 10:1581. [PMID: 32038253 PMCID: PMC6989486 DOI: 10.3389/fphar.2019.01581] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/05/2019] [Indexed: 01/10/2023] Open
Abstract
Apathy is one of the most frequent behavioral disturbances in many neurodegenerative disorders and is known to have a negative impact on the disease progression, particularly in Alzheimer’s disease. Therapeutic options are currently limited and non-pharmacological approaches should constitute first line treatments. Pharmacological agents likely to reduce apathy levels are lacking. The objective of the present article is to review recent pharmacological treatments for apathy in neurodegenerative disorders. The Pubmed database was searched with a particular focus on articles published as of January 2017. Current main levels of evidence have been reported so far with cholinergic, glutamatergic and dopaminergic agents to reduce levels of apathy, despite several conflicting results. Treatment duration and samples sizes may have however decreased the validity of previous results. Ongoing studies involving more participants/treatment duration or distinct neural pathways may provide new insights in the treatment of apathy in neurodegenerative disorders.
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Affiliation(s)
- Anamaria Bogdan
- Centre Hospitalier Universitaire de Nice, Centre Mémoire de Ressources et de Recherche, Nice, France
| | - Valeria Manera
- CoBTeK Lab "Cognition Behaviour Technology", University of Nice Sophia Antipolis, Nice, France
| | - Alexandra Koenig
- CoBTeK Lab "Cognition Behaviour Technology", University of Nice Sophia Antipolis, Nice, France
| | - Renaud David
- Centre Hospitalier Universitaire de Nice, Centre Mémoire de Ressources et de Recherche, Nice, France
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15
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Neuroimaging depression and anxiety in essential tremor: A diffusion tensor imaging study. Clin Imaging 2019; 58:96-104. [PMID: 31284179 DOI: 10.1016/j.clinimag.2019.06.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/26/2019] [Accepted: 06/26/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Patients with essential tremor (ET) may exhibit non-motor features, including those that are neuropsychiatric. Depression and anxiety are the most common among these. This study aims to investigate the possible relationship between microstructural brain changes and symptoms of depression and anxiety in ET. METHODS We assessed 62 ET patients (40 women and 22 men, mean age 46.0 ± 20.4) for symptoms of depression and anxiety using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Thirty-two patients had severe or moderate symptoms of anxiety, and 15 patients had severe or moderate depressive symptoms. Microstructural brain changes were evaluated using diffusion tensor imaging (DTI), which was reported using fractional anisotropy (FA), mean diffusivity (MD), apparent diffusion coefficient (ADC), radial diffusivity (RD), and axial diffusivity (AD) values calculated for 17 regions of interest including the prefrontal cortex, paralimbic and limbic structures and cerebellar peduncles. We evaluated the relationship between observed changes in brain regions and symptoms of depression and anxiety. RESULTS Decreased left amygdala FA (p = 0.003) and increased left amygdala RD (p = 0.04) were detected in depressed vs. non-depressed ET patients. Left ventrolateral prefrontal cortex (VLPFC) FA (p = 0.02) and left precuneus FA (p = 0.02) values differed between anxious patients vs. non-anxious ET patients. BDI scores were correlated with left amygdala FA and left RD, while BAI scores were correlated with left VLPFC FA and left precuneus FA. DISCUSSION Our results provide evidence that symptoms of depression and anxiety could be based in structural brain changes observed in patients with ET.
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16
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Picillo M, Cuoco S, Tepedino MF, Cappiello A, Volpe G, Erro R, Santangelo G, Pellecchia MT, Barone P. Motor, cognitive and behavioral differences in MDS PSP phenotypes. J Neurol 2019; 266:1727-1735. [PMID: 30989369 DOI: 10.1007/s00415-019-09324-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/09/2019] [Accepted: 04/11/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Movement Disorder Society (MDS) new diagnostic criteria for Progressive Supranuclear palsy (PSP) identifying different disease phenotypes were recently released. The aim of the present study is to report on the cognitive and behavioral features of the different phenotypes diagnosed according to the MDS criteria. METHODS Forty-nine PSP patients underwent an extensive battery of clinical assessments. Differences between PSP subtypes were computed with χ2 or ANOVA tests. Using the z scores, subjects were classified as having normal cognition, mild cognitive impairment, single or multiple domain, and dementia. A logistic regression model was implemented to investigate the major determinants of PSP non-Richardson's syndrome phenotype. RESULTS Half of the cohort presented Richardson's syndrome (46.9%), followed by PSP with parkinsonism and corticobasal syndrome (22.4% and 14.2%, respectively). Richardson's syndrome and PSP with corticobasal syndrome presented a similar burden of disease. The only cognitive testing differentiating the phenotypes were semantic fluency and ideomotor apraxia. The majority of our cohort was either affected by dementia or presented normal cognition. Richardson's syndrome presented the highest rate of dementia. The only marker of PSP non-Richardson's syndrome phenotype was better performance in visuo-spatial testing, implying worse visuo-spatial abilities in PSP Richardson's syndrome. CONCLUSION Available clinical assessments hardly capture differences between PSP phenotypes. The cognitive testing differentiating the PSP phenotypes were semantic fluency and ideomotor apraxia. In PSP, mild cognitive impairment likely represents an intermediate step from normal cognition to dementia. The only marker of PSP non-Richardson's syndrome phenotype was better performance in visuo-spatial testing.
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Affiliation(s)
- Marina Picillo
- Department of Medicine, Surgery and Dentistry, Neuroscience Section, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, 84131, Baronissi (Salerno), Italy.
| | - Sofia Cuoco
- Department of Medicine, Surgery and Dentistry, Neuroscience Section, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, 84131, Baronissi (Salerno), Italy
| | - Maria Francesca Tepedino
- Department of Medicine, Surgery and Dentistry, Neuroscience Section, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, 84131, Baronissi (Salerno), Italy
| | - Arianna Cappiello
- Department of Medicine, Surgery and Dentistry, Neuroscience Section, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, 84131, Baronissi (Salerno), Italy
| | - Giampiero Volpe
- Department of Medicine, Surgery and Dentistry, Neuroscience Section, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, 84131, Baronissi (Salerno), Italy
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry, Neuroscience Section, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, 84131, Baronissi (Salerno), Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, 81100, Caserta, Italy
| | - Maria Teresa Pellecchia
- Department of Medicine, Surgery and Dentistry, Neuroscience Section, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, 84131, Baronissi (Salerno), Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry, Neuroscience Section, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, 84131, Baronissi (Salerno), Italy
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17
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Ghazi Sherbaf F, Same K, Aarabi MH. High angular resolution diffusion imaging correlates of depression in Parkinson's disease: a connectometry study. Acta Neurol Belg 2018; 118:573-579. [PMID: 29728904 DOI: 10.1007/s13760-018-0937-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 04/26/2018] [Indexed: 11/30/2022]
Abstract
Depression is a significant disabling feature in Parkinson's disease (PD). However, the neuropathology of this comorbidity is still unclear. In fact, few studies have tried to elucidate the neural correlates of depression in PD and have mostly examined specific regions of interest. In this study, we applied diffusion MRI connectometry, a powerful complementary approach to investigate alterations in whole white matter pathways regarding the severity of depressive symptoms. Using a multiple regression model, the correlation of severity of depressive symptoms assessed by the Hospital Anxiety and Depression Scale (HADS) with white matter connectivity was surveyed in 27 non-demented PD patients related to 26 age, sex, and educational level-matched healthy subjects. Results revealed areas, where white matter quantitative anisotropy (QA) was correlated with depression score in PD patients, without any significant association in healthy controls. The analysis showed a significant negative association (false discovery rate < 0.05) between scores on depression subscale of HADS in PD patients and QA of left Cingulum, Genu, and Splenium of the Corpus Callosum, and anterior and posterior limbs of the right internal capsule. This finding might improve our understanding of the neural basis of depression and its severity in PD.
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Affiliation(s)
- Farzaneh Ghazi Sherbaf
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Same
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hadi Aarabi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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18
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Ducharme S, Price BH, Dickerson BC. Apathy: a neurocircuitry model based on frontotemporal dementia. J Neurol Neurosurg Psychiatry 2018; 89:389-396. [PMID: 29066518 PMCID: PMC6561783 DOI: 10.1136/jnnp-2017-316277] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/02/2017] [Accepted: 09/14/2017] [Indexed: 01/14/2023]
Abstract
Apathy is a symptom shared among many neurological and psychiatric disorders. However, the underlying neurocircuitry remains incompletely understood. Apathy is one of the core features of behavioural variant frontotemporal dementia (bvFTD), a neurodegenerative disease presenting with heterogeneous combinations of socioaffective symptoms and executive dysfunction. We reviewed all neuroimaging studies of apathy in frontotemporal dementia (FTD) attempting to refine a neurocircuitry model and inform clinical definitions. Levels of apathy have been consistently shown to correlate with the severity of executive dysfunctions across a wide range of diseases, including FTD. Some authors view 'energisation'-the loss of which is central in apathy-as a core executive function. Apathy in FTD is most robustly associated with atrophy, hypometabolism and/or hypoperfusion in the dorsolateral prefrontal cortex, the anterior and middle cingulate cortex, the orbitofrontal cortex and the medial and ventromedial superior frontal gyri. Data also suggest that abnormalities in connecting white matter pathways and functionally connected more posterior cortical areas could contribute to apathy. There is a lack of consistency across studies due to small samples, lenient statistical thresholds, variable measurement scales and the focus on apathy as a unitary concept. Integrating findings across studies, we revise a neurocircuitry model of apathy divided along three subcomponents (cognition/planning, initiation, emotional-affective/motivation) with specific neuroanatomical and cognitive substrates. To increase consistency in clinical practice, a recommendation is made to modify the bvFTD diagnostic criteria of apathy/inertia. More generally, we argue that bvFTD constitutes a disease model to study the neurocircuitry of complex behaviours as a 'lesion-based' approach to neuropsychiatric symptoms observed across diagnostic categories.
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Affiliation(s)
- Simon Ducharme
- Department of Psychiatry, Montreal Neurological Institute and McGill University Health Centre, Montreal, Québec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Québec, Canada
| | - Bruce H Price
- Department of Neurology, Harvard University, McLean Hospital, Boston, Massachusetts, USA
| | - Bradford C Dickerson
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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19
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Apathy in drug-naïve patients with Parkinson's disease. Parkinsonism Relat Disord 2017; 44:28-32. [PMID: 28844367 DOI: 10.1016/j.parkreldis.2017.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/19/2017] [Accepted: 08/08/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study is to explore the prevalence and clinical correlates of apathy in early-stage Parkinson's disease (PD) from a cohort of Chinese patients. METHODS A cross-sectional analysis of 133 treatment-naive PD patients was conducted. Each subject was categorized as PD with or without apathy using the Lille Apathy Rating Scale (LARS). RESULTS Of 133 patients, 30 PD patients (22.56%) reported apathy, of whom 23 (17.29%) did not have concomitant depression. The stepwise binary logistic regression model indicated that the lower Frontal assessment battery (FAB) score (OR = 0.623, 95% CI = 0.466-0.834, P = 0.001), the higher sleep/fatigue score from the Non-Motor Symptoms Scale (NMSS) (OR = 1.171, 95% CI = 1.071-1.279, P = 0.001), the higher Hamilton Depression Rating Scale including 24 items (HAMD-24) score (OR = 1.112, 95% CI = 1.005-1.230, P = 0.039) and the higher Unified Parkinson's Disease Rating Scale (UPDRS) part III score (OR = 1.119, 95% CI = 1.045-1.198, P = 0.001) were associated with apathy. No significant associations were found between apathy and other parameters such as age, sex distribution, disease duration, anxiety, Fatigue Severity Scale (FSS) score, Montreal Cognitive Assessment (MOCA) score and remaining domain scores for NMSS. CONCLUSIONS Apathy is not rare (22.56%) in Chinese treatment-naïve PD patients. Apathy in PD is not only related to the severity of motor symptoms of the disease but also to some non-motor symptoms, such as executive dysfunction, depression and sleep disturbances.
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20
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Dukart J, Sambataro F, Bertolino A. Distinct Role of Striatal Functional Connectivity and Dopaminergic Loss in Parkinson's Symptoms. Front Aging Neurosci 2017; 9:151. [PMID: 28588475 PMCID: PMC5441129 DOI: 10.3389/fnagi.2017.00151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 05/03/2017] [Indexed: 11/22/2022] Open
Abstract
Degeneration of dopaminergic neurons is a hallmark of Parkinson's disease. However, its link to Parkinson's disease symptoms remains unclear. Striatal resting state functional connectivity differentiates between Parkinson's disease patients and healthy controls and might be a potential mediator of the effects of striatal dopaminergic degeneration onto Parkinson's disease symptoms. Here, we evaluated the relationship between dopaminergic deficits, striatal functional connectivity (SFC) at rest and different Parkinson's disease clinical symptoms in the largest currently established cohort of de novo Parkinson's disease patients. We show that SFC is an independent predictor of symptom severity in Parkinson's disease in addition to striatal dopaminergic deficits. Furthermore, we find that distinct SFC networks are associated with symptoms reflecting the ability to perform daily routine automatized motor tasks and clinician-rated Parkinson's disease motor symptoms. We find that reduced SFC is a major and independent predictor of Parkinson's disease symptoms going beyond the mere reflection of striatal dopaminergic input loss. These findings indicate the high value of SFC as a clinically relevant biomarker in Parkinson's disease.
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Affiliation(s)
- Juergen Dukart
- Roche Pharmaceutical Research and Early Development, Neuroscience, Ophthalmology and Rare Diseases, Discovery and Translational Area, Roche Innovation Center BaselBasel, Switzerland
| | - Fabio Sambataro
- Roche Pharmaceutical Research and Early Development, Neuroscience, Ophthalmology and Rare Diseases, Discovery and Translational Area, Roche Innovation Center BaselBasel, Switzerland
- Department of Experimental and Clinical Medical Sciences, University of UdineUdine, Italy
| | - Alessandro Bertolino
- Roche Pharmaceutical Research and Early Development, Neuroscience, Ophthalmology and Rare Diseases, Discovery and Translational Area, Roche Innovation Center BaselBasel, Switzerland
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo MoroBari, Italy
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21
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Bertens AS, Moonen JEF, de Waal MWM, Foster-Dingley JC, de Ruijter W, Gussekloo J, van der Mast RC, de Craen AJM. Validity of the three apathy items of the Geriatric Depression Scale (GDS-3A) in measuring apathy in older persons. Int J Geriatr Psychiatry 2017; 32:421-428. [PMID: 27060966 DOI: 10.1002/gps.4484] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 02/02/2016] [Accepted: 03/15/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The Geriatric Depression Scale (GDS)-3A, a three-item subset of the GDS-15, is increasingly used as a measure for apathy in research settings to assess factors associating with this neuropsychiatric syndrome. We aimed to assess how accurately the GDS-3A discriminates between presence and absence of apathy in two populations of community-dwelling older persons, using the Apathy Scale as reference standard. METHODS Baseline data were used from 427 participants of the Discontinuation of Antihypertensive Treatment in Elderly people (DANTE) Study Leiden and 1118 participants of the PROactive Management Of Depression in the Elderly (PROMODE) Study, all ≥75 years and with available GDS-3A and Apathy Scale measurements. A cut-off score of ≥14 was used for presence of apathy according to the Apathy Scale. Areas under the receiver operating characteristic curve (AUC) were calculated. Based on the likelihood ratios for GDS-3A scores, a cut-off of ≥2 was used for presence of apathy according to the GDS-3A to calculate test characteristics. RESULTS The AUC was 0.68 (95% confidence interval 0.62-0.73) in the DANTE Study and 0.72 (0.67-0.77) in the PROMODE Study. In the DANTE Study sensitivity was 29.3% (21.4-38.1) and specificity was 88.5% (84.4-91.8), whereas in the PROMODE Study sensitivity was 32.8% (24.5-41.1) and specificity 92.6% (90.9-94.2). Stratification on population characteristics did not yield more favourable test characteristics. CONCLUSION The GDS-3A has low sensitivity and high specificity as a measure of apathy in two populations of older persons. Using the GDS-3A in research might yield estimates biassed towards the null in case of non-differential misclassification. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Anne Suzanne Bertens
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | - Justine E F Moonen
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | - Margot W M de Waal
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Wouter de Ruijter
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Psychiatry, CAPRI-University of Antwerp, Antwerp, Belgium
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, the Netherlands
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22
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Moretti R, Signori R. Neural Correlates for Apathy: Frontal-Prefrontal and Parietal Cortical- Subcortical Circuits. Front Aging Neurosci 2016; 8:289. [PMID: 28018207 PMCID: PMC5145860 DOI: 10.3389/fnagi.2016.00289] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 11/15/2016] [Indexed: 01/10/2023] Open
Abstract
Apathy is an uncertain nosographical entity, which includes reduced motivation, abulia, decreased empathy, and lack of emotional involvement; it is an important and heavy-burden clinical condition which strongly impacts in everyday life events, affects the common daily living abilities, reduced the inner goal directed behavior, and gives the heaviest burden on caregivers. Is a quite common comorbidity of many neurological disease, However, there is no definite consensus on the role of apathy in clinical practice, no definite data on anatomical circuits involved in its development, and no definite instrument to detect it at bedside. As a general observation, the occurrence of apathy is connected to damage of prefrontal cortex (PFC) and basal ganglia; “emotional affective” apathy may be related to the orbitomedial PFC and ventral striatum; “cognitive apathy” may be associated with dysfunction of lateral PFC and dorsal caudate nuclei; deficit of “autoactivation” may be due to bilateral lesions of the internal portion of globus pallidus, bilateral paramedian thalamic lesions, or the dorsomedial portion of PFC. On the other hand, apathy severity has been connected to neurofibrillary tangles density in the anterior cingulate gyrus and to gray matter atrophy in the anterior cingulate (ACC) and in the left medial frontal cortex, confirmed by functional imaging studies. These neural networks are linked to projects, judjing and planning, execution and selection common actions, and through the basolateral amygdala and nucleus accumbens projects to the frontostriatal and to the dorsolateral prefrontal cortex. Therefore, an alteration of these circuitry caused a lack of insight, a reduction of decision-making strategies, and a reduced speedness in action decision, major responsible for apathy. Emergent role concerns also the parietal cortex, with its direct action motivation control. We will discuss the importance of these circuits in different pathologies, degenerative or vascular, acute or chronic.
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Affiliation(s)
- Rita Moretti
- Neurology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste Trieste, Italy
| | - Riccardo Signori
- Neurology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste Trieste, Italy
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Neural correlates of apathy in patients with neurodegenerative disorders, acquired brain injury, and psychiatric disorders. Neurosci Biobehav Rev 2016; 69:381-401. [DOI: 10.1016/j.neubiorev.2016.08.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 03/11/2016] [Accepted: 08/06/2016] [Indexed: 11/21/2022]
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Almeida L, Ahmed B, Walz R, De Jesus S, Patterson A, Martinez-Ramirez D, Vaillancourt D, Bowers D, Ward H, Okun MS, McFarland NR. Depressive Symptoms are Frequent in Atypical Parkinsonian Disorders. Mov Disord Clin Pract 2016; 4:191-197. [PMID: 28944256 DOI: 10.1002/mdc3.12382] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To compare the incidence and prevalence of depressive symptoms in atypical parkinsonian (APD) syndromes versus Parkinson disease (PD). METHODS In a large retrospective patient cohort we analyzed the incidence and prevalence of depressive symptoms using the Beck Depression Inventory (BDI) and evaluated subjects longitudinally on subsequent visits. For individuals who followed in subsequent visits we calculated incidence rates in person-years as a measure of incidence. RESULTS We identified 361 patients with APD including Progressive Supranuclear Palsy (PSP), Corticobasal Degeneration (CBD), Multiple System Atrophy (MSA) and Dementia with Lewy Bodies (DLB), and 2352 PD controls. The mean BDI values were significantly higher in APD (F=14.19, p < 0.001). A significantly higher proportion of APD subjects screened positive for depressive symptoms both at initial and subsequent patient visits (p < 0.001), which appeared to be more severe in the APD subgroups. UPDRS part III and disease duration weakly correlated with depressive symptoms. CONCLUSIONS Our results suggest that the incidence and prevalence of depressive symptoms are higher in APD and appear also to be more severe than in PD. Depressive symptoms in APD are common and affect patients regardless of disease duration or motor severity.
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Affiliation(s)
- Leonardo Almeida
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States
| | - Bilal Ahmed
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States
| | - Roger Walz
- Department of Neurology, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Sol De Jesus
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States
| | - Addie Patterson
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States
| | - Daniel Martinez-Ramirez
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States
| | - David Vaillancourt
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States.,Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, United States
| | - Dawn Bowers
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States.,Department of Clinical & Health Psychology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States
| | - Herbert Ward
- Department of Psychiatry, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States
| | - Michael S Okun
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States
| | - Nikolaus R McFarland
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States
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Diederich NJ, Goldman JG, Stebbins GT, Goetz CG. Failing as doorman and disc jockey at the same time: Amygdalar dysfunction in Parkinson's disease. Mov Disord 2015; 31:11-22. [PMID: 26650182 DOI: 10.1002/mds.26460] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 09/20/2015] [Accepted: 09/23/2015] [Indexed: 02/01/2023] Open
Abstract
In Braak's model of ascending degeneration in Parkinson's disease (PD), involvement of the amygdala occurs simultaneously with substantia nigra degeneration. However, the clinical manifestations of amygdalar involvement in PD have not been fully delineated. Considered a multitask manager, the amygdala is a densely connected "hub," coordinating and integrating tasks ranging from prompt, multisensorial emotion recognition to adequate emotional responses and emotional tuning of memories. Although phylogenetically predisposed to handle fear, the amygdala handles both aversive and positive emotional inputs. In PD, neuropathological and in vivo studies suggest primarily amygdalar hypofunction. However, as dopamine acts as an inverted U-shaped amygdalar modulator, medication-induced hyperactivity of the amygdala can occur. We propose that amygdalar (network) dysfunction contributes to reduced recognition of negative emotional face expressions, impaired theory of mind, reactive hypomimia, and impaired decision making. Similarly, impulse control disorders in predisposed individuals, hallucinations, anxiety, and panic attacks may be related to amygdalar dysfunction. When available, we discuss amygdala-independent trigger mechanisms of these symptoms. Although dopaminergic agents have mostly an activation effect on amygdalar function, adaptive and compensatory network changes may occur as well, but these have not been sufficiently explored. In conclusion, our model of amygdalar involvement brings together several elements of Parkinson's disease phenomenology heretofore left unexplained and provides a framework for testable hypotheses in patients during life and in autopsy analyses.
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Affiliation(s)
- Nico J Diederich
- Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg.,Centre for Systems Biomedicine, University of Luxembourg, Campus Esch-Belval, Esch-s.-Alzette, Luxembourg.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Jennifer G Goldman
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
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Danqing X. Acupuncture for Parkinson's Disease: a review of clinical, animal, and functional Magnetic Resonance Imaging studies. J TRADIT CHIN MED 2015; 35:709-17. [DOI: 10.1016/s0254-6272(15)30164-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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27
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Alzahrani H, Venneri A. Cognitive and neuroanatomical correlates of neuropsychiatric symptoms in Parkinson's disease: A systematic review. J Neurol Sci 2015; 356:32-44. [DOI: 10.1016/j.jns.2015.06.037] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 05/25/2015] [Accepted: 06/17/2015] [Indexed: 12/13/2022]
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Psychological Benefits of Nonpharmacological Methods Aimed for Improving Balance in Parkinson's Disease: A Systematic Review. Behav Neurol 2015; 2015:620674. [PMID: 26236107 PMCID: PMC4508472 DOI: 10.1155/2015/620674] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/07/2015] [Accepted: 06/10/2015] [Indexed: 01/20/2023] Open
Abstract
Parkinson's disease (PD) is a serious condition with a major negative impact on patient's physical and mental health. Postural instability is one of the cardinal difficulties reported by patients to deal with. Neuroanatomical, animal, and clinical studies on nonparkinsonian and parkinsonian subjects suggest an important correlation between the presence of balance dysfunction and multiple mood disorders, such as anxiety, depression, and apathy. Considering that balance dysfunction is a very common symptom in PD, we can presume that by its management we could positively influence patient's state of mind too. This review is an analysis of nonpharmacological methods shown to be effective and successful for improving balance in patients suffering from PD. Strategies such as general exercise, robotic assisted training, Tai Chi, Qi Gong, Yoga, dance (such as tango or ballet), box, virtual reality-based, or neurofeedback-based techniques and so forth can significantly improve the stability in these patients. Beside this physical outcome, many methods have also shown effect on quality of life, depression level, enjoyment, and motivation to continue in practicing the method independently. The purpose of this review is to provide information about practical and creative methods designed to improve balance in PD and highlight their positive impact on patient's psychology.
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Santangelo G, Vitale C, Picillo M, Cuoco S, Moccia M, Pezzella D, Erro R, Longo K, Vicidomini C, Pellecchia MT, Amboni M, Brunetti A, Salvatore M, Barone P, Pappatà S. Apathy and striatal dopamine transporter levels in de-novo, untreated Parkinson's disease patients. Parkinsonism Relat Disord 2015; 21:489-93. [DOI: 10.1016/j.parkreldis.2015.02.015] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/06/2015] [Accepted: 02/17/2015] [Indexed: 01/26/2023]
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Langner-Lemercier S, Drapier S, Naudet F, Le Clanche N, Houvenaghel JF, Sauleau P, Jannin P, Haegelen C, Le Jeune F, Vérin M. Preoperative brain metabolism and quality of life after subthalamic nucleus stimulation in Parkinson's disease. J Neurol 2015; 262:881-9. [PMID: 25634679 DOI: 10.1007/s00415-015-7647-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/08/2015] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
Abstract
Subthalamic nucleus deep brain stimulation (STN-DBS) has been proven to improve health-related quality of life (HRQoL) in patients with Parkinson's disease (PD) presenting medically refractory motor complications and dyskinesia. However, some patients fail to benefit from STN-DBS despite rigorous preoperative selection. We postulated that they have a particular, clinically ineloquent, brain metabolism before surgery. We divided 40 stimulated PD patients into two groups (responders vs. nonresponders) depending on whether they reported or not a clinically significant improvement in their quality of life 1 year after surgery. We retrospectively compared their preoperative brain metabolism on the basis of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) scans. We also analyzed their neuropsychological and psychiatric profiles before and after surgery. All 40 patients met the STN-DBS selection criteria, but only 50% of them had significantly improved 1 year after surgery. Preoperative PET scans showed that metabolism was higher in the left insula, both inferior frontal gyri and left precentral gyrus in nonresponders than in responders. Clinically, postoperative motor scores were similar in both groups, but a worsening of the depression score was observed among nonresponders. PET imaging revealed that nonresponders were characterized by distinctive brain functioning pre-surgery, in regions involved in associative and limbic circuits, as a result of PD-related degeneration. STN-DBS may have interfered with this already abnormal circuitry, leading to the occurrence of complex nonmotor symptoms reducing quality of life. Preoperative brain metabolism could be a useful biomarker for anticipating STN-DBS efficacy in terms of HRQoL in the context of advanced PD.
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Affiliation(s)
- Sophie Langner-Lemercier
- Department of Neurology, Rennes University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes Cedex 9, France,
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Affiliation(s)
- M. Benoit
- Psychiatry - Clinical Neuroscience Department; Pasteur Hospital, University of Nice Sophia-Antipolis; Nice France
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Santangelo G, Vitale C, Trojano L, Picillo M, Moccia M, Pisano G, Pezzella D, Cuoco S, Erro R, Longo K, Pellecchia MT, Amboni M, De Rosa A, De Michele G, Barone P. Relationship between apathy and cognitive dysfunctions in de novo untreated Parkinson's disease: a prospective longitudinal study. Eur J Neurol 2014; 22:253-60. [PMID: 24848193 DOI: 10.1111/ene.12467] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 03/26/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Apathy may be either a symptom of major depression or a behavioral disturbance occurring in concomitance with depression or alone in Parkinson's disease (PD). The aim of the present study was to determine the progression of cognitive impairment in drug-naïve untreated PD patients with or without clinically significant apathy. METHODS Sixty-two PD patients with a disease duration <2 years and without history of present or past therapy with pro-dopaminergic agents were included and underwent the Apathy Evaluation Scale (S-AES), a clinical interview based on diagnostic criteria for apathy and a comprehensive neuropsychological battery to assess memory, frontal functions and visuospatial functions. Two years after the first assessment, all patients were re-evaluated on the S-AES, a clinical interview and neuropsychological tests. RESULTS According to the cut-off value of the S-AES and diagnostic criteria for apathy, eight patients experienced apathy at both baseline and follow-up (A+A+), nine patients had apathy only at follow-up (A-A+), 37 patients never experienced apathy (A-A-) and eight patients showed apathy at the baseline only (A+A-). Cognitive performance significantly declined in all four groups. At both baseline and follow-up A+A+ performed worse than A-A- on visuospatial and frontal tests; A-A+ had lower scores than A-A- on the interference task of the Stroop test (IT-ST). Regression analysis showed that poor performance on the IT-ST at baseline was the only independent predictor of onset of apathy at follow-up. CONCLUSIONS The results indicated a relationship between apathy and dysexecutive syndrome in early PD. Reduced scores on the IT-ST may predict development of apathy in PD patients.
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Affiliation(s)
- G Santangelo
- Department of Psychology, Second University of Naples, Caserta, Italy; IDC-Hermitage-Capodimonte, Naples, Italy
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Chen ST, Siddarth P, Saito NY, Rueda F, Haight T, Ercoli LM, Miller KJ, Lavretsky H, Barrio JR, Bookheimer SY, Small GW, Merrill DA. Psychological well-being and regional brain amyloid and tau in mild cognitive impairment. Am J Geriatr Psychiatry 2014; 22:362-9. [PMID: 23567426 PMCID: PMC3883933 DOI: 10.1016/j.jagp.2012.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 08/17/2012] [Accepted: 09/26/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine whether psychological well-being in people with mild cognitive impairment (MCI), a risk state for Alzheimer disease (AD), is associated with in vivo measures of brain pathology. METHODS Cross-sectional clinical assessments and positron emission tomography (PET) scans after intravenous injections of 2-(1-{6-[(2-[F18]fluoroethyl)(methyl)amino]-2-naphthyl}ethylidene)malononitrile (FDDNP), a molecule that binds to plaques and tangles, were performed on middle-aged and older adults at a university research institute. Volunteers were aged 40-85 years with MCI (N = 35) or normal cognition (N = 29) without depression or anxiety. Statistical analyses included general linear models, using regional FDDNP-PET binding values as dependent variables and the Vigor-Activity subscale of the Profile of Mood States (POMS) as the independent variable, covarying for age. The POMS is a self-rated inventory of 65 adjectives that describe positive and negative feelings. RESULTS Scores on the POMS Vigor-Activity subscale were inversely associated with degree of FDDNP binding in the posterior cingulate cortex (r = -0.35, p = 0.04) in the MCI group but not in the control group. CONCLUSION Psychological well-being, as indicated by self-reports of greater vigor and activity, is associated with lower FDDNP-PET binding in the posterior cingulate cortex, a region involved in emotional regulation, in individuals with MCI but not in those with normal cognition. These findings are consistent with previous work indicating that deposition of brain amyloid plaques and tau tangles may result in noncognitive and cognitive symptoms in persons at risk for AD.
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Affiliation(s)
- Stephen T Chen
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA.
| | - Prabha Siddarth
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
| | - Nathan Y Saito
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
| | - Flori Rueda
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
| | - Taylor Haight
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
| | - Linda M Ercoli
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA; UCLA Longevity Center, University of California, Los Angeles, CA
| | - Karen J Miller
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA; UCLA Longevity Center, University of California, Los Angeles, CA
| | - Helen Lavretsky
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
| | - Jorge R Barrio
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA
| | - Susan Y Bookheimer
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
| | - Gary W Small
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA; Alzheimer's Disease Research Center, University of California, Los Angeles, CA; UCLA Longevity Center, University of California, Los Angeles, CA
| | - David A Merrill
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA; UCLA Longevity Center, University of California, Los Angeles, CA
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Correlations of apathy and depression with postural instability in Parkinson disease. J Neurol Sci 2014; 338:162-5. [DOI: 10.1016/j.jns.2013.12.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 12/22/2013] [Accepted: 12/24/2013] [Indexed: 11/30/2022]
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Chung EJ, Hwang JH, Lee MJ, Hong JH, Ji KH, Yoo WK, Kim SJ, Song HK, Lee CS, Lee MS, Kim YJ. Expansion of the clinicopathological and mutational spectrum of Perry syndrome. Parkinsonism Relat Disord 2014; 20:388-93. [PMID: 24484619 DOI: 10.1016/j.parkreldis.2014.01.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 01/09/2014] [Accepted: 01/13/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Perry syndrome (PS) caused by DCTN1 gene mutation is clinically characterized by autosomal dominant parkinsonism, depression, severe weight loss, and hypoventilation. Previous pathological studies have reported relative sparing of the cerebral cortex in this syndrome. Here, we characterize novel clinical and neuroimaging features in 3 patients with PS. METHODS (18)F-fluorinated N-3-fluoropropyl-2-ß-carboxymethoxy-3-β-(4-iodophenyl) nortropane ([(18)F]FP-CIT) PET, [(18)F]fluorodeoxyglucose PET, or volumetric MRI was performed in probands, and imaging data were analyzed and compared with those of control subjects. RESULTS We identified 2 novel mutations of DCTN1. Oculogyric crisis that presented before levodopa treatment was observed in 1 case. One patient had supranuclear gaze palsy. In 2 cases, [(18)F]FP-CIT showed marked loss of dopamine transporter binding with only mild parkinsonism. Areas of hypometabolism or cortical thickness change were observed in dorsolateral frontal, anterior cingulate, lateral temporal, and inferior parietal cortices. CONCLUSION Oculomotor manifestations are not uncommon in PS. Neuroimaging studies suggest involvement of the frontotemporoparietal cortex, which may be the clinical correlate of apathy and depression, as well as pathological changes in subcortical structures.
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Affiliation(s)
- Eun Joo Chung
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ji Hye Hwang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myung Jun Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hoon Hong
- ILSONG Institute of Life Science, Hallym University, Anyang, Republic of Korea
| | - Ki Hwan Ji
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Woo-Kyoung Yoo
- Department of Physical and Rehabilitation Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea; Hallym Institute of Translational Genomics & Bioinformatics, Hallym University Medical Center, Republic of Korea
| | - Sang Jin Kim
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Hyun Kyu Song
- School of Life Sciences and Biotechnology, Korea University, Seoul, Republic of Korea
| | - Chong S Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myung-Sik Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yun Joong Kim
- ILSONG Institute of Life Science, Hallym University, Anyang, Republic of Korea; Hallym Institute of Translational Genomics & Bioinformatics, Hallym University Medical Center, Republic of Korea; Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
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Huang C, Ravdin LD, Nirenberg MJ, Piboolnurak P, Severt L, Maniscalco JS, Solnes L, Dorfman BJ, Henchcliffe C. Neuroimaging markers of motor and nonmotor features of Parkinson's disease: an 18f fluorodeoxyglucose positron emission computed tomography study. Dement Geriatr Cogn Disord 2013; 35:183-96. [PMID: 23445555 DOI: 10.1159/000345987] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2012] [Indexed: 01/21/2023] Open
Abstract
AIM We sought to identify markers of motor and nonmotor function in Parkinson's disease (PD) using advanced neuroimaging techniques in subjects with PD. METHODS We enrolled 26 nondemented PD subjects and 12 control subjects. All subjects underwent [(18)F]fluorodeoxyglucose positron emission computed tomography (FDG-PET) and magnetic resonance imaging, and a complete neuropsychological battery. RESULTS FDG-PET of subjects with PD revealed significant metabolic elevations in the bilateral posterior lentiform nucleus, posterior cingulate, and parahippocampus, and metabolic reductions in the bilateral temporoparietal association cortex and occipital lobe versus controls. PD subjects had significant reductions in executive/attention function, memory/verbal learning, and speed of thinking, and significantly increased depression, anxiety and apathy scores compared with controls. Motor dysfunction correlated with increased metabolism in the posterior lentiform nucleus, pons, and cerebellum, and decreased metabolism in the temporoparietal lobe. Cognitive dysfunction correlated with increased posterior cingulate metabolism and decreased temporoparietal lobe metabolism. Depressive symptoms correlated with increased amygdala metabolism; anxiety scores correlated with decreased caudate metabolism, and apathy scores correlated with increased metabolism in the anterior cingulate and orbitofrontal lobe and decreased metabolism in the temporoparietal association cortex. CONCLUSIONS Our findings showed that motor, cognitive, and emotional dysfunction in PD are associated with distinct patterns of cerebral metabolic changes.
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Affiliation(s)
- Chaorui Huang
- Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, NY 10021, USA. chh2019 @ med.cornell.edu
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Chen JJ, Marsh L. Depression in Parkinson's disease: identification and management. Pharmacotherapy 2013; 33:972-83. [PMID: 23798003 DOI: 10.1002/phar.1314] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Depression is a common psychiatric comorbidity in Parkinson's disease (PD) and contributes to significant impairments in cognitive, functional, motor, and social performance. This results in reduced quality of life, higher levels of care dependency, and increased caregiver burden. When treating depression, it is important to ensure that the patient's response to treatment will be adequately monitored. This can be accomplished in neurology or primary care settings, or in clinical settings with interdisciplinary treatment teams. Mental health services should be engaged early as a component of ongoing comprehensive care. This article reviews a general approach to treating the pharmacotherapy of depression in PD. Ultimately, clinicians should rely on empiric assessments of known risks and putative benefits to guide treatment decisions and should include a targeted and individualized multimodal approach that utilizes psychotherapeutic interventions along with pharmacologic therapies.
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Affiliation(s)
- Jack J Chen
- Schools of Medicine and Pharmacy, Loma Linda University, Loma Linda, California
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Harris E, McNamara P, Durso R. Apathy in patients with Parkinson disease as a function of side of onset. J Geriatr Psychiatry Neurol 2013; 26:95-104. [PMID: 23584852 DOI: 10.1177/0891988713481267] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In previous studies among patients with Parkinson disease (PD) who were administered the Apathy Evaluation Scale (AES), between 12% and 51% evidenced clinically significant apathy. Although apathy is a risk factor for dementia, its causes and clinical correlates have not been adequately studied. In particular, side of onset of disease, though a likely predictor of apathy and dementia, has not been thoroughly investigated. METHODS A total of 30 mid-stage patients with PD and 35 community-dwelling elderly control patients (CPs) were administered the AES (self version) along with a battery of cognitive and neuropsychiatric assessments. Persons close to patients with PD and CPs completed the AES--other (informant) version about the patient or CP. Multiple linear regression analysis examined predictors of apathy severity after controlling for mood, levodopa dosage equivalents (LDEs), gender, age, and disease severity (Hoehn--Yahr [H-Y] stage). RESULTS Patients with right-onset disease more frequently exhibited apathy and evidenced significantly higher total AES scores than left-onset patients with PD or CPs (P < .03). Of all the patients, 42% with right-onset PD versus 11.1% of the patients with left-onset PD exhibited clinically significant levels of apathy. There were no differences for self versus informant scores for right-onset patients with PD. The AES scores were not correlated with depression, stress, anxiety, LDEs, gender, age, and H-Y stage. There were no gender differences for any AES variables. CONCLUSION Clinically significant levels of apathy are much more likely to occur in patients with right-onset disease. These patients may be at greater risk of PD-related dementia.
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Affiliation(s)
- Erica Harris
- Department of Behavioral Sciences and Epidemiology, Naval Health Research Center, San Diego, CA 92106, USA.
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Poletti M, Bonuccelli U. Acute and chronic cognitive effects of levodopa and dopamine agonists on patients with Parkinson's disease: a review. Ther Adv Psychopharmacol 2013; 3:101-13. [PMID: 24167681 PMCID: PMC3805397 DOI: 10.1177/2045125312470130] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The spatiotemporal progression of dopamine depletion in Parkinson's disease (PD) provides a special model for assessing dopaminergic effects on neural systems with differential baseline dopamine levels. This study aims at reviewing cognitive effects of dopaminergic stimulation in PD. While considering dopaminergic drugs (levodopa or dopamine agonists), temporal intervals (acute or chronic) and cognitive domains, we found that empirical evidence was almost focused on acute effects of levodopa on executive functions. The paucity of empirical evidence suggests that no meaningful conclusions can be actually drawn and further research is needed in relation to: (1) other cognitive domains; (2) the acute cognitive effects of dopamine agonists, as compared with levodopa; (3) possible differences between cognitive effects of different dopamine agonists; (4) the cognitive effects of chronic dopaminergic therapies. The latter issue is of particular clinical interest considering that many PD patients present a mild cognitive impairment: is this cognitive feature worsened or improved by the prolonged dopaminergic therapy? In addition to the potential risk of inducing dyskinesia and behavioral side effects such as impulse control disorders, also cognitive effects of prolonged dopaminergic treatments should be taken in account by clinicians in order to anticipate or to delay their prescription to PD patients.
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Affiliation(s)
- Michele Poletti
- Department of Neuroscience, University of Pisa, via Roma 55, Pisa, Italy
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Depressione e malattia di Parkinson. Neurologia 2013. [DOI: 10.1016/s1634-7072(12)63928-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Hahn C, Lim HK, Won WY, Ahn KJ, Jung WS, Lee CU. Apathy and white matter integrity in Alzheimer's disease: a whole brain analysis with tract-based spatial statistics. PLoS One 2013; 8:e53493. [PMID: 23301077 PMCID: PMC3536751 DOI: 10.1371/journal.pone.0053493] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 11/29/2012] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to investigate the microstructural alterations of white matter (WM) in Alzheimer's disease (AD) patients with apathy and to observe the relationships with the severity of apathy. Sixty drug-naïve subjects took part in this study (30 apathetic and 30 nonapathetic subjects with AD). The loss of integrity in WM was compared in AD patients with and without apathy through measurement of fractional anisotropy (FA) using by tract-based spatial statistics (TBSS). In addition, we explored the correlation pattern between FA values and the severity of apathy in AD patients with apathy. The apathy group had significantly reduced FA values (p(corrected)<0.05) in the genu of the corpus callosum compared to the nonapathy group. The severity of apathy was negatively correlated with FA values of the left anterior and posterior cingulum, right superior longitudinal fasciculus, splenium, body and genu of the corpus callosum and bilateral uncinate fasciculusin the apathy group (p(corrected)<0.05). This study was the first to explore FA values in whole brain WM in AD patients with apathy. The findings of these microstructural alterations of WM may be the key to the understanding of underlying neurobiological mechanism and clinical significances of apathy in AD.
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Affiliation(s)
- Changtae Hahn
- Department of Psychiatry, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun-Kook Lim
- Department of Psychiatry, Saint Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Wang Yeon Won
- Department of Psychiatry, The Saint Paul Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kook Jin Ahn
- Department of Radiology, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won-Sang Jung
- Department of Radiology, Saint Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Chang Uk Lee
- Department of Psychiatry, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
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Abstract
Major depressive disorder is a serious medical illness which is responsible for considerable morbidity and disability. Despite decades of research, the neural basis for depression is still incompletely understood. In this review, evidence from neuroimaging, neuropsychiatric and brain stimulations studies are explored to answer the question regarding the localization of depression in the brain. Neuroimaging studies indicate that although many regions of the brain have been repeatedly implicated in the pathophysiology of depression, not many consistent findings have been found until present. In recent times, the focus of neuroimaging has shifted from regional brain abnormalities to circuit level connectivity abnormalities. However, connectivity models are inherently more complicated, and the validity of these models remains to be tested. Neuropsychiatric studies of illnesses such as Parkinson's disease and stroke provide promising clues regarding areas involved in depression, but again consistent findings are rare. Similarly, stimulation of a variety of brain regions and circuits has been reported as being effective in depression. Therefore, the current knowledge indicates that the pathophysiology of depression may be distributed across many brain regions and circuits. In future studies, this distributed nature of depression needs to be further investigated, primary and secondary areas affected need to be identified, and new paradigms to explain complex mental functions need to be explored.
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Affiliation(s)
- Mayur Pandya
- Department of Psychiatry and Center for Behavioral Health, Neurological Institute, Cleveland Clinic
| | - Murat Altinay
- Department of Psychiatry and Center for Behavioral Health, Neurological Institute, Cleveland Clinic
| | - Donald A. Malone
- Department of Psychiatry and Center for Behavioral Health, Neurological Institute, Cleveland Clinic
| | - Amit Anand
- Indiana University Center for Neuroimaging, Department of Radiology, 950 West Walnut Street, E124, Indianapolis, IN 46202
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