1
|
Yao J, Shen Z, Jin H, Ma T, Wang J, Li S, Zeng M, Liu X, Peng Y. Dexmedetomidine after deep brain stimulation for prevention of delirium in elderly patients with Parkinson's disease: protocol for a single-centre, randomised, double-blind, placebo-controlled trial in China. BMJ Open 2023; 13:e070185. [PMID: 37433729 DOI: 10.1136/bmjopen-2022-070185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Parkinson's disease is one of the most common neurodegenerative diseases. Deep brain stimulation (DBS) can improve motor symptoms in patients with middle and late Parkinson's disease, reduce the use of levodopa, and thus reduce drug-related side effects. Postoperative delirium can significantly reduce the short-term and long-term quality of life in elderly patients, which can be alleviated by dexmedetomidine (DEX). However, whether prophylactic DEX could reduce the incidence of postoperative delirium in patients with Parkinson's disease was still unknown. METHODS AND ANALYSIS This is a single-centre, randomised, double-blinded, placebo-controlled group trial. A total of 292 patients aged 60 years and above elected for DBS will be stratified according to DBS procedure, subthalamic nucleus or globus pallidus interna, then randomly allocated to the DEX group or the placebo control group with a 1:1 ratio, respectively. In the DEX group, patients will be injected with the DEX continuously with an electronic pump at a rate of 0.1 µg/kg/hour for 48 hours at the beginning of general anaesthesia induction. In the control group, normal saline will be administered at the same rate for patients as in the DEX group. The primary endpoint is the incidence of postoperative delirium within 5 days after surgery. Postoperative delirium is assessed by the combination of the Richmond Anxiety Scale and the Confusion Assessment Method (CAM) for the intensive care unit or the 3-minute diagnostic interview for CAM as applicable. The secondary endpoints include the incidence of adverse events and non-delirium complications, the length of stay in the intensive care unit and hospital and all-cause 30-day mortality after the operation. ETHICS AND DISSEMINATION The protocol has been approved by the Ethics Committee of Beijing Tiantan Hospital of Capital Medical University (KY2022-003-03). The results of this study will be disseminated through presentation at scientific conferences and publication in scientific journals. TRIAL REGISTRATION NUMBER NCT05197439.
Collapse
Affiliation(s)
- Jingxin Yao
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongyuan Shen
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hailong Jin
- Department of Anesthesiology, Beijing Daxing District People's Hospital, Capital Medical University, Beijing, China
| | - Tingting Ma
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jie Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shu Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Min Zeng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoyuan Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuming Peng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
2
|
Li S, Ritz B, Gong Y, Cockburn M, Folle AD, Del Rosario I, Yu Y, Zhang K, Castro E, Keener AM, Bronstein J, Paul KC. Proximity to residential and workplace pesticides application and the risk of progression of Parkinson's diseases in Central California. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 864:160851. [PMID: 36526213 PMCID: PMC11121507 DOI: 10.1016/j.scitotenv.2022.160851] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Pesticide exposure has consistently been associated with Parkinson's disease (PD) onset. Yet, fewer epidemiologic studies have examined whether pesticides influence PD motor and non-motor symptom progression. OBJECTIVES Using a geographic information system tool that integrates agricultural pesticide use reports and land use records to derive ambient exposures at residences and workplaces, we assessed associations between specific pesticides previously related to PD onset with PD symptom progression in two PD patient cohorts living in agricultural regions of California. METHODS We calculated the pounds of pesticide applied agriculturally near each participant's residential or occupational addresses from 1974 to the year of PD diagnosis, using a geographic information system tool that links the California Pesticide Use Reports database to land use data. We examined 53 pesticides selected a priori as they have previously been associated with PD onset. We longitudinally followed two PD patient cohorts (PEG1 N = 242, PEG2 N = 259) for an average of 5.0 years (SD ± 3.5) and 2.7 years (SD ± 1.6) respectively and assessed PD symptoms using the movement disorder specialist-administered Unified Parkinson's disease Rating Scale part III (UPDRS), Mini-Mental State Examination (MMSE), and Geriatric Depression Scale (GDS). Weighted time-to-event regression models were implemented to estimate effects. RESULTS Ten agricultural pesticides, including copper sulfate (pentahydrate), 2-methyl-4-chlorophenoxyacetic acid (MCPA) dimethylamine salt, tribufos, sodium cacodylate, methamidophos, ethephon, propargite, bromoxynil octanoate, monosodium methanearsonate (MSMA), and dicamba, were associated with faster symptom progression. Among these pesticides, residential or workplace proximity to higher amounts of copper sulfate (pentahydrate) and MCPA (dimethylamine salt) was associated with all three progression endpoints (copper sulfate: HRs = 1.22-1.36, 95 % CIs = 1.03-1.73; MCPA: HRs = 1.27-1.35, 95 % CIs = 1.02-1.70). CONCLUSIONS Our findings suggest that pesticide exposure may not only be relevant for PD onset but also PD progression phenotypes. We have implicated ten specific pesticide active ingredients in faster PD motor and non-motor decline.
Collapse
Affiliation(s)
- Shiwen Li
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Beate Ritz
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Yufan Gong
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Myles Cockburn
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, CA, USA
| | - Aline Duarte Folle
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Irish Del Rosario
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Yu Yu
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Keren Zhang
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Emily Castro
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Adrienne M Keener
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Jeff Bronstein
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Kimberly C Paul
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA.
| |
Collapse
|
3
|
Paul KC, Kusters C, Furlong M, Zhang K, Yu Y, Folle AD, Del Rosario I, Keener A, Bronstein J, Sinsheimer JS, Horvath S, Ritz B. Immune system disruptions implicated in whole blood epigenome-wide association study of depression among Parkinson's disease patients. Brain Behav Immun Health 2022; 26:100530. [PMID: 36325427 PMCID: PMC9618774 DOI: 10.1016/j.bbih.2022.100530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/01/2022] [Indexed: 11/09/2022] Open
Abstract
Although Parkinson's Disease (PD) is typically described in terms of motor symptoms, depression is a common feature. We explored whether depression influences blood-based genome-wide DNA methylation (DNAm) in 692 subjects from a population-based PD case-control study, using both a history of clinically diagnosed depression and current depressive symptoms measured by the geriatric depression scale (GDS). While PD patients in general had more immune activation and more accelerated epigenetic immune system aging than controls, the patients experiencing current depressive symptoms (GDS≥5) showed even higher levels of both markers than patients without current depressive symptoms (GDS<5). For PD patients with a history of clinical depression compared to those without, we found no differences in immune cell composition. However, a history of clinical depression among patients was associated with differentially methylated CpGs. Epigenome-wide association analysis (EWAS) revealed 35 CpGs associated at an FDR≤0.05 (569 CpGs at FDR≤0.10, 1718 CpGs at FDR≤0.15). Gene set enrichment analysis implicated immune system pathways, including immunoregulatory interactions between lymphoid and non-lymphoid cells (p-adj = 0.003) and cytokine-cytokine receptor interaction (p-adj = 0.004). Based on functional genomics, 25 (71%) of the FDR≤0.05 CpGs were associated with genetic variation at 45 different methylation quantitative trait loci (meQTL). Twenty-six of the meQTLs were also expression QTLs (eQTLs) associated with the abundance of 53 transcripts in blood and 22 transcripts in brain (substantia nigra, putamen basal ganglia, or frontal cortex). Notably, cg15199181 was strongly related to rs823114 (SNP-CpG p-value = 3.27E-310), a SNP identified in a PD meta-GWAS and related to differential expression of PM20D1, RAB29, SLC41A1, and NUCKS1. The entire set of genes detected through functional genomics was most strongly overrepresented for interferon-gamma-mediated signaling pathway (enrichment ratio = 18.8, FDR = 4.4e-03) and T cell receptor signaling pathway (enrichment ratio = 13.2, FDR = 4.4e-03). Overall, the current study provides evidence of immune system involvement in depression among Parkinson's patients. Parkinson's disease (PD) is associated with clinical depression prior to PD onset and depressive symptoms after PD diagnosis. Epigenome-wide analysis revealed CpGs related to current depressive symptoms and a history of clinical depression among PD patients. Patients experiencing current depressive symptoms had the highest epigenetic-based neutrophil-to-lymphocyte ratio on average. Patients with a history of clinical depression had differentially methylated CpGs in genes enriched for immune system pathways. Many of the depression associated CpGs were linked to differential expression through meQTL/eQTLs, which included GWAS variants.
Collapse
Affiliation(s)
- Kimberly C. Paul
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
- Corresponding author. 73-320B CHS, CAMPUS-177220, UCLA, Los Angeles, CA, 90095, USA.
| | - Cynthia Kusters
- Departments of Human Genetics, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Melissa Furlong
- University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Keren Zhang
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Yu Yu
- Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Aline Duarte Folle
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Irish Del Rosario
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Adrienne Keener
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Jeff Bronstein
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Janet S. Sinsheimer
- Departments of Human Genetics, David Geffen School of Medicine, Los Angeles, CA, USA
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Steve Horvath
- Departments of Human Genetics, David Geffen School of Medicine, Los Angeles, CA, USA
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Beate Ritz
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| |
Collapse
|
4
|
Zong Y, Hao C, Zhang Y, Wu S. Quality of life assessment after total knee arthroplasty in patients with Parkinson's disease. BMC Musculoskelet Disord 2022; 23:230. [PMID: 35264128 PMCID: PMC8908622 DOI: 10.1186/s12891-022-05176-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/02/2022] [Indexed: 11/28/2022] Open
Abstract
Background The number of Parkinson’s patients (PD) undergoing total knee arthroplasty (TKA) is increasing. The purpose of the study was to characterize quality of life (QOL) outcomes for patients with coexisting PD and knee osteoarthritis (KOA) following TKA. Methods Patients with coexisting PD and KOA undergoing TKA between June 2014 and June 2020 were included. These patients were matched to controls with KOA alone by age, gender, basic social background information and Knee society score (KSS). The primary measure was to assess the QOL by the absolute changes in the EuroQOL5-Dimensions (EQ-5D), Pain and Disability Questionnaire (PDQ), and Patient Health Questionnaire-9(PHQ-9) at the last follow-up (LFU). Secondary measures were changes in QOL that exceeded the minimum clinically important difference value (MCID). Data on the health status and QOL of all patients were collected. Simple and multivariate regression analysis was used to evaluate the impact of PD on their QOL. Results Twelve KOA patients with PD were compared with 48 controls. Control patients experienced QOL improvement across all three measures:EQ-5D index (0.545–0.717, P < 0.01), PDQ (81.1–52.3, P < 0.01) and PHQ-9(8.22–5.91, P < 0.01) were significantly improved at the LFU; while in patients with PD, only PDQ (91.0–81.4, P = 0.03) slightly improved. There were significant differences in the improvement of QOL between PD patients and the control group through EQ-5D (0.531 vs.0.717, P < 0.01) and PDQ (81.4vs.52.3, P < 0.01) at the LFU. Conclusion TKA has no benefit of QOL beyond a slight improvement in pain-related disability in the KOA patients with PD.
Collapse
Affiliation(s)
- Yaqi Zong
- Department of Orthopedics, Bao Di Clinical College of Tianjin Medical University, Bao Di Hospital, 8 Guangchuan Road, Baodi District, Tianjin, 301800, Tianjin, China
| | - Congqiang Hao
- Department of Orthopedics, Bao Di Clinical College of Tianjin Medical University, Bao Di Hospital, 8 Guangchuan Road, Baodi District, Tianjin, 301800, Tianjin, China
| | - Yingjian Zhang
- Department of Orthopedics, Bao Di Clinical College of Tianjin Medical University, Bao Di Hospital, 8 Guangchuan Road, Baodi District, Tianjin, 301800, Tianjin, China
| | - Shuwen Wu
- Department of Orthopedics, Bao Di Clinical College of Tianjin Medical University, Bao Di Hospital, 8 Guangchuan Road, Baodi District, Tianjin, 301800, Tianjin, China.
| |
Collapse
|
5
|
Carapellotti AM, Rodger M, Doumas M. Evaluating the effects of dance on motor outcomes, non-motor outcomes, and quality of life in people living with Parkinson's: a feasibility study. Pilot Feasibility Stud 2022; 8:36. [PMID: 35139914 PMCID: PMC8827282 DOI: 10.1186/s40814-022-00982-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Community-based dance programs for people living with Parkinson’s have grown in popularity over the past two decades. Studies investigating these programs have demonstrated multidimensional benefits in motor, non-motor, and quality of life related outcomes, yet there is a need to focus on the feasibility of larger trials. The primary objective of this study was to assess the feasibility and acceptability of conducting a trial investigating dance and Parkinson’s in Northern Ireland. The secondary objectives were to conduct preliminary analyses of the classes’ effects and to assess the appropriateness of outcome measures for a randomized controlled trial. Methods Participants were recruited through the community, Parkinson’s UK, and university contacts to participate in a 12-week dance intervention inspired by the Dance for PD® model. Pre- and post-intervention, participants completed the following outcomes: MDS-UPDRS III, TUG, DT-TUG, Sensory Organization Test, MoCA, Trail Making Tests A&B, Digit Symbol Substitution Test, Digit Span, PDQ-39, FOG-Q, PHQ-9, FES-I, and an exit questionnaire (post-test only). Data were analyzed using paired samples t tests or Wilcoxon signed ranked test. Results Ten people living with Parkinson’s participated. Running a larger trial was deemed infeasible in this setting due to recruitment issues; conversely, the dance intervention was accepted by participants with all but one completing the study. Functional mobility (TUG), symptoms of depression (PHQ-9), and bodily discomfort showed improvement. All other outcomes did not. The exit questionnaire revealed that the social aspect of classes was important, and improvements in mood or mental state were cited most frequently as perceived benefits. Outcome measures were feasible, with some changes suggested for future trials. Conclusions This study highlighted the infeasibility of running a larger trial using this design in this setting despite demonstrating the acceptability of implementing a dance program in Northern Ireland for people living with Parkinson’s. The results support existing evidence demonstrating that dance may improve functional mobility and symptoms of depression in people living with Parkinson’s, though the study design and small sample size prevent the generalizability of results. The findings also support the idea that dancing has the potential to support several aspects of physical, emotional, mental, and social health. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-00982-9.
Collapse
Affiliation(s)
- Anna M Carapellotti
- School of Psychology, Queen's University Belfast, 18-30 Malone Road, Belfast, BT9 5BN, UK.
| | - Matthew Rodger
- School of Psychology, Queen's University Belfast, 18-30 Malone Road, Belfast, BT9 5BN, UK
| | - Michail Doumas
- School of Psychology, Queen's University Belfast, 18-30 Malone Road, Belfast, BT9 5BN, UK
| |
Collapse
|
6
|
Antidepressant-Like Properties of Intrastriatal Botulinum Neurotoxin-A Injection in a Unilateral 6-OHDA Rat Model of Parkinson's Disease. Toxins (Basel) 2021; 13:toxins13070505. [PMID: 34357977 PMCID: PMC8310221 DOI: 10.3390/toxins13070505] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/09/2021] [Accepted: 07/14/2021] [Indexed: 12/14/2022] Open
Abstract
Parkinson’s patients often suffer from depression and anxiety, for which there are no optimal treatments. Hemiparkinsonian (hemi-PD) rats were used to test whether intrastriatal Botulinum neurotoxin-A (BoNT-A) application could also have antidepressant-like properties in addition to the known improvement of motor performance. To quantify depression- and anxiety-like behavior, the forced swim test, tail suspension test, open field test, and elevated plus maze test were applied to hemi-PD rats injected with BoNT-A or vehicle. Furthermore, we correlated the results in the forced swim test, open field test, and elevated plus maze test with the rotational behavior induced by apomorphine and amphetamine. Hemi-PD rats did not show significant anxiety-like behavior as compared with Sham 6-OHDA- + Sham BoNT-A-injected as well as with non-injected rats. However, hemi-PD rats demonstrated increased depression-like behaviors compared with Sham- or non-injected rats; this was seen by increased struggling frequency and increased immobility frequency. Hemi-PD rats intrastriatally injected with BoNT-A exhibited reduced depression-like behavior compared with the respective vehicle-receiving hemi-PD animals. The significant effects of intrastriatally applied BoNT-A seen in the forced swim test are reminiscent of those found after various antidepressant drug therapies. Our data correspond with the efficacy of BoNT-A treatment of glabellar frown lines in treating patients with major depression and suggest that also intrastriatal injected BoNT-A may have some antidepressant-like effect on hemi-PD.
Collapse
|
7
|
Kitani-Morii F, Kasai T, Horiguchi G, Teramukai S, Ohmichi T, Shinomoto M, Fujino Y, Mizuno T. Risk factors for neuropsychiatric symptoms in patients with Parkinson's disease during COVID-19 pandemic in Japan. PLoS One 2021; 16:e0245864. [PMID: 33481879 PMCID: PMC7822544 DOI: 10.1371/journal.pone.0245864] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/30/2020] [Indexed: 02/08/2023] Open
Abstract
The worsening of neuropsychiatric symptoms such as depression, anxiety, and insomnia in patients with Parkinson’s disease (PD) has been a concern during the COVID-19 pandemic, because most people worked in self-isolation for fear of infection. We aimed to clarify the impact of social restrictions imposed due to the COVID-19 pandemic on neuropsychiatric symptoms in PD patients and to identify risk factors associated with these symptoms. A cross-sectional, hospital-based survey was conducted from April 22, 2020 to May 15, 2020. PD patients and their family members were asked to complete paper-based questionnaires about neuropsychiatric symptoms by mail. PD patients were evaluated for motor symptoms using MDS-UPDRS part 2 by telephone interview. A total of 71 responders (39 PD patients and 32 controls) completed the study. Although there was no difference in the age distribution, the rate of females was significantly lower in PD patients (35%) than controls (84%) (P < 0.001). Participants with clinical depression (PHQ-9 score ≥ 10) were more common in PD patients (39%) than controls (6%) (P = 0.002). Multivariate logistic regression analysis revealed that an MDS-UPDRS part 2 score was correlated with the presence of clinical depression (PHQ-9 score ≥ 10) and clinical anxiety (GAD-7 score ≥ 7) (clinical depression: OR, 1.31; 95% CI, 1.04–1.66; P = 0.025; clinical anxiety: OR, 1.36; 95% CI, 1.07–1.72; P = 0.013). In the presence of social restrictions, more attention needs to be paid to the neuropsychiatric complications of PD patients, especially those with more severe motor symptoms.
Collapse
Affiliation(s)
- Fukiko Kitani-Morii
- Department of Molecular Pathobiology of Brain Diseases, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Kasai
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
- * E-mail:
| | - Go Horiguchi
- Division of Data Science, The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Teramukai
- Division of Data Science, The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuma Ohmichi
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Makiko Shinomoto
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuzo Fujino
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiki Mizuno
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
8
|
Keener AM, Paul KC, Folle A, Bronstein JM, Ritz B. Cognitive Impairment and Mortality in a Population-Based Parkinson's Disease Cohort. JOURNAL OF PARKINSONS DISEASE 2019; 8:353-362. [PMID: 29843251 DOI: 10.3233/jpd-171257] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a heterogeneous disorder with variability in phenotype and progression. OBJECTIVE We describe characteristics of PD patients in the largest population-based cohort followed for progression to date, and evaluate clinical risk factors for cognitive impairment and mortality. METHODS We collected longitudinal data using the Unified Parkinson's Disease Rating Scale (UPDRS), Mini-Mental State Exam (MMSE), and Geriatric Depression Scale (GDS) in 242 new-onset PD patients followed for progression. We compared those who developed cognitive impairment (MMSE≤24) with those who did not, using t-tests, chi-square tests, and Cox proportional hazards regression. Mortality risk factors were assessed in all 360 patients enrolled at baseline. RESULTS Thirty-four patients developed cognitive impairment during follow-up. Baseline characteristics predictive of faster time to cognitive impairment were older age at diagnosis, fewer years of education, and longer average sleep duration reported. The 197 patients who died were older at diagnosis, reported longer average sleep duration, had lower baseline MMSE scores, higher UPDRS-III scores, and a higher proportion were of the postural instability gait difficulty (PIGD) subtype. Patients with the tremor dominant (TD) subtype at baseline were less likely to develop cognitive impairment or die during follow-up. Progression of cognitive, depressive, and motor symptoms occurred in parallel. CONCLUSIONS Motor symptom severity and subtype influence the incidence of cognitive impairment and mortality in PD, with the TD motor subtype being relatively protective. In addition, we newly found that longer average sleep duration at baseline predicts faster progression to cognitive impairment and mortality.
Collapse
Affiliation(s)
- Adrienne M Keener
- Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.,Department of Neurology, Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Kimberly C Paul
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Aline Folle
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Jeff M Bronstein
- Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Beate Ritz
- Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| |
Collapse
|
9
|
Reliability and Validity of the Patient Health Questionnaire-9 as a Screening Tool for Poststroke Depression. J Neurosci Nurs 2019; 51:147-152. [PMID: 31058767 DOI: 10.1097/jnn.0000000000000442] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Screening for poststroke depression (PSD) using a valid and reliable tool is recommended for all stroke survivors. This literature review identifies the specificity, sensitivity, and appropriateness of the 9-item Patient Health Questionnaire (PHQ-9) to screen stroke patients for PSD. METHODS Relevant databases were searched using the following selection criteria: (1) peer-reviewed primary research, (2) published from 2012 to 2018 (to evaluate the most recent research using this tool), and (3) examined the specificity and sensitivity of the PHQ-9 for screening stroke survivors for PSD. RESULTS Six studies, with an overall level of evidence grade of "B," representing an overall total sample size of 930 participants (851 given a diagnosis of stroke and 49 given a diagnosis of transient ischemic attacks) met criteria for inclusion in the review. Only 2 studies reported data on all of the components necessary to determine the robustness of this tool to screen for depression in stroke survivors. CONCLUSION Evidence regarding the sensitivity and specificity of the PHQ-9 to screen stroke patients for PSD is inconclusive. Additional research is needed to address the appropriateness of the PHQ-9 as a depression screening tool in this population. Clinicians should validate the results of PHQ-9 screening of ischemic stroke patients for PSD with the Structured Clinical Interview for DSM-5, the standard for diagnosing depression, before initiating treatment of PSD.
Collapse
|
10
|
Kadhim S, Pringsheim T, Le A, Fiest KM, Patten SB, Prisnie JC, Gill S, Bulloch AGM, Hu B, Jette N. Validating screening tools for depression in Parkinson's disease. Mov Disord 2018; 33:1184-1186. [PMID: 29573354 DOI: 10.1002/mds.27371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 01/14/2018] [Accepted: 02/11/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sandra Kadhim
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Mathison Center for Mental Health Research & Education, University of Calgary, Alberta, Canada
| | - Anne Le
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Critical Care Medicine, University of Calgary, Alberta, Canada
| | - Scott B Patten
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Mathison Center for Mental Health Research & Education, University of Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Alberta, Canada
| | - Joey C Prisnie
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Stephanie Gill
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Andrew G M Bulloch
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Mathison Center for Mental Health Research & Education, University of Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Alberta, Canada
| | - Bin Hu
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Nathalie Jette
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
11
|
Paul KC, Sinsheimer JS, Cockburn M, Bronstein JM, Bordelon Y, Ritz B. Organophosphate pesticides and PON1 L55M in Parkinson's disease progression. ENVIRONMENT INTERNATIONAL 2017; 107:75-81. [PMID: 28689109 PMCID: PMC5600289 DOI: 10.1016/j.envint.2017.06.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/08/2017] [Accepted: 06/22/2017] [Indexed: 05/13/2023]
Abstract
BACKGROUND Parkinson's disease (PD) has motor and non-motor features that contribute to its phenotype and functional decline. Organophosphate (OP) pesticides and PON1 L55M, which influences OP metabolism, have been implicated in multiple mechanisms related to neuronal cell death and may influence PD symptom progression. OBJECTIVE To investigate whether ambient agricultural OP exposure and PON1 L55M influence the rate of motor, cognitive, and mood-related symptom progression in PD. METHODS We followed a longitudinal cohort of 246 incident PD patients on average over 5years (7.5years after diagnosis), repeatedly measuring symptom progression with the Mini-Mental State Exam (MMSE), Unified Parkinson's Disease Rating Scale (UPDRS), and Geriatric Depressive Scale (GDS). OP exposures were generated with a geographic information system (GIS) based exposure assessment tool. We employed repeated-measures regression to assess associations between OP exposure and/or PON1 L55M genotype and progression. RESULTS High OP exposures were associated with faster progression of motor (UPDRS β=0.24, 95% CI=-0.01, 0.49) and cognitive scores (MMSE β=-0.06, 95% CI=-0.11, -0.01). PON1 55MM was associated with faster progression of motor (UPDRS β=0.28, 95% CI=0.08, 0.48) and depressive symptoms (GDS β=0.07; 95% CI=0.01, 0.13). We also found the PON1 L55M variant to interact with OP exposures in influencing MMSE cognitive scores (β=-1.26, 95% CI=-2.43, -0.09). CONCLUSION Our study provides preliminary support for the involvement of OP pesticides and PON1 in PD-related motor, cognitive, or depressive symptom progression. Future studies are needed to replicate findings and examine whether elderly populations generally are similarly impacted by pesticides or PON1 55M genotypes.
Collapse
Affiliation(s)
- Kimberly C Paul
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Janet S Sinsheimer
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California, USA; Departments of Human Genetics and Biomathematics, David Geffen School of Medicine, Los Angeles, California, USA
| | - Myles Cockburn
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, CA, USA
| | - Jeff M Bronstein
- Department of Neurology, David Geffen School of Medicine, Los Angeles, California, USA
| | - Yvette Bordelon
- Department of Neurology, David Geffen School of Medicine, Los Angeles, California, USA
| | - Beate Ritz
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA; Department of Neurology, David Geffen School of Medicine, Los Angeles, California, USA.
| |
Collapse
|
12
|
Manea L, Boehnke JR, Gilbody S, Moriarty AS, McMillan D. Are there researcher allegiance effects in diagnostic validation studies of the PHQ-9? A systematic review and meta-analysis. BMJ Open 2017; 7:e015247. [PMID: 28965089 PMCID: PMC5640143 DOI: 10.1136/bmjopen-2016-015247] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To investigate whether an authorship effect is found that leads to better performance in studies conducted by the original developers of the Patient Health Questionnaire (PHQ-9) (allegiant studies). DESIGN Systematic review with random effects bivariate diagnostic meta-analysis. Search strategies included electronic databases, examination of reference lists and forward citation searches. INCLUSION CRITERIA Included studies provided sufficient data to calculate the diagnostic accuracy of the PHQ-9 against a gold standard diagnosis of major depression using the algorithm or the summed item scoring method at cut-off point 10. DATA EXTRACTION Descriptive information, methodological quality criteria and 2×2 contingency tables. RESULTS Seven allegiant and 20 independent studies reported the diagnostic performance of the PHQ-9 using the algorithm scoring method. Pooled diagnostic OR (DOR) for the allegiant group was 64.40, and 15.05 for non-allegiant studies group. The allegiance status was a significant predictor of DOR variation (p<0.0001).Five allegiant studies and 26 non-allegiant studies reported the performance of the PHQ-9 at recommended cut-off point of 10. Pooled DOR for the allegiant group was 49.31, and 24.96 for the non-allegiant studies. The allegiance status was a significant predictor of DOR variation (p=0.015).Some potential alternative explanations for the observed authorship effect including differences in study characteristics and quality were found, although it is not clear how some of them account for the observed differences. CONCLUSIONS Allegiant studies reported better performance of the PHQ-9. Allegiance status was predictive of variation in the DOR. Based on the observed differences between independent and non-independent studies, we were unable to conclude or exclude that allegiance effects are present in studies examining the diagnostic performance of the PHQ-9. This study highlights the need for future meta-analyses of diagnostic validation studies of psychological measures to evaluate the impact of researcher allegiance in the primary studies.
Collapse
Affiliation(s)
- Laura Manea
- Deparment of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, United Kingdom
| | - Jan Rasmus Boehnke
- Dundee Centre for Health And Related Research, University of Dundee, Dundee, United Kingdom
| | - Simon Gilbody
- Deparment of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, United Kingdom
| | | | - Dean McMillan
- Deparment of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, United Kingdom
| |
Collapse
|
13
|
Rutten S, Vriend C, van der Werf YD, Berendse HW, Weintraub D, van den Heuvel OA. The bidirectional longitudinal relationship between insomnia, depression and anxiety in patients with early-stage, medication-naïve Parkinson's disease. Parkinsonism Relat Disord 2017; 39:31-36. [PMID: 28365203 PMCID: PMC5441947 DOI: 10.1016/j.parkreldis.2017.01.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 12/24/2016] [Accepted: 01/29/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION While anxiety, depression and insomnia frequently (co-)occur in Parkinson's disease (PD) patients, little is known about their temporal relationship. In this study, we tested two hypotheses: i) insomnia predicts an increase in symptoms of depression or anxiety and ii) anxiety or depression at baseline predicts insomnia in PD patients six months later. METHODS We used longitudinal data from a prospective cohort study of early-stage, medication-naïve PD patients. Primary outcome measures were: anxiety symptoms, measured with the State-Trait Anxiety Inventory (STAI); depressive symptoms, measured with the 15-item Geriatric Depression Scale (GDS-15); and insomnia, defined as a score ≥ 2 on item 1.7 of the Movement Disorder Society - Unified Parkinson's Disease Rating Scale. We performed linear and logistic regression analyses, correcting for baseline value of the respective outcome variable. RESULTS Baseline insomnia was not associated with GDS-15 or STAI total score at follow-up. In a post hoc analysis, we found that insomnia predicted a higher STAI State score (B(SE) = 2.50 (1.07), p < 0.05), while the association with the STAI Trait score was not significant. Baseline STAI scores (B(SE) = 0.02 (0.01), p = 0.001) and GDS-15 score (B(SE) = 0.15 (0.05), p < 0.001) were significantly associated with insomnia at follow-up. CONCLUSION Symptoms of anxiety and depression may constitute a risk factor for insomnia in PD. The relationship between insomnia and anxiety is bidirectional, which suggests that both anxiety and sleep disorders can start a negative spiral in PD patients, where one enhances the other. Independent clinical attention for these symptoms in PD patients is therefore warranted.
Collapse
Affiliation(s)
- Sonja Rutten
- Department of Psychiatry, VU University Medical Center (VUmc), The Netherlands; Department of Anatomy & Neurosciences, VUmc, The Netherlands.
| | - Chris Vriend
- Department of Psychiatry, VU University Medical Center (VUmc), The Netherlands; Department of Anatomy & Neurosciences, VUmc, The Netherlands; Amsterdam Neuroscience, Amsterdam, The Netherlands; Department of Neurology, VUmc, The Netherlands
| | - Ysbrand D van der Werf
- Department of Anatomy & Neurosciences, VUmc, The Netherlands; Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Henk W Berendse
- Amsterdam Neuroscience, Amsterdam, The Netherlands; Department of Neurology, VUmc, The Netherlands
| | - Daniel Weintraub
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, United States
| | - Odile A van den Heuvel
- Department of Psychiatry, VU University Medical Center (VUmc), The Netherlands; Department of Anatomy & Neurosciences, VUmc, The Netherlands; Amsterdam Neuroscience, Amsterdam, The Netherlands
| |
Collapse
|
14
|
Xiao R, Miller JA, Lubelski D, Alberts JL, Mroz TE, Benzel EC, Krishnaney AA, Machado AG. Quality of life outcomes following cervical decompression for coexisting Parkinson's disease and cervical spondylotic myelopathy. Spine J 2016; 16:1358-1366. [PMID: 27496286 DOI: 10.1016/j.spinee.2016.07.530] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/13/2016] [Accepted: 07/18/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Coexisting Parkinson's disease (PD) and cervical spondylotic myelopathy (CSM) presents a diagnostic and therapeutic challenge due to symptomatic similarities between the diseases. Whereas CSM patients are routinely treated with surgery, PD patients face poorer outcomes following spine surgery. No studies have investigated the quality of life (QOL) outcomes following decompression in coexisting PD and CSM. PURPOSE The purpose of the present study was to characterize QOL outcomes for patients with coexisting PD and CSM following cervical decompression. STUDY DESIGN/SETTING This is a matched cohort study at a single tertiary-care center. PATIENT SAMPLE Patients with coexisting PD and CSM undergoing cervical decompression between June 2009 and December 2014 were included. These patients were matched to controls with CSM alone by age, gender, American Society of Anesthesiologists classification, Modified Japanese Orthopaedic Association scores, and operative parameters. OUTCOME MEASURES The primary outcome measure was QOL outcomes assessed by change in the EuroQol 5-Dimensions (EQ-5D), Pain Disability Questionnaire (PDQ), and Patient Health Questionnaire-9 (PHQ-9) at last follow-up (LFU). Change in QOL exceeding the minimal clinically important difference (MCID) was secondary. METHODS QOL data were collected using the institutional prospectively collected database of patient-reported health status measures. Simple and multivariable regressions were used to assess the impact of PD upon change in QOL. RESULTS Eleven PD patients were matched to 44 controls. Control patients experienced QOL improvement across all three measures, whereas PD patients only improved with respect to PDQ(89.9-80.7, p=.03). Despite no significant differences in preoperative QOL, PD patients experienced poorer QOL at LFU in EQ-5D (0.526 vs. 0.707, p=.01) and PDQ (80.7 vs. 51.4, p=.03), and less frequently achieved an EQ-5D MCID (18% vs. 57%, p=.04). However, no differences in the achievement of an MCID in PDQ or PHQ-9 were observed between cohorts. Multivariable regression identified PD as a significant independent predictor of poorer improvement in EQ-5D (β=-0.09, p<.01) and failure to achieve an EQ-5D MCID (odds ratio: 0.08, p<.01). CONCLUSIONS This is the first study to characterize QOL outcomes following cervical decompression for patients with coexisting PD and CSM. Although myelopathy may have been less severe among PD patients, a significant reduction in pain-related disability was observed following decompression. However, PD predicted diminished improvement in overall QOL measured by the EQ-5D.
Collapse
Affiliation(s)
- Roy Xiao
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, NA-24, Cleveland, OH 44195, USA
| | - Jacob A Miller
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, NA-24, Cleveland, OH 44195, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University, 855 N Wolfe St, Baltimore, MD 21205, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Ave, ND20, Cleveland, OH 44195, USA
| | - Thomas E Mroz
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA
| | - Edward C Benzel
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA
| | - Ajit A Krishnaney
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA
| | - Andre G Machado
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
| |
Collapse
|
15
|
Goodarzi Z, Mrklas KJ, Roberts DJ, Jette N, Pringsheim T, Holroyd-Leduc J. Detecting depression in Parkinson disease: A systematic review and meta-analysis. Neurology 2016; 87:426-37. [PMID: 27358339 DOI: 10.1212/wnl.0000000000002898] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/18/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Failure to detect depression in patients with Parkinson disease (PD) can lead to worsened outcomes for patients and caregivers. Accurate identification of depression would enable practitioners to provide comprehensive care for their patients with PD. METHODS Our objective was to examine the diagnostic accuracy of tools for detecting depression in adult outpatients with PD. We searched MEDLINE, PsycINFO, and EMBASE (inception to December 1, 2015), gray literature, and bibliographies of included studies. The pooled prevalence of depression across studies and diagnostic accuracy estimates were calculated using random-effects models. Diagnostic accuracy estimates were calculated across the best-reported cutoffs from each study and across specific cutoffs, when feasible. RESULTS Out of 8,184 citations, 21 studies were included, evaluating 24 tools, with 4 amenable to meta-analysis. The pooled prevalence of major depression was 22.9% (95% confidence interval [CI] 18.1-27.7). The 15-item Geriatric Depression Scale (GDS-15) had a pooled sensitivity of 0.81 (95% CI 0.64-0.91) and specificity of 0.91 (95% CI 0.87-0.94). The most sensitive cutoff for the GDS-15 was 5 at 0.91 (95% CI 0.83-1.00). The Beck Depression Inventory I/Ia had a pooled sensitivity of 0.79 (95% CI 0.61-0.90) and specificity of 0.85 (95% CI 0.79-0.90). The Montgomery-Åsberg Depression Rating Scale yielded a pooled sensitivity of 0.77 (95% CI 0.69-0.83) and specificity of 0.92 (95% CI 0.79-0.97). The Unified Parkinson's Disease Rating Scale had a pooled sensitivity of 0.72 (95% CI 0.64-0.79) and specificity of 0.80 (95% CI 0.70-0.87). All estimates had heterogeneity. CONCLUSIONS There are several valid tools for detecting depression in patients with PD. Practitioners should choose one that fits their clinical practice.
Collapse
Affiliation(s)
- Zahra Goodarzi
- From the Departments of Community Health Sciences (Z.G., K.J.M., D.J.R., N.J., T.P., J.H.-L.) and Clinical Neurosciences (N.J., T.P.), University of Calgary; Research Priorities and Implementation (K.J.M.), Alberta Health Services, Edmonton; Departments of Critical Care Medicine (D.J.R.) and Surgery (D.J.R.), Hotchkiss Brain Institute and O'Brien Institute for Public Health (N.J., T.P., J.H.-L.), and Departments of Psychiatry and Pediatrics (T.P.) and Medicine (Z.G., J.H.-L.), University of Calgary and Alberta Health Services, Canada.
| | - Kelly J Mrklas
- From the Departments of Community Health Sciences (Z.G., K.J.M., D.J.R., N.J., T.P., J.H.-L.) and Clinical Neurosciences (N.J., T.P.), University of Calgary; Research Priorities and Implementation (K.J.M.), Alberta Health Services, Edmonton; Departments of Critical Care Medicine (D.J.R.) and Surgery (D.J.R.), Hotchkiss Brain Institute and O'Brien Institute for Public Health (N.J., T.P., J.H.-L.), and Departments of Psychiatry and Pediatrics (T.P.) and Medicine (Z.G., J.H.-L.), University of Calgary and Alberta Health Services, Canada
| | - Derek J Roberts
- From the Departments of Community Health Sciences (Z.G., K.J.M., D.J.R., N.J., T.P., J.H.-L.) and Clinical Neurosciences (N.J., T.P.), University of Calgary; Research Priorities and Implementation (K.J.M.), Alberta Health Services, Edmonton; Departments of Critical Care Medicine (D.J.R.) and Surgery (D.J.R.), Hotchkiss Brain Institute and O'Brien Institute for Public Health (N.J., T.P., J.H.-L.), and Departments of Psychiatry and Pediatrics (T.P.) and Medicine (Z.G., J.H.-L.), University of Calgary and Alberta Health Services, Canada
| | - Nathalie Jette
- From the Departments of Community Health Sciences (Z.G., K.J.M., D.J.R., N.J., T.P., J.H.-L.) and Clinical Neurosciences (N.J., T.P.), University of Calgary; Research Priorities and Implementation (K.J.M.), Alberta Health Services, Edmonton; Departments of Critical Care Medicine (D.J.R.) and Surgery (D.J.R.), Hotchkiss Brain Institute and O'Brien Institute for Public Health (N.J., T.P., J.H.-L.), and Departments of Psychiatry and Pediatrics (T.P.) and Medicine (Z.G., J.H.-L.), University of Calgary and Alberta Health Services, Canada
| | - Tamara Pringsheim
- From the Departments of Community Health Sciences (Z.G., K.J.M., D.J.R., N.J., T.P., J.H.-L.) and Clinical Neurosciences (N.J., T.P.), University of Calgary; Research Priorities and Implementation (K.J.M.), Alberta Health Services, Edmonton; Departments of Critical Care Medicine (D.J.R.) and Surgery (D.J.R.), Hotchkiss Brain Institute and O'Brien Institute for Public Health (N.J., T.P., J.H.-L.), and Departments of Psychiatry and Pediatrics (T.P.) and Medicine (Z.G., J.H.-L.), University of Calgary and Alberta Health Services, Canada
| | - Jayna Holroyd-Leduc
- From the Departments of Community Health Sciences (Z.G., K.J.M., D.J.R., N.J., T.P., J.H.-L.) and Clinical Neurosciences (N.J., T.P.), University of Calgary; Research Priorities and Implementation (K.J.M.), Alberta Health Services, Edmonton; Departments of Critical Care Medicine (D.J.R.) and Surgery (D.J.R.), Hotchkiss Brain Institute and O'Brien Institute for Public Health (N.J., T.P., J.H.-L.), and Departments of Psychiatry and Pediatrics (T.P.) and Medicine (Z.G., J.H.-L.), University of Calgary and Alberta Health Services, Canada
| |
Collapse
|
16
|
Martinez-Martin P, Leentjens AFG, de Pedro-Cuesta J, Chaudhuri KR, Schrag AE, Weintraub D. Accuracy of screening instruments for detection of neuropsychiatric syndromes in Parkinson's disease. Mov Disord 2015; 31:270-9. [PMID: 26695691 DOI: 10.1002/mds.26522] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 12/27/2022] Open
Abstract
Parkinson's disease includes neuropsychiatric manifestations, such as depression, anxiety, apathy, psychosis, and impulse control disorders, which often are unreported by patients and caregivers or undetected by doctors. Given their substantial impact on patients and caregivers as well as the existence of effective therapies for some of these disorders, screening for neuropsychiatric symptoms is important. Instruments for screening have a particular methodology for validation, and their performance is expressed in terms of accuracy compared with formal diagnostic criteria. The present study reviews the attributes of the screening instruments applied for detection of the aforementioned major neuropsychiatric symptoms in Parkinson's disease. A quasi-systematic review (including predefined selection criteria, but not evaluating the quality of the reviewed studies) was carried out on the basis of previous systematic reviews (commissioned by the American Academy of Neurology and the Movement Disorder Society) and made current by conducting a literature search (2005-2014). For depression, 11 scales and questionnaires were shown to be valid for Parkinson's disease screening. The recently developed Parkinson Anxiety Scale and the Geriatric Anxiety Inventory demonstrate satisfactory properties as screening instruments for anxiety, and the Lille Apathy Rating Scale for detection of apathy. No scale adequately screens for psychosis, so a specific psychosis instrument should be developed. The Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (Questionnaire and Rating Scale) are valid for comprehensive screening of impulse control disorders, and the Parkinson's Disease-Sexual Addiction Screening Test for hypersexuality specifically.
Collapse
Affiliation(s)
- Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Albert F G Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jesus de Pedro-Cuesta
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Kallol Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence, King's College London, London, United Kingdom.,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre and Dementia Unit at South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
| | - Anette E Schrag
- UCL Institute of Neurology, University College London, London, Royal Free Campus, London, United Kingdom
| | - Daniel Weintraub
- Department of Psychiatry and Departments of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| |
Collapse
|
17
|
Bulloch AGM, Fiest KM, Williams JVA, Lavorato DH, Berzins SA, Jetté N, Pringsheim TM, Patten SB. Depression--a common disorder across a broad spectrum of neurological conditions: a cross-sectional nationally representative survey. Gen Hosp Psychiatry 2015; 37:507-12. [PMID: 26153456 DOI: 10.1016/j.genhosppsych.2015.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/19/2015] [Accepted: 06/08/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To estimate the prevalence of depression across a range of neurological conditions in a nationally representative sample. METHODS The data source was the Survey of Living with Neurological Conditions in Canada (SLNCC), which accrued its sample by selecting participants from the Canadian Community Health Survey. The point prevalence of depression was estimated by assessment of depressive symptoms with the Patient Health Questionnaire, Brief (Patient Health Questionnaire, 9-item). RESULTS A total of n=4408 participated in the SLNCC. The highest point prevalence of depression (>30%) was seen in those with traumatic brain injury and brain/spinal cord tumors. Depression was also highly prevalent (18-28%) in those with (listed from highest to lowest) Alzheimer's disease/dementia, dystonia, multiple sclerosis, Parkinson's disease, stroke, migraine, epilepsy and spina bifida. The odds ratios for depression, with the referent group being the general population, were significant (from highest to lowest) for migraine, traumatic brain injury, stroke, dystonia and epilepsy. CONCLUSIONS All neurological conditions included in this study are associated with an elevated prevalence of depression in community populations. The conditions with the highest prevalence are traumatic brain injury and brain/spinal cord tumors.
Collapse
Affiliation(s)
- Andrew G M Bulloch
- Department of Community Health Sciences, University of Calgary, Canada; Department of Psychiatry, University of Calgary, Canada; Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Canada.
| | - Kirsten M Fiest
- Department of Community Health Sciences, University of Calgary, Canada; Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Canada
| | | | - Dina H Lavorato
- Department of Community Health Sciences, University of Calgary, Canada
| | - Sandra A Berzins
- Department of Community Health Sciences, University of Calgary, Canada; Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Canada
| | - Nathalie Jetté
- Department of Community Health Sciences, University of Calgary, Canada; Department of Clinical Neurosciences, Hotchkiss Brain Institute and Institute for Public Health, University of Calgary, Canada
| | - Tamara M Pringsheim
- Department of Clinical Neurosciences, Hotchkiss Brain Institute and Institute for Public Health, University of Calgary, Canada; Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Canada
| | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Canada; Department of Psychiatry, University of Calgary, Canada; Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Canada
| |
Collapse
|
18
|
Manea L, Gilbody S, McMillan D. A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry 2015; 37:67-75. [PMID: 25439733 DOI: 10.1016/j.genhosppsych.2014.09.009] [Citation(s) in RCA: 442] [Impact Index Per Article: 49.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 09/05/2014] [Accepted: 09/16/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND The depression module of the Patient Health Questionnaire-9 (PHQ-9) is a widely used depression screening instrument in nonpsychiatric settings. The PHQ-9 can be scored using different methods, including an algorithm based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and a cut-off based on summed-item scores. The algorithm was the originally proposed scoring method to screen for depression. We summarized the diagnostic test accuracy of the PHQ-9 using the algorithm scoring method across a range of validation studies and compared the diagnostic properties of the PHQ-9 using the algorithm and summed scoring method at the proposed cut-off point of 10. METHODS We performed a systematic review of diagnostic accuracy studies of the PHQ-9 using the algorithm scoring method to detect major depressive disorder (MDD). We used meta-analytic methods to calculate summary sensitivity, specificity, likelihood ratios and diagnostic odds ratios for diagnosing MDD of the PHQ-9 using algorithm scoring method. In studies that reported both scoring methods (algorithm and summed-item scoring at proposed cut-off point of ≥10), we compared the diagnostic properties of the PHQ-9 using these methods. RESULTS We found 27 validation studies that validated the algorithm scoring method of the PHQ-9 in various settings. There was substantial heterogeneity across studies, which makes the pooled results difficult to interpret. In general, sensitivity was low whereas specificity was good. Thirteen studies reported the diagnostic properties of the PHQ-9 for both scoring methods. Pooled sensitivity for algorithm scoring method was lower while specificities were good for both scoring methods. Heterogeneity was consistently high; therefore, caution should be used when interpreting these results. INTERPRETATION This review shows that, if the algorithm scoring method is used, the PHQ-9 has a low sensitivity for detecting MDD. This could be due to the rating scale categories of the measure, higher specificity or other factors that warrant further research. The summed-item score method at proposed cut-off point of ≥10 has better diagnostic performance for screening purposes or where a high sensitivity is needed.
Collapse
Affiliation(s)
- Laura Manea
- Hull York Medical School and Department of Health Sciences, University of York, Heslington, York YO105DD, United Kingdom.
| | - Simon Gilbody
- Hull York Medical School and Department of Health Sciences, University of York, Heslington, York YO105DD, United Kingdom
| | - Dean McMillan
- Hull York Medical School and Department of Health Sciences, University of York, Heslington, York YO105DD, United Kingdom
| |
Collapse
|
19
|
Achey MA, Beck CA, Beran DB, Boyd CM, Schmidt PN, Willis AW, Riggare SS, Simone RB, Biglan KM, Dorsey ER. Virtual house calls for Parkinson disease (Connect.Parkinson): study protocol for a randomized, controlled trial. Trials 2014; 15:465. [PMID: 25431346 PMCID: PMC4289172 DOI: 10.1186/1745-6215-15-465] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/06/2014] [Indexed: 01/18/2023] Open
Abstract
Background Interest in improving care for the growing number of individuals with chronic conditions is rising. However, access to care is limited by distance, disability, and distribution of doctors. Small-scale studies in Parkinson disease, a prototypical chronic condition, have suggested that delivering care using video house calls is feasible, offers similar clinical outcomes to in-person care, and reduces travel burden. Methods/Design We are conducting a randomized comparative effectiveness study (Connect.Parkinson) comparing usual care in the community to usual care augmented by virtual house calls with a Parkinson disease specialist. Recruitment is completed centrally using online advertisements and emails and by contacting physicians, support groups, and allied health professionals. Efforts target areas with a high proportion of individuals not receiving care from neurologists. Approximately 200 individuals with Parkinson disease and their care partners will be enrolled at 20 centers throughout the United States and followed for one year. Participants receive educational materials, then are randomized in a 1:1 ratio to continue their usual care (control arm) or usual care and specialty care delivered virtually (intervention arm). Care partners are surveyed about their time and travel burden and their perceived caregiver burden. Participants are evaluated via electronic survey forms and videoconferencing with a blinded independent rater at baseline and at 12 months. All study activities are completed remotely. The primary outcomes are: (1) feasibility, as measured by the proportion of visits completed, and (2) quality of life, as measured by the 39-item Parkinson’s Disease Questionnaire. Secondary outcomes include measures of clinical benefit, quality of care, time and travel burden, and caregiver burden. Discussion Connect.Parkinson will evaluate the feasibility and effectiveness of using technology to deliver care into the homes of individuals with Parkinson disease. The trial may serve as a model for increasing access and delivering patient-centered care at home for individuals with chronic conditions. Trial registration This trial was registered on clinicaltrials.gov on January 8, 2014 [NCT02038959]. Electronic supplementary material The online version of this article (doi:10.1186/1745-6215-15-465) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | | | | | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL 7th Floor, Center Tower, Baltimore, MD 21224, USA.
| | | | | | | | | | | | | |
Collapse
|
20
|
Lacerte A, Chouinard S, Jodoin N, Bernard G, Rouleau GA, Panisset M. Increased Prevalence of Non-motor Symptoms in Essential Tremor. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2014; 4:162. [PMID: 25247108 PMCID: PMC4159683 DOI: 10.7916/d82v2d91] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 08/12/2014] [Indexed: 12/01/2022]
Abstract
Background Cases with essential tremor (ET) have been described with Lewy body inclusions, the hallmark of Parkinson disease (PD). Patients with PD may suffer from anosmia, depression, constipation, and rapid eye movement sleep behavior disorder (RBD), sometimes years before the appearance of their motor syndrome. The objective of this study was to evaluate the prevalence of these non-motor Parkinson's associated symptoms in patients with ET. Methods Fifty ET subjects were contacted by phone and given questionnaires evaluating the presence or absence of anosmia, depression, constipation, and RBD. Frequencies of these symptoms were compared with their published prevalence in the general population. Results Of the patients with ET, 4.5% reported having anosmia or hyposmia and 21.7% reported being constipated, similar to what is observed in the general population. Using a screening questionnaire for RBD, 43.5% of ET patients are possibly suffering from RBD, whereas in the general population prevalence is estimated to be 0.5%. Finally, depression was detected in 21.7% of ET patients; in the general population, prevalence is 5%. Discussion Patients with ET seem to have more RBD and more depression than found in the general population. Prospective studies with normal control groups are needed to confirm these findings.
Collapse
Affiliation(s)
- Annie Lacerte
- André-Barbeau Movement Disorders Unit Service of Neurology, Centre Hospitalier de l'Université de Montréal and Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Sylvain Chouinard
- André-Barbeau Movement Disorders Unit Service of Neurology, Centre Hospitalier de l'Université de Montréal and Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Nicolas Jodoin
- André-Barbeau Movement Disorders Unit Service of Neurology, Centre Hospitalier de l'Université de Montréal and Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Geneviève Bernard
- Division of Pediatric Neurology, Montreal Children Hospital, McGill University, Québec, Canada
| | - Guy A Rouleau
- André-Barbeau Movement Disorders Unit Service of Neurology, Centre Hospitalier de l'Université de Montréal and Department of Medicine, Université de Montréal, Montréal, Québec, Canada ; CENUM, Centre de recherche du Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Michel Panisset
- André-Barbeau Movement Disorders Unit Service of Neurology, Centre Hospitalier de l'Université de Montréal and Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
21
|
Zhong Q, Gelaye B, Rondon M, Sánchez SE, García PJ, Sánchez E, Barrios YV, Simon GE, Henderson DC, Cripe SM, Williams MA. Comparative performance of Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale for screening antepartum depression. J Affect Disord 2014; 162:1-7. [PMID: 24766996 PMCID: PMC4040145 DOI: 10.1016/j.jad.2014.03.028] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 03/14/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We sought to evaluate the psychometric properties of two widely used screening scales: the Patient Health Questionnaire (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS) among pregnant Peruvian women. METHODS This cross-sectional study included 1517 women receiving prenatal care from February 2012 to March 2013. A structured interview was used to collect data using PHQ-9 and EPDS. We examined reliability, construct and concurrent validity between two scales using internal consistency indices, factor structures, correlations, and Cohen׳s kappa. RESULTS Both scales had good internal consistency (Cronbach׳s alpha>0.8). Correlation between PHQ-9 and EPDS scores was fair (rho=0.52). Based on exploratory factor analysis (EFA), both scales yielded a two-factor structure. EFA including all items from PHQ-9 and EPDS yielded four factors, namely, "somatization", "depression and suicidal ideation", "anxiety and depression", and "anhedonia". The agreement between the two scales was generally fair at different cutoff scores with the highest Cohen׳s kappa being 0.46. CONCLUSIONS Both the PHQ-9 and EPDS are reliable and valid scales for antepartum depression assessment. The PHQ-9 captures somatic symptoms, while EPDS detects depressive symptoms comorbid with anxiety during early pregnancy. Our findings suggest simultaneous administration of both scales may improve identification of antepartum depressive disorders in clinical settings.
Collapse
Affiliation(s)
- Qiuyue Zhong
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, K505F, Boston, MA 02115, United States.
| | - Marta Rondon
- Department of Medicine, Cayetano Heredia Peruvian University, Lima, Peru
| | | | | | | | - Yasmin V Barrios
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | | | | | - Swee May Cripe
- School of Medicine, Perdana University, Kuala Lumpur, Malaysia
| | | |
Collapse
|
22
|
Chen CM, Huang GH, Chen CCH. Older patients’ depressive symptoms 6 months after prolonged hospitalization: Course and interrelationships with major associated factors. Arch Gerontol Geriatr 2014; 58:339-43. [DOI: 10.1016/j.archger.2013.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/17/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
|
23
|
Glueck CL, Reschly AL. EXAMINING CONGRUENCE WITHIN SCHOOL-FAMILY PARTNERSHIPS: DEFINITION, IMPORTANCE, AND CURRENT MEASUREMENT APPROACHES. PSYCHOLOGY IN THE SCHOOLS 2014. [DOI: 10.1002/pits.21745] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
24
|
Watson GS, Cholerton BA, Gross RG, Weintraub D, Zabetian CP, Trojanowski JQ, Montine TJ, Siderowf A, Leverenz JB. Neuropsychologic assessment in collaborative Parkinson's disease research: a proposal from the National Institute of Neurological Disorders and Stroke Morris K. Udall Centers of Excellence for Parkinson's Disease Research at the University of Pennsylvania and the University of Washington. Alzheimers Dement 2013; 9:609-14. [PMID: 23164549 PMCID: PMC3612566 DOI: 10.1016/j.jalz.2012.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 07/24/2012] [Accepted: 07/24/2012] [Indexed: 11/23/2022]
Abstract
Cognitive impairment (CI) and behavioral disturbances can be the earliest symptoms of Parkinson's disease (PD), ultimately afflict the vast majority of PD patients, and increase caregiver burden. Our two Morris K. Udall Centers of Excellence for Parkinson's Disease Research were supported by the National Institute of Neurological Disorders and Stroke (NINDS) in an effort to recommend a comprehensive yet practical approach to cognitive and behavioral assessment to further collaborative research. We recommend a stepwise approach with two levels of standardized evaluation to establish a common battery, as well as an alternative testing recommendation for severely impaired subjects, and review supplemental tests that may be useful in specific research settings. Our flexible approach may be applied to studies with varying emphasis on cognition and behavior, does not place undue burden on participants or resources, and has a high degree of compatibility with existing test batteries to promote collaboration.
Collapse
Affiliation(s)
- G. Stennis Watson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Brenna A. Cholerton
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Rachel G. Gross
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Daniel Weintraub
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Cyrus P. Zabetian
- Geriatric, Veterans Affairs-Puget Sound Health Care System, Seattle WA
- Parkinson’s Disease Research, Education and Clinical Centers, Veterans Affairs-Puget Sound Health Care System, Seattle WA
- Department of Neurology, University of Washington, Seattle, WA
| | - John Q. Trojanowski
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
- Institute on Aging, University of Pennsylvania, Philadelphia, PA
- Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, PA
| | | | - Andrew Siderowf
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - James B. Leverenz
- Mental Illness, Veterans Affairs-Puget Sound Health Care System, Seattle WA
- Parkinson’s Disease Research, Education and Clinical Centers, Veterans Affairs-Puget Sound Health Care System, Seattle WA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- Department of Neurology, University of Washington, Seattle, WA
| |
Collapse
|
25
|
Chagas MHN, Tumas V, Rodrigues GR, Machado-de-Sousa JP, Filho AS, Hallak JEC, Crippa JAS. Validation and internal consistency of Patient Health Questionnaire-9 for major depression in Parkinson's disease. Age Ageing 2013; 42:645-9. [PMID: 23761457 DOI: 10.1093/ageing/aft065] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND depression is common in Parkinson's disease (PD), although frequently under-recognised. Among the scales used to investigate depressive features in PD, the Patient Health Questionnaire-9 (PHQ-9) has been largely used, but no specific cut-off scores for depression have been established thus far, which hinders the use of the PHQ-9 in clinical and research settings. OBJECTIVE we assessed the discriminant validity of the PHQ-9 in order to establish the best cut-off score for the diagnosis of major depression in PD patients. METHOD one hundred and ten patients with a diagnosis of PD without dementia were evaluated with the Structured Clinical Interview for DSM-IV (SCID), considered as the gold standard for the diagnosis of major depression. Eighty-four PD patients completed the PHQ-9, the 15-item Geriatric Depression Scale (GDS-15) and the Zung Self-rating Depression Scale (SDS). RESULTS the prevalence of current depression in the sample of PD patients was 25.5%. Maximal discrimination between depressed and non-depressed patients was reached with a cut-off score of 9 in the PHQ-9 (sensitivity of 100% and specificity of 83.1%). The internal consistency of the scale was 0.83 and, when used as a diagnostic instrument, the PHQ-9 had a sensitivity of 52.6% and specificity of 95.4%. The correlation coefficient between the PHQ-9 and the other two scales was 0.63. CONCLUSIONS the PHQ-9 is an adequate instrument for the screening-but not diagnosis-of depression in PD patients, with optimal sensitivity and specificity attained with a cut-off score of 9.
Collapse
Affiliation(s)
- Marcos Hortes N Chagas
- Behavior and Neurosciences Department, University of São Paulo, Av., Bandeirantes, 3900, Ribeirão Preto, SP 14048-900, Brazil.
| | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
OBJECTIVE Parkinson's disease (PD) is a degenerative and disabling disease in which medical providers focus mainly on ameliorating problems in day-to-day functioning. This review summarizes current knowledge about the efficacy and tolerability of psychopharmacological agents in the treatment of depression, anxiety, psychosis, and insomnia in patients with PD. Recommended or promising nonpharmacological interventions are also reviewed. METHOD Studies were identified using computerized searches, with further references obtained from the bibliographies of the reviewed articles. RESULT Findings in the research literature provide growing evidence concerning the antidepressant treatment of patients with PD. Psychoeducational interventions for managing depression and anxiety symptoms also appear promising. Music therapy has proven to be particularly effective for patients with PD. Psychosis is common in patients with PD. When psychosis is induced by antiparkinson drugs, a dose reduction can be considered, but it is seldom successful. Patients with PD do not generally tolerate conventional antipsychotic medications, justifying evaluation of newer atypical agents in this population. Cholinesterase inhibitors have also become increasingly important in the treatment of PD in recent years. Finally, insomnia is a very frequent complaint in patients with PD and may also contribute to the development of depression. Patients should be encouraged to improve sleep hygiene and use behavioral interventions. Definitive trials of treatments for sleep disorders in this population are also warranted. CONCLUSION Therapeutic approaches to the treatment of PD and its associated psychiatric symptoms must be individualized and may involve a combination of antiparkinson drugs, psychopharmacological treatment, and/or psychotherapeutic interventions.
Collapse
|
27
|
Schreiber MA, Thompson AW. The pharmacologic management of depression in Parkinson's disease. Degener Neurol Neuromuscul Dis 2013; 3:1-9. [PMID: 30890888 PMCID: PMC6065611 DOI: 10.2147/dnnd.s36917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Depression in Parkinson's disease (PD) is common, and it appears to worsen the motor and cognitive progression of the disease, and limits the patient's quality of life. In this paper, we review the pharmacotherapy of depression in people with PD. We find that evidence is sparse when it comes to this patient population. There is some evidence that older tricyclic antidepressants (nortriptyline and desipramine) may be effective in this population. There is also growing evidence that newer antidepressants like paroxetine and venlafaxine may be effective. We will also review a number of other promising medication treatments. What is apparent is the need for more research identifying the most effective medications for treating depression in this population. We provide recommendations that fall in line with current evidence-based practice for managing depression in the general population. Also, we suggest that collaborative models of depression care may be a promising approach to support the identification and effective treatment of those with PD also suffering from depressive disorders.
Collapse
Affiliation(s)
- Matthew A Schreiber
- University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA,
| | - Alexander W Thompson
- University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA,
| |
Collapse
|
28
|
Avidan A, Hays RD, Diaz N, Bordelon Y, Thompson AW, Vassar SD, Vickrey BG. Associations of sleep disturbance symptoms with health-related quality of life in Parkinson's disease. J Neuropsychiatry Clin Neurosci 2013; 25:319-26. [PMID: 24247858 PMCID: PMC3960993 DOI: 10.1176/appi.neuropsych.12070175] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors examined associations of various sleep-disturbance symptoms with health-related quality of life (HRQOL) in 153 adults with Parkinson's disease (PD). PD patients reported more snoring, sleep inadequacy, daytime somnolence, and sleep-maintenance problems than the general population. Symptoms having the broadest and strongest unique associations with generic HRQOL (eight scales; two composites of SF-36) were daytime somnolence (five scales; one composite), sleep initiation (eight scales; two composites), and awakening short of breath or with headache (six scales; two composites). Associations of selected sleep-disturbance symptoms--some unanticipated--suggest that assessing specific symptoms is worthwhile in clinical care.
Collapse
Affiliation(s)
- Alon Avidan
- Department of Neurology, UCLA, Los Angeles CA
| | - Ron D. Hays
- Departments of Medicine and Department of Health Policy and Management, UCLA, Los Angeles CA
| | - Natalie Diaz
- Department of Neurology, Harbor-UCLA, Los Angeles CA
| | | | | | - Stefanie D. Vassar
- Department of Neurology, UCLA, Los Angeles CA
- Parkinson’s Disease Research, Education, and Clinical Center; VA Greater Los Angeles Healthcare System; Los Angeles, CA
| | - Barbara G. Vickrey
- Department of Neurology, UCLA, Los Angeles CA
- Parkinson’s Disease Research, Education, and Clinical Center; VA Greater Los Angeles Healthcare System; Los Angeles, CA
| |
Collapse
|
29
|
Confirmatory factor analysis of the motor unified Parkinson's disease rating scale. PARKINSONS DISEASE 2012; 2012:719167. [PMID: 23133789 PMCID: PMC3486132 DOI: 10.1155/2012/719167] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 07/05/2012] [Accepted: 07/25/2012] [Indexed: 11/18/2022]
Abstract
The motor examination section of the unified Parkinson's disease rating scale (UPDRS) is widely used in research but few studies have examined whether subscales exist that tap relatively distinct motor abnormalities. We analyzed data from 193 persons enrolled in a population-based study in Central California. Patients were examined after overnight PD medication washout ("OFF" state) and approximately one hour after taking medication ("ON" state). We performed confirmatory factor analysis of the UPDRS for OFF and ON state examinations; correlations, reliability, and relative validity of resulting subscales were evaluated. A model with five factors (gait/posture, tremor, rigidity, bradykinesia affecting the left extremities, bradykinesia affecting the right extremities) fit the data well, with similar results for OFF and ON states. Internal consistency reliability coefficients were 0.90 or higher for all subscales. The gait/posture subscale most strongly discriminated across levels of patient reported PD symptom severity and of how PD affects them on a daily basis. Compared to the right sided bradykinesia subscale, the left sided bradykinesia subscale had higher discrimination across levels of self-reported PD symptom severity and functional impairment. This supports motor UPDRS containing multiple subscales that can be analyzed separately and provide information distinct from the total score that may be useful in clinical studies.
Collapse
|
30
|
McDowell K, Chesselet MF. Animal models of the non-motor features of Parkinson's disease. Neurobiol Dis 2012; 46:597-606. [PMID: 22236386 PMCID: PMC3442929 DOI: 10.1016/j.nbd.2011.12.040] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Revised: 12/17/2011] [Accepted: 12/22/2011] [Indexed: 12/21/2022] Open
Abstract
The non-motor symptoms (NMS) of Parkinson's disease (PD) occur in roughly 90% of patients, have a profound negative impact on their quality of life, and often go undiagnosed. NMS typically involve many functional systems, and include sleep disturbances, neuropsychiatric and cognitive deficits, and autonomic and sensory dysfunction. The development and use of animal models have provided valuable insight into the classical motor symptoms of PD over the past few decades. Toxin-induced models provide a suitable approach to study aspects of the disease that derive from the loss of nigrostriatal dopaminergic neurons, a cardinal feature of PD. This also includes some NMS, primarily cognitive dysfunction. However, several NMS poorly respond to dopaminergic treatments, suggesting that they may be due to other pathologies. Recently developed genetic models of PD are providing new ways to model these NMS and identify their mechanisms. This review summarizes the current available literature on the ability of both toxin-induced and genetically-based animal models to reproduce the NMS of PD.
Collapse
Affiliation(s)
- Kimberly McDowell
- Department of Neurology, The David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1769, USA
| | - Marie-Françoise Chesselet
- Department of Neurology, The David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1769, USA
| |
Collapse
|
31
|
Williams JR, Hirsch ES, Anderson K, Bush AL, Goldstein SR, Grill S, Lehmann S, Little JT, Margolis RL, Palanci J, Pontone G, Weiss H, Rabins P, Marsh L. A comparison of nine scales to detect depression in Parkinson disease: which scale to use? Neurology 2012; 78:998-1006. [PMID: 22422897 DOI: 10.1212/wnl.0b013e31824d587f] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The Methods of Optimal Depression Detection in Parkinson's Disease (MOOD-PD) study compared the psychometric properties of 9 depression scales to provide guidance on scale selection in Parkinson disease (PD). METHODS Patients with PD (n = 229) from community-based neurology practices completed 6 self-report scales (Beck Depression Inventory [BDI]-II, Center for Epidemiologic Studies Depression Rating Scale-Revised [CESD-R], 30-item Geriatric Depression Scale [GDS-30], Inventory of Depressive Symptoms-Patient [IDS-SR], Patient Health Questionnaire-9 [PHQ-9], and Unified Parkinson's Disease Rating Scale [UPDRS]-Part I) and were administered 3 clinician-rated scales (17-item Hamilton Depression Rating Scale [HAM-D-17], Inventory of Depressive Symptoms-Clinician [IDS-C], and Montgomery-Åsberg Depression Rating Scale [MADRS] and a psychiatric interview. DSM-IV-TR diagnoses were established by an expert panel blinded to the self-reported rating scale data. Receiver operating characteristic curves were used to estimate the area under the curve (AUC) of each scale. RESULTS All scales performed better than chance (AUC 0.75-0.85). Sensitivity ranged from 0.66 to 0.85 and specificity ranged from 0.60 to 0.88. The UPDRS Depression item had a smaller AUC than the BDI-II, HAM-D-17, IDS-C, and MADRS. The CESD-R also had a smaller AUC than the MADRS. The remaining AUCs were statistically similar. CONCLUSIONS The GDS-30 may be the most efficient depression screening scale to use in PD because of its brevity, favorable psychometric properties, and lack of copyright protection. However, all scales studied, except for the UPDRS Depression, are valid screening tools when PD-specific cutoff scores are used.
Collapse
Affiliation(s)
- J R Williams
- Food and Drug Administration, Silver Spring, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Christofoletti G, Cândido ER, Olmedo L, Miziara SRB, Beinotti F. Efeito de uma intervenção cognitivo-motora sobre os sintomas depressivos de pacientes com doença de Parkinson. JORNAL BRASILEIRO DE PSIQUIATRIA 2012. [DOI: 10.1590/s0047-20852012000200004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJETIVO: Verificar a eficácia de uma intervenção cognitivo-motora sobre os sintomas depressivos de pacientes com DP idiopática. MÉTODOS: Foi realizado um estudo longitudinal, composto por 26 pacientes, divididos entre os grupos experimental e controle. Os sujeitos foram avaliados pela Escala de Depressão Geriátrica, sendo o grupo experimental submetido a uma sequência de exercícios fisioterápicos de estimulação cognitivo-motora durante seis meses. Para a análise dos dados, foram aplicados os testes de Análise de Variâncias para medidas repetidas, a estatística por contraste e o teste t de Student para amostras independentes, sob um nível de significância de 5%. RESULTADOS: Os resultados apontaram homogeneidade dos grupos no momento inicial, e o grupo submetido ao tratamento fisioterápico obteve uma tendência de significância na interação "momento de intervenção" versus "grupo", evidenciado pelo erro alfa de 6%, com contraste linear de dados. CONCLUSÃO: O protocolo proposto apresentou boa aceitação pelos pacientes com DP. Apesar de não termos alcançado um intervalo de confiança de 95%, a tendência de significância obtida vislumbra um potencial do referido protocolo, mas com a necessidade de maiores estudos comprobatórios.
Collapse
Affiliation(s)
- Gustavo Christofoletti
- Universidade Federal de Mato Grosso do Sul; Programa de Pós-graduação Stricto-Sensu em Saúde e Desenvolvimento do Centro-Oeste
| | | | | | | | | |
Collapse
|