Depression in Parkinson's disease

Altered spontaneous brain activity in patients with Parkinson's disease accompanied by depressive symptoms, as revealed by regional homogeneity and functional connectivity in the prefrontal-limbic system

As patients with Parkinson’s disease (PD) are at high risk for comorbid depression, it is hypothesized that these two diseases are sharing common pathogenic pathways. Using regional homogeneity (ReHo) and functional connectivity approaches, we characterized human regional brain activity at resting state to examine specific brain networks in patients with PD and those with PD and depression (PDD). This study comprised 41 PD human patients and 25 normal human subjects. The patients completed the Hamilton Depression Rating Scale and were further divided into two groups: patients with depressive symptoms and non-depressed PD patients (nD-PD). Compared with the non-depressed patients, those with depressive symptoms exhibited significantly increased regional activity in the left middle frontal gyrus and right inferior frontal gyrus, and decreased ReHo in the left amygdala and bilateral lingual gyrus. Brain network connectivity analysis revealed decreased functional connectivity within the prefrontal-limbic system and increased functional connectivity in the prefrontal cortex and lingual gyrus in PDD compared with the nD-PD group. In summary, the findings showed regional brain activity alterations and disruption of the mood regulation network in PDD patients. The pathogenesis of PDD may be attributed to abnormal neural activity in multiple brain regions.

The factor structure of the SF-36 in Parkinson's disease

RATIONALE, AIMS AND OBJECTIVES

The concept of quality of life (QoL) has emerged as an important psychological dimension in individuals experiencing Parkinson's disease (PD). The current study sought to determine the factor structure of the Medical Outcomes Study Short-Form 36 (SF-36) version 2 in patients with PD in order to evaluate how this measure might best be used to assess QoL in this clinical population.

METHOD

Confirmatory factor analyses were conducted on self-report SF-36 data from 339 individuals diagnosed with PD. Six structural models of the SF-36 were evaluated against the participants' data.

RESULTS

The underlying factor structure of the SF-36 in PD was observed to be inconsistent with the assumed measurement model of SF-36 but consistent with contemporary theoretical models of the instrument.

CONCLUSIONS

The use of the SF-36 in individuals with PD can be recommended when eight subscales are used and reported. Evidence to support the use of the instrument as a two-subscale measure of physical health and mental health components was not found.

Telephone-administered cognitive behavioral therapy: a case study of anxiety and depression in Parkinson's disease

Parkinson's disease (PD) is a chronic medical illness with a high incidence of psychiatric comorbidity, specifically depression and anxiety. Research on treatment of such psychiatric complications is scarce. Non-pharmaceutical treatment options are especially attractive. Cognitive behavioral therapy (CBT) is a psychotherapeutic treatment option that has been successful in other chronically medically ill populations with comorbid depression and anxiety. The current research had two aims. The first was to pilot the feasibility of screening and identifying PD patients with symptoms of anxiety and depression in a specialized outpatient clinic. The second aim was to pilot the feasibility of telephone-administered CBT for the treatment of depression and anxiety in persons with PD, which was done through a case series comparing telephone-administered CBT to a Support strategy. A fairly large portion (67.5%) of patients screened in the outpatient clinic were identified as having symptoms of anxiety and/or depression. Results also indicated that CBT delivered via the telephone is a useful approach for targeting psychiatric symptoms in this population. A case example is given to illustrate the clinical considerations associated with delivering therapy via telephone to persons with PD.

The assessment of depression in Parkinson's disease

BACKGROUND

Motor symptoms form the hallmark of Parkinson's Disease (PD), although features like depression are often present. Depression rating scales [e.g. Montgomery-Asberg Depression Rating Scale (MADRS)] used in PD measure affective, cognitive and somatic symptoms. An important clinical question is which items of the MADRS are likely to be influenced by PD symptoms.

METHODS

Depression was assessed in 43 PD patients who scored below the cut-off of the MADRS and who differed widely in motor severity.

RESULTS

Parkinson's Disease patients scored relatively highest on Concentration difficulties, Reduced sleep and Inner tension. Reduced sleep, Lassitude and Suicidal thoughts were associated with motor severity and specifically with Bradykinesia, Rigidity and Axial impairment, however not with Tremor. To avoid a possible influence on our results of coincidentally included PD patients with a depression, all associations between somatic MADRS items and motor severity were corrected for the influence of affective symptoms of depression. All associations remained significant.

DISCUSSION

In conclusion, the items Reduced sleep and Lassitude of the MADRS are likely to be influenced by motor symptoms. The high score on Concentration difficulties is suggested to be a reflection of cognitive dysfunction in PD. Thus, when assessing depression in PD, using a depression rating scale like the MADRS, adjusted cut-off scores are required.

Deep brain stimulation for the treatment of Parkinson's disease

Approximately 30,000 patients have been treated throughout the world with deep brain stimulation for Parkinson's disease and other conditions. With accumulating experience, there has been an appreciation of the important benefits of this procedure, including the alleviation of disability and improvement in the quality of life. We have also become aware of some limitations of DBS surgery. Among the important issues that remain to be resolved are the timing of surgery, whether early or late in the course of the disease, and the best target for the individual patient, including a reassessment of the relative merits of globus pallidus versus subthalamic nucleus surgery. A better understanding of the symptoms that are resistant to both levodopa therapy and DBS surgery is also required.

The Disability Discrimination Act, a necessary, but not sufficient safeguard for people with progressive conditions in the workplace? The experiences of younger people with Parkinson's disease

PURPOSE

This study explored the impact of Parkinson's disease (PD) on employment from the perspective of affected individuals. Particular attention was paid to factors that may affect the duration of employment after onset/diagnosis.

METHOD

Data were collected in two phases, i) a postal survey (n = 339), and ii) one to one interviews (n = 24).

RESULTS

Four out of five participants reported that PD had made work difficult for them, only 15.3% had worked for more than five years post-diagnosis at the time of the survey. Several participants reported having experienced considerable stress prior to leaving work. Factors that precipitated withdrawal from the labour market included severity of symptoms, lack of support in the workplace, and opportunities for 'early retirement'. Factors associated with maintaining employment included age at diagnosis, support received from employers, and manipulation of drug therapy.

CONCLUSIONS

It can be very difficult for people with PD to continue in paid employment for more than a few years post diagnosis. The relatively low level of contact between people with PD who were in employment and health professionals suggest that employment retention is not seen as major role for this group of professionals. There is a need for positive action to support people with progressive conditions in the workplace.

The feasibility of using cognitive behaviour therapy for depression associated with Parkinson's disease: a literature review

Clinicians and researchers have called for more information on how to treat depression in Parkinson's disease. Cognitive Behaviour Therapy (CBT) has been identified as the treatment of choice for a range of psychological disorders and is increasingly applied to depression associated with chronic medical conditions. The present paper will review the relevant literature on CBT treatment effectiveness and the nature of depression in Parkinson's disease before suggesting how CBT might be adapted to assist this client group. The authors conclude that CBT is a promising option for depressed patients coping with Parkinson's disease, but further research is recommended.

Antidepressant-like and antinociceptive-like actions of 4-(4′-chlorophenyl)-6-(4″-methylphenyl)-2-hydrazinepyrimidine Mannich base in mice

This study investigated the possible antidepressant and antinociceptive action of CPMPH Mannich base, as well as the involvement of serotonergic, dopaminergic, noradrenergic and opioid systems and the L-arginine-nitric oxide pathway in the antidepressant-like effect of CPMPH in the forced swimming test (FST) in mice. The immobility time in the FST was significantly reduced by CPMPH (0.1-10 mg/kg, i.p.), without accompanying changes in the ambulation in an open-field. CPMPH at high doses (i.p. or s.c. routes) produced a significant inhibition of acetic acid-induced writhing. The antidepressant-like effect of CPMPH (1 mg/kg, i.p.) in the FST was prevented by pre-treatment of mice with methysergide (2 mg/kg, i.p., a non-selective serotonin receptor antagonist), sulpiride (32 mg/kg, i.p., a D2 receptor antagonist) or yohimbine (1 mg/kg, i.p., an alpha2-adrenoceptor antagonist). In contrast, the antidepressant-like effect of CPMPH was not affected by pre-treatment (i.p.) with naloxone (1 mg/kg, a non-selective opioid receptor antagonist) or L-arginine (750 mg/kg, a nitric oxide precursor). The results demonstrate that CPMPH had an antidepressant-like action that appears to be mediated through its interaction with serotonergic, dopaminergic and noradrenergic systems.

Conceptualization of depression in Parkinson's disease

AIMS

To discuss the current methodological and conceptual difficulties inherent in characterizing the emotional manifestations of neurodegenerative disease through critically reviewing depression as a manifestation of idiopathic Parkinson's disease (PD).

METHODS

Selective literature review of the neurobiological, psychological, and physical basis of depressive symptoms in PD from 1993-2003, with reference to key earlier articles.

CONCLUSIONS

There are difficulties in defining the syndromes of PD itself as well as depression in PD. The use of more conceptually reductionistic definitions of emotion and behavior in comprehensive longitudinal studies of the natural history of PD is recommended.

Bilateral Subthalamic Nucleus Stimulation for Parkinson's Disease: A Systematic Review of the Clinical Literature

OBJECTIVE:

To evaluate the benefits and adverse effects of bilateral subthalamic nucleus stimulation in the treatment of Parkinson's disease (PD) by systematically reviewing the published literature.

METHODS:

A search of the PubMed database using the key words subthalamic, nucleus, and stimulation yielded 624 articles published between 1966 and December 2003. Only articles that included original, nonduplicated descriptions of patients with PD treated with bilateral subthalamic nucleus stimulation were selected for further analysis.

RESULTS:

A total of 38 studies from 34 neurosurgical centers in 13 countries were identified for critical review. The outcomes for 471 patients with PD treated with bilateral subthalamic nucleus stimulation were assessed according to the Unified Parkinson's Disease Rating Scale in both on-medication and off-medication conditions. With stimulation, Unified Parkinson's Disease Rating Scale motor scores in the off-medication condition improved by 50% after 6 months, 56% after 12 months, 51% after 2 years, and 49% after 5 years compared with preoperative off-medication scores. At 12 months of subthalamic nucleus stimulation, the mean improvement in tremor was 81%, in rigidity was 63%, in bradykinesia was 52%, in gait was 64%, and in postural instability was 69% when compared with preoperative off-medication subscores. On-medication dyskinesias were reduced by 94%, as assessed 12 months after stimulation using the Unified Parkinson's Disease Rating Scale IV complications of therapy score. There was an overall 52% reduction in the l-dopa-equivalent dose intake after 12 months of stimulation. Most adverse effects were mild to moderate. There was a 1 to 2% incidence of severe adverse effects (death or permanent neurological deficits related to intracerebral hemorrhages). Nineteen percent of the patients had adverse effects related to stimulation that could be reversed by changing stimulation parameters. There was a 9% incidence of adverse effects related to the hardware (infections, lead and pulse generator problems).

CONCLUSION:

Bilateral subthalamic nucleus stimulation is effective in the treatment of PD. Further refinements in patient selection and surgical technique may lessen the incidence of complications associated with this procedure.

Tryptophan hydroxylase regulation. Drug-induced modifications that alter serotonin neuronal function

Tryptophan hydroxylase is the initial and rate-limiting enzyme in the biosynthesis of the neurotransmitter serotonin. A variety of drugs are known to diminish the function of this enzyme, and possibly cause damage to serotonin neurons. These include the substituted amphetamines methamphetamine and 3,4-methylenedioxy-methamphetamine, as well as L-DOPA, the most common therapy for Parkinsons Disease. In view of the important role for dopamine in the effects of these drugs on tryptophan hydroxylase and on serotonin neurons, we tested whether dopamine could alter the activity of this important enzyme. We found that dopamine-derived quinones, but not dopamine, inactivate tryptophan hydroxylase and convert the protein to a redox-cycling quinoprotein. This posttranslational modification of tryptophan hydroxylase could play a role in the drug-induced reduction in serotonin synthesis.

Parkinson's disease and the U.S. health care system

Parkinson's disease is an expanding healthcare problem in our society. With the burgeoning elderly population in this country, it is important for community health nurses to understand the management of these patients. Although the cause of idiopathic Parkinson's disease is still unknown, there is much new research developing in this area. Local and national foundations are available to assist the patient and caregiver in education, referrals, and support groups. The effects of this disease process on the patient and family are profound. New government legislation may offer a promising link to researchers and practitioners nationwide. Healthcare implications are varied, and nurses need to keep abreast of changes in Medicare and managed care systems to ensure that homebound clients receive needed services. Community health nurses provide a vital link in the healthcare system for the Parkinson's patient.