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Petkus AJ, Donahue E, Jakowec MW, Bayram E, Van Horn JD, Litvan I, Petzinger GM, Schiehser DM. Data-driven sequence of cognitive decline in people with Parkinson's disease. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-333270. [PMID: 38816189 DOI: 10.1136/jnnp-2023-333270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/08/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Understanding the sequential progression of cognitive impairments in Parkinson's disease (PD) is crucial for elucidating neuropathological underpinnings, refining the assessment of PD-related cognitive decline stages and enhancing early identification for targeted interventions. The first aim of this study was to use an innovative event-based modeling (EBM) analytic approach to estimate the sequence of cognitive declines in PD. The second aim was to validate the EBM by examining associations with EBM-derived individual-specific estimates of cognitive decline severity and performance on independent cognitive screening measures. METHODS This cross-sectional observational study included 99 people with PD who completed a neuropsychological battery. Individuals were classified as meeting the criteria for mild cognitive impairment (PD-MCI) or subtle cognitive decline by consensus. An EBM was constructed to compare cognitively healthy individuals with those with PD-MCI or subtle cognitive disturbances. Multivariable linear regression estimated associations between the EBM-derived stage of cognitive decline and performance on two independent cognitive screening tests. RESULTS The EBM estimated that tests assessing executive function and visuospatial ability become abnormal early in the sequence of PD-related cognitive decline. Each higher estimated stage of cognitive decline was associated with approximately 0.24 worse performance on the Dementia Rating Scale (p<0.001) and 0.26 worse performance on the Montreal Cognitive Assessment (p<0.001) adjusting for demographic and clinical variables. CONCLUSION Findings from this study will have important clinical implications for practitioners, on specific cognitive tests to prioritise, when conducting neuropsychological evaluations with people with PD. Results also highlight the importance of frontal-subcortical system disruption impacting executive and visuospatial abilities.
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Affiliation(s)
- Andrew John Petkus
- Department of Neurology, University of Southern California, Los Angeles, California, USA
| | - Erin Donahue
- Department of Neurology, University of Southern California, Los Angeles, California, USA
| | - Michael W Jakowec
- Department of Neurology, University of Southern California, Los Angeles, California, USA
| | - Ece Bayram
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - John Darrell Van Horn
- Department of Psychology, University of Virginia, Charlottesville, Virginia, USA
- School of Data Science, University of Virginia, Charlottesville, Virginia, USA
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Giselle M Petzinger
- Department of Neurology, University of Southern California, Los Angeles, California, USA
| | - Dawn M Schiehser
- Veterans Administration San Diego Healthcare System (VASDHS), San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
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Plzáková V, Mana J, Růžička E, Nikolai T. Efficacy of non-computerized cognitive rehabilitation in Parkinson's disease: A one year follow up study. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-12. [PMID: 38710156 DOI: 10.1080/23279095.2024.2341808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
In this study, we explored the effect of non-computerized cognitive rehabilitation in patients with Parkinson's disease in comparison with an intervention with elements of music therapy after the completion of a three-month program and one year after the end of the intervention. After the initial neuropsychological examination, the respondents were divided into two intervention groups. The experimental group (n = 26) underwent a twelve-week program of cognitive rehabilitation at a frequency of 60 minutes once a week. The control group (n = 27) underwent an intervention program with elements of music therapy at the same frequency. Respondents who underwent the cognitive rehabilitation program improved in the delayed recall from visual memory in the follow-up examination after the end of the cognitive intervention. One year after the end, the effect of cognitive rehabilitation persisted in delayed recall from visual memory and in executive mental flexibility. Cognitive rehabilitation is an effective approach to compensate for cognitive deficits in P D, but other approaches to cognitive stimulation may be equally effective.
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Affiliation(s)
- Vladimíra Plzáková
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
- Institute of Neuropsychiatric Care, Prague, Czech Republic
- Rehabilitation Hospital Beroun, Beroun, Czech Republic
| | - Josef Mana
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Evžen Růžička
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Tomáš Nikolai
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
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3
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Burchill E, Watson CJ, Fanshawe JB, Badenoch JB, Rengasamy E, Ghanem DA, Holle C, Conti I, Sadeq MA, Saini A, Lahmar A, Cross B, McGuigan G, Nandrha A, Kane EJ, Wozniak J, Farouk Ghorab RM, Song J, Sommerlad A, Lees A, Zandi MS, David AS, Lewis G, Carter B, Rogers JP. The impact of psychiatric comorbidity on Parkinson's disease outcomes: a systematic review and meta-analysis. THE LANCET REGIONAL HEALTH. EUROPE 2024; 39:100870. [PMID: 38361749 PMCID: PMC10867667 DOI: 10.1016/j.lanepe.2024.100870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/17/2024]
Abstract
Background The burden of psychiatric symptoms in Parkinson's disease includes depression, anxiety, apathy, psychosis, and impulse control disorders. However, the relationship between psychiatric comorbidities and subsequent prognosis and neurological outcomes is not yet well understood. In this systematic review and meta-analysis, in individuals with Parkinson's disease, we aimed to characterise the association between specific psychiatric comorbidities and subsequent prognosis and neurological outcomes: cognitive impairment, death, disability, disease progression, falls or fractures and care home admission. Methods We searched MEDLINE, Embase, PsycINFO and AMED up to 13th November 2023 for longitudinal observational studies which measured disease outcomes in people with Parkinson's disease, with and without specific psychiatric comorbidities, and a minimum of two authors extracted summary data. Studies of individuals with other parkinsonian conditions and those with outcome measures that had high overlap with psychiatric symptoms were excluded to ensure face validity. For each exposure-outcome pair, a random-effects meta-analysis was conducted based on standardised mean difference, using adjusted effect sizes-where available-in preference to unadjusted effect sizes. Study quality was assessed using the Newcastle-Ottawa Scale. Between-study heterogeneity was assessed using the I2 statistic and publication bias was assessed using funnel plots. PROSPERO Study registration number: CRD42022373072. Findings There were 55 eligible studies for inclusion in meta-analysis (n = 165,828). Data on participants' sex was available for 164,514, of whom 99,182 (60.3%) were male and 65,460 (39.7%) female. Study quality was mostly high (84%). Significant positive associations were found between psychosis and cognitive impairment (standardised mean difference [SMD] 0.44, [95% confidence interval [CI] 0.23-0.66], I2 30.9), psychosis and disease progression (SMD 0.46, [95% CI 0.12-0.80], I2 70.3%), depression and cognitive impairment (SMD 0.37 [95% CI 0.10-0.65], I2 27.1%), depression and disease progression (SMD 0.46 [95% CI 0.18-0.74], I2 52.2), depression and disability (SMD 0.42 [95% CI 0.25-0.60], I2 7.9%), and apathy and cognitive impairment (SMD 0.60 [95% CI 0.02-1.19], I2 27.9%). Between-study heterogeneity was moderately high. Interpretation Psychosis, depression, and apathy in Parkinson's disease are all associated with at least one adverse outcome, including cognitive impairment, disease progression and disability. Whether this relationship is causal is not clear, but the mechanisms underlying these associations require exploration. Clinicians should consider these psychiatric comorbidities to be markers of a poorer prognosis in people with Parkinson's disease. Future studies should investigate the underlying mechanisms and which treatments for these comorbidities may affect Parkinson's disease outcomes. Funding Wellcome Trust, UK National Institute for Health Research (NIHR), National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London, National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at University College London Hospitals NHS Foundation Trust, National Brain Appeal.
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Affiliation(s)
- Ella Burchill
- Division of Psychiatry, University College London, London, UK
| | - Cameron James Watson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | - Jack B. Fanshawe
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - James Brunton Badenoch
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Emma Rengasamy
- Department of Public Health and Primary Care, University of Cambridge, UK
| | | | | | - Isabella Conti
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mohammed Ahmed Sadeq
- Faculty of Medicine, Misr University for Science and Technology, 6th of October City, Egypt
| | - Aman Saini
- Medical School, University College London, London, UK
| | | | - Ben Cross
- Mersey Care NHS Foundation Trust, Liverpool, UK
| | | | - Amar Nandrha
- Medical School, University College London, London, UK
| | | | - Julia Wozniak
- Medical School, University College London, London, UK
| | | | - Jia Song
- Camden and Islington NHS Foundation Trust, London, UK
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Andrew Lees
- UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Michael S. Zandi
- UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Anthony S. David
- Division of Psychiatry, University College London, London, UK
- UCL Institute of Mental Health, University College London, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, King's College London, London, UK
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Yoon SY, Heo SJ, Kim YW, Lee SC, Shin J, Lee JW. Depressive Symptoms and the Subsequent Risk of Parkinson's Disease: A Nationwide Cohort Study. Am J Geriatr Psychiatry 2024; 32:339-348. [PMID: 37953133 DOI: 10.1016/j.jagp.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE Only a few studies have focused on depressive symptoms and Parkinson's disease (PD) risk. As a time lag exists from the onset of depressive symptoms to the diagnosis of depression, elucidating the association between depressive symptoms and PD development might be helpful for the early prediction of PD. We investigate the association between depressive symptoms and subsequent PD risk using nationwide population-based cohort database. DESIGN AND SETTING Cohort study using the Korean National Health Insurance Service data between 2007 and 2017, with longitudinal follow-up until 2019. PARTICIPANTS A total of 98,296 elderly people responded to a self-reported questionnaire from the National Health Screening Program on depressive symptoms. MEASUREMENTS The association between depressive symptoms such as 1) decreased activity or motivation, 2) worthlessness, and 3) hopelessness and PD risk was analyzed. RESULTS During median 5.06-year follow-up, 839 PD cases occurred: 230 in individuals with depressive symptoms and 609 in those without symptoms. Results showed an increased risk of PD development in those with depressive symptoms (HR = 1.47, 95% CI, 1.26-1.71), with dose-response association between the number of depressive symptoms and PD risk. Even in those already diagnosed with depression, combined depressive symptoms were linked to a higher risk compared to those without symptoms (with symptoms, HR = 2.71, 95% CI, 2.00-3.68; without symptoms, HR = 1.84, 95% CI, 1.43-2.36). CONCLUSION Individuals with depressive symptoms were at an increased risk of developing PD, and there was a dose-response association between the number of depressive symptoms and PD risk.
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Affiliation(s)
- Seo Yeon Yoon
- Department and Research Institute of Rehabilitation Medicine (SYY, YWK, SCL), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok-Jae Heo
- Department of Biostatistics and Computing (SJH), Yonsei University Graduate School, Seoul, Republic of Korea
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine (SYY, YWK, SCL), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Chul Lee
- Department and Research Institute of Rehabilitation Medicine (SYY, YWK, SCL), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaeyong Shin
- Department of Preventive Medicine and Public Health (JS), Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Jang Woo Lee
- Department of Physical Medicine and Rehabilitation (JWL), National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
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5
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Silva RH, Lopes-Silva LB, Cunha DG, Becegato M, Ribeiro AM, Santos JR. Animal Approaches to Studying Risk Factors for Parkinson's Disease: A Narrative Review. Brain Sci 2024; 14:156. [PMID: 38391730 PMCID: PMC10887213 DOI: 10.3390/brainsci14020156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
Despite recent efforts to search for biomarkers for the pre-symptomatic diagnosis of Parkinson's disease (PD), the presence of risk factors, prodromal signs, and family history still support the classification of individuals at risk for this disease. Human epidemiological studies are useful in this search but fail to provide causality. The study of well-known risk factors for PD in animal models can help elucidate mechanisms related to the disease's etiology and contribute to future prevention or treatment approaches. This narrative review aims to discuss animal studies that investigated four of the main risk factors and/or prodromal signs related to PD: advanced age, male sex, sleep alterations, and depression. Different databases were used to search the studies, which were included based on their relevance to the topic. Although still in a reduced number, such studies are of great relevance in the search for evidence that leads to a possible early diagnosis and improvements in methods of prevention and treatment.
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Affiliation(s)
- R H Silva
- Behavioral Neuroscience Laboratory, Department of Pharmacology, Universidade Federal de São Paulo, São Paulo 04021-001, SP, Brazil
| | - L B Lopes-Silva
- Behavioral Neuroscience Laboratory, Department of Pharmacology, Universidade Federal de São Paulo, São Paulo 04021-001, SP, Brazil
| | - D G Cunha
- Behavioral Neuroscience Laboratory, Department of Pharmacology, Universidade Federal de São Paulo, São Paulo 04021-001, SP, Brazil
| | - M Becegato
- Behavioral Neuroscience Laboratory, Department of Pharmacology, Universidade Federal de São Paulo, São Paulo 04021-001, SP, Brazil
| | - A M Ribeiro
- Laboratory of Neuroscience and Bioprospecting of Natural Products, Department of Biosciences, Universidade Federal de São Paulo, Santos 11015-020, SP, Brazil
| | - J R Santos
- Behavioral and Evolutionary Neurobiology Laboratory, Department of Biosciences, Federal University of Sergipe, Itabaiana 49500-000, SE, Brazil
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6
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Herlihy RA, Alicandri F, Berger H, Rehman H, Kao Y, Akhtar K, Dybas E, Mahoney-Rafferty E, Von Stein K, Kirby R, Tawfik A, Skumurski R, Feustel PJ, Molho ES, Shin DS. Investigation of non-invasive focused ultrasound efficacy on depressive-like behavior in hemiparkinsonian rats. Exp Brain Res 2024; 242:321-336. [PMID: 38059986 DOI: 10.1007/s00221-023-06750-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023]
Abstract
Depression is a common non-motor symptom in Parkinson's disease (PD) that includes anhedonia and impacts quality of life but is not effectively treated with conventional antidepressants clinically. Vagus nerve stimulation improves treatment-resistant depression in the general population, but research about its antidepressant efficacy in PD is limited. Here, we administered peripheral non-invasive focused ultrasound to hemiparkinsonian ('PD') and non-parkinsonian (sham) rats to mimic vagus nerve stimulation and assessed its antidepressant-like efficacy. Following 6-hydroxydopamine (6-OHDA) lesion, akinesia-like immobility was assessed in the limb-use asymmetry test, and despair- and anhedonic-like behaviors were evaluated in the forced swim test and sucrose preference test, respectively. After, tyrosine hydroxylase immuno-staining was employed to visualize and quantify dopaminergic degeneration in the substantia nigra pars compacta, ventral tegmental area, and striatum. We found that PD rats exhibited akinesia-like immobility and > 90% reduction in tyrosine hydroxylase immuno-staining ipsilateral to the lesioned side. PD rats also demonstrated anhedonic-like behavior in the sucrose preference test compared to sham rats. No 6-OHDA lesion effect on immobility in the forced swim test limited conclusions about the efficacy of ultrasound on despair-like behavior. However, ultrasound improved anhedonic-like behavior in PD rats and this efficacy was sustained through the end of the 1-week recovery period. The greatest number of animals demonstrating increased sucrose preference was in the PD group receiving ultrasound. Our findings here are the first to posit that peripheral non-invasive focused ultrasound to the celiac plexus may improve anhedonia in PD with further investigation needed to reveal its potential for clinical applicability.
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Affiliation(s)
- Rachael A Herlihy
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Francisco Alicandri
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Hudy Berger
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Huda Rehman
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Yifan Kao
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Kainat Akhtar
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Elizabeth Dybas
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Emily Mahoney-Rafferty
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Kassie Von Stein
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Raven Kirby
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Angela Tawfik
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Rachel Skumurski
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Paul J Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Eric S Molho
- Department of Neurology, Albany Medical Center, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Damian S Shin
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY, 12208, USA.
- Department of Neurology, Albany Medical Center, 47 New Scotland Ave, Albany, NY, 12208, USA.
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7
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Balasubramanian S, Mehmood KT, Al-Baldawi S, Zúñiga Salazar G, Zúñiga D. Behind the Mask: Parkinson's Disease and Depression. Cureus 2024; 16:e52663. [PMID: 38380213 PMCID: PMC10877222 DOI: 10.7759/cureus.52663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/22/2024] Open
Abstract
Parkinson's disease (PD) is a common, prevalent neurodegenerative disease. It is mainly characterized by motor symptoms such as rigidity, tremors, and bradykinesia, but it can also manifest with non-motor symptoms, of which depression is the most frequent. The latter can impair the quality of life, yet it gets overlooked and goes untreated because of the significant overlap in their clinical features, hence making the diagnosis difficult. Furthermore, there is limited data on the availability of appropriate criteria for making the diagnosis of depression in PD patients, as it can occur with varying expressions throughout the course of PD or it can also precede it. This review article has included a brief discussion on the diagnosis of depression in PD patients and their overlapped clinical manifestations. Understanding the mechanisms underlying the disease processes of PD and depression and the pathways interconnecting them gives better knowledge on devising treatment options for the patients. Only studies from Pubmed were included and all other databases were excluded. Studies from the last 50 years were included. Suitable references included in these studies were also extracted. Thus, depression in PD and PD in depression, along with their pharmacological and non-pharmacological treatment options, have been discussed.
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Affiliation(s)
| | | | | | | | - Diego Zúñiga
- Medicine, Universidad Católica de Santiago de Guayaquil, Guayaquil, ECU
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8
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Angelopoulou E, Bougea A, Paudel YN, Georgakopoulou VE, Papageorgiou SG, Piperi C. Genetic Insights into the Molecular Pathophysiology of Depression in Parkinson's Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1138. [PMID: 37374342 DOI: 10.3390/medicina59061138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/05/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Parkinson's disease (PD) is a clinically heterogeneous disorder with poorly understood pathological contributing factors. Depression presents one of the most frequent non-motor PD manifestations, and several genetic polymorphisms have been suggested that could affect the depression risk in PD. Therefore, in this review we have collected recent studies addressing the role of genetic factors in the development of depression in PD, aiming to gain insights into its molecular pathobiology and enable the future development of targeted and effective treatment strategies. Materials and Methods: we have searched PubMed and Scopus databases for peer-reviewed research articles published in English (pre-clinical and clinical studies as well as relevant reviews and meta-analyses) investigating the genetic architecture and pathophysiology of PD depression. Results: in particular, polymorphisms in genes related to the serotoninergic pathway (sodium-dependent serotonin transporter gene, SLC6A4, tryptophan hydrolase-2 gene, TPH2), dopamine metabolism and neurotransmission (dopamine receptor D3 gene, DRD3, aldehyde dehydrogenase 2 gene, ALDH2), neurotrophic factors (brain-derived neurotrophic factor gene, BDNF), endocannabinoid system (cannabinoid receptor gene, CNR1), circadian rhythm (thyrotroph embryonic factor gene, TEF), the sodium-dependent neutral amino acid transporter B(0)AT2 gene, SLC6A15), and PARK16 genetic locus were detected as altering susceptibility to depression among PD patients. However, polymorphisms in the dopamine transporter gene (SLC6A3), monoamine oxidase A (MAOA) and B (MAOB) genes, catechol-O-methyltransferase gene (COMT), CRY1, and CRY2 have not been related to PD depression. Conclusions: the specific mechanisms underlying the potential role of genetic diversity in PD depression are still under investigation, however, there is evidence that they may involve neurotransmitter imbalance, mitochondrial impairment, oxidative stress, and neuroinflammation, as well as the dysregulation of neurotrophic factors and their downstream signaling pathways.
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Affiliation(s)
- Efthalia Angelopoulou
- Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 75 M. Asias Street, 11527 Athens, Greece
| | - Anastasia Bougea
- Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Yam Nath Paudel
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Subang Jaya 46150, Selangor, Malaysia
| | | | - Sokratis G Papageorgiou
- Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Christina Piperi
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 75 M. Asias Street, 11527 Athens, Greece
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9
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Interian A, Miller RB, Hill LMS, Latorre M, King AR, Rodriguez KM, Mann SL, Kashan RS, Dissanayaka NN, Dobkin RD. A Pilot Study of Telehealth Mindfulness-Based Cognitive Therapy for Depression in Parkinson's Disease. J Geriatr Psychiatry Neurol 2023; 36:143-154. [PMID: 35603772 DOI: 10.1177/08919887221103579] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Parkinson's disease (PD) is characterized by high-rates of depression with limited evidence-based treatment options to improve mood. Objective: To expand therapeutic options, we evaluated the feasibility and effect of a telehealth mindfulness-based cognitive therapy intervention adapted for PD (MBCT-PD) in a sample of participants with DSM-5 depressive disorders. Methods: Fifteen participants with PD and clinically-significant depression completed 9 sessions of MBCT-PD. Depression, anxiety, and quality of life were evaluated at baseline, endpoint, and 1-month follow-up. Results: Telehealth MBCT-PD was feasible and beneficial. Completion rates exceeded 85% and treatment satisfaction rates were high. Notable improvements were observed for depression, anxiety, and quality of life over the course of the trial. Conclusion: Telehealth MBCT-PD shows promise and warrants further evaluation via randomized clinical trial with more diverse participants. Such research holds the potential to expand the range of therapeutic options for depression in PD, thereby setting the stage for personalized care.
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Affiliation(s)
- Alejandro Interian
- 20063VA New Jersey Healthcare System, Lyons, NJ, USA.,20061Rutgers-Robert Wood Johnson Medical School, Department of Psychiatry, Piscataway, NJ, USA
| | | | | | | | - Arlene R King
- 20063VA New Jersey Healthcare System, Lyons, NJ, USA
| | | | - Sarah L Mann
- 20063VA New Jersey Healthcare System, Lyons, NJ, USA
| | - Rachel S Kashan
- 20061Rutgers-Robert Wood Johnson Medical School, Department of Psychiatry, Piscataway, NJ, USA
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, 25056The University of Queensland, Brisbane, AU-QLD, Australia.,School of Psychology, 12287University of Queensland, Brisbane, AU-QLD, Australia.,Department of Neurology, 303224Royal Brisbane & Women's Hospital, Brisbane, AU-QLD, Australia
| | - Roseanne D Dobkin
- 20061Rutgers-Robert Wood Johnson Medical School, Department of Psychiatry, Piscataway, NJ, USA
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10
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Ahmad MH, Rizvi MA, Ali M, Mondal AC. Neurobiology of depression in Parkinson's disease: Insights into epidemiology, molecular mechanisms and treatment strategies. Ageing Res Rev 2023; 85:101840. [PMID: 36603690 DOI: 10.1016/j.arr.2022.101840] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 12/25/2022] [Accepted: 12/31/2022] [Indexed: 01/03/2023]
Abstract
Parkinson's disease (PD) is characterized mainly by motor dysfunctions due to the progressive loss of dopaminergic neurons. However, PD patients experience a multitude of debilitating non-motor symptoms, including depression, which may have deleteriously detrimental effects on life. Depression is multifactorial and exhibits a bimodal progression in PD, but its underlying molecular mechanisms are poorly understood. Studies demonstrating the pathophysiology of depression in PD and the specific treatment strategies for depression-like symptoms in PD patients are largely lacking, often underrated, under-recognized and, consequently, inadequately/under-treated. Nevertheless, reports suggest that the incidence of depression is approximately 20-30% of PD patients and may precede the onset of motor symptoms. Diagnosing depression in PD becomes difficult due to the clinical overlap in symptomatology between the two diseases, and the nigrostriatal dysfunction alone is insufficient to explain depressive symptoms in PD. Therefore, the current study provides an overview of the molecular mechanisms underlying the development of depression in PD and new insights into developing current antidepressant strategies to treat depression in PD. This review will identify and understand the molecular pathological mechanisms of depression in PD that will fundamentally help tailoring therapeutic interventions for depressive symptoms in PD.
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Affiliation(s)
- Mir Hilal Ahmad
- Laboratory of Cellular and Molecular Neurobiology, School of Life Sciences, Jawaharlal Nehru University, New Delhi 110067, India; Genome Biology Lab, Department of Biosciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Moshahid Alam Rizvi
- Genome Biology Lab, Department of Biosciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Mansoor Ali
- Cancer Biology Laboratory, School of Life Sciences, Jawaharlal Nehru University, New Delhi 110067, India
| | - Amal Chandra Mondal
- Laboratory of Cellular and Molecular Neurobiology, School of Life Sciences, Jawaharlal Nehru University, New Delhi 110067, India.
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11
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Wang J, Sun L, Chen L, Sun J, Xie Y, Tian D, Gao L, Zhang D, Xia M, Wu T. Common and distinct roles of amygdala subregional functional connectivity in non-motor symptoms of Parkinson's disease. NPJ Parkinsons Dis 2023; 9:28. [PMID: 36806219 PMCID: PMC9938150 DOI: 10.1038/s41531-023-00469-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/02/2023] [Indexed: 02/19/2023] Open
Abstract
Neuroimaging studies suggest a pivotal role of amygdala dysfunction in non-motor symptoms (NMS) of Parkinson's disease (PD). However, the relationship between amygdala subregions (the centromedial (CMA), basolateral (BLA) and superficial amygdala (SFA)) and NMS has not been delineated. We used resting-state functional MRI to examine the PD-related alterations in functional connectivity for amygdala subregions. The left three subregions and right BLA exhibited between-group differences, and were commonly hypo-connected with the frontal, temporal, insular cortex, and putamen in PD. Each subregion displayed distinct hypoconnectivity with the limbic systems. Partial least-squares analysis revealed distinct amygdala subregional involvement in diverse NMS. Hypo-connectivity of all four subregions was associated with emotion, pain, olfaction, and cognition. Hypo-connectivity of the left SFA was associated with sleepiness. Our findings highlight the hypofunction of the amygdala subregions in PD and their preliminary associations with NMS, providing new insights into the pathogenesis of NMS.
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Affiliation(s)
- Junling Wang
- grid.24696.3f0000 0004 0369 153XCenter for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China
| | - Lianglong Sun
- grid.20513.350000 0004 1789 9964State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100091 China ,grid.20513.350000 0004 1789 9964Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, 100091 China ,grid.20513.350000 0004 1789 9964IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100091 China
| | - Lili Chen
- grid.24696.3f0000 0004 0369 153XCenter for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China
| | - Junyan Sun
- grid.24696.3f0000 0004 0369 153XCenter for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China
| | - Yapei Xie
- grid.20513.350000 0004 1789 9964State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100091 China ,grid.20513.350000 0004 1789 9964Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, 100091 China ,grid.20513.350000 0004 1789 9964IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100091 China
| | - Dezheng Tian
- grid.20513.350000 0004 1789 9964State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100091 China ,grid.20513.350000 0004 1789 9964Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, 100091 China ,grid.20513.350000 0004 1789 9964IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100091 China
| | - Linlin Gao
- grid.417031.00000 0004 1799 2675Department of General Medicine, Tianjin Union Medical Center, Tianjin, 300122 China
| | - Dongling Zhang
- grid.24696.3f0000 0004 0369 153XCenter for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China
| | - Mingrui Xia
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100091, China. .,Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, 100091, China. .,IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100091, China.
| | - Tao Wu
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
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12
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Kim R, Lee TL, Lee H, Ko DK, Jeon B, Kang N. Effects of Exercise on Depressive Symptoms in Patients With Parkinson Disease: A Meta-analysis. Neurology 2023; 100:e377-e387. [PMID: 36220597 DOI: 10.1212/wnl.0000000000201453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/08/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The purpose of this study was to provide clear evidence in support of the use of exercise to improve depressive symptoms in patients with Parkinson disease (PD) and to investigate whether this effect differs by exercise type and intensity. METHODS Three independent reviewers searched for randomized controlled trials (RCTs) that applied exercise interventions with depressive symptoms as an outcome measure for patients with PD on PubMed and Web of Science up to February 28, 2022. Random-effects meta-analyses were performed, in which standardized mean differences (SMDs) between the effects of exercise and control interventions on depressive symptoms with 95% CIs were calculated. RESULTS A total of 19 RCTs including 1,302 patients with PD were eligible for meta-analysis, and we obtained 23 comparisons from the included studies for data synthesis. Physical exercise interventions showed significant effects on the reduction in depressive symptoms in patients with PD (SMD = 0.829; 95% CI = 0.516-1.142; p < 0.001). Moderator analyses on exercise type revealed significant positive effects for combined exercise interventions (SMD = 1.111; 95% CI = 0.635-1.587; p < 0.001), whereas aerobic training alone failed to show significant effects (SMD = 0.202; 95% CI = -0.045 to 0.449; p = 0.108). Both light-to-moderate intensity exercises (SMD = 0.971; 95% CI = 0.521-1.421; p < 0.001) and moderate-to-vigorous intensity exercises (SMD = 0.779; 95% CI = 0.407-1.152; p < 0.001) significantly improved depressive symptoms with a small difference between the exercise intensities. DISCUSSION Our results suggest that physical exercise has significant antidepressant effects in patients with PD. These effects seemed to be more closely associated with exercise type than intensity. Different types of exercise interventions may result in greater benefit and require further investigation.
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Affiliation(s)
- Ryul Kim
- From the Department of Neurology (R.K.), Inha University Hospital, Inha University College of Medicine, Incheon, Korea; Department of Human Movement Science (T.L.L., H.L., D.K.K., N.K.), Incheon National University, Korea; Division of Sport Science (T.L.L., H.L., D.K.K., N.K.), Sport Science Institute & Health Promotion Center, Incheon National University, Korea; Department of Neurology (B.J.), Seoul National University Hospital, Seoul National University College of Medicine, Korea; and Neuromechanical Rehabilitation Research Laboratory (N.K.), Incheon National University, Korea
| | - Tae Lee Lee
- From the Department of Neurology (R.K.), Inha University Hospital, Inha University College of Medicine, Incheon, Korea; Department of Human Movement Science (T.L.L., H.L., D.K.K., N.K.), Incheon National University, Korea; Division of Sport Science (T.L.L., H.L., D.K.K., N.K.), Sport Science Institute & Health Promotion Center, Incheon National University, Korea; Department of Neurology (B.J.), Seoul National University Hospital, Seoul National University College of Medicine, Korea; and Neuromechanical Rehabilitation Research Laboratory (N.K.), Incheon National University, Korea
| | - Hanall Lee
- From the Department of Neurology (R.K.), Inha University Hospital, Inha University College of Medicine, Incheon, Korea; Department of Human Movement Science (T.L.L., H.L., D.K.K., N.K.), Incheon National University, Korea; Division of Sport Science (T.L.L., H.L., D.K.K., N.K.), Sport Science Institute & Health Promotion Center, Incheon National University, Korea; Department of Neurology (B.J.), Seoul National University Hospital, Seoul National University College of Medicine, Korea; and Neuromechanical Rehabilitation Research Laboratory (N.K.), Incheon National University, Korea
| | - Do Kyung Ko
- From the Department of Neurology (R.K.), Inha University Hospital, Inha University College of Medicine, Incheon, Korea; Department of Human Movement Science (T.L.L., H.L., D.K.K., N.K.), Incheon National University, Korea; Division of Sport Science (T.L.L., H.L., D.K.K., N.K.), Sport Science Institute & Health Promotion Center, Incheon National University, Korea; Department of Neurology (B.J.), Seoul National University Hospital, Seoul National University College of Medicine, Korea; and Neuromechanical Rehabilitation Research Laboratory (N.K.), Incheon National University, Korea
| | - Beomseok Jeon
- From the Department of Neurology (R.K.), Inha University Hospital, Inha University College of Medicine, Incheon, Korea; Department of Human Movement Science (T.L.L., H.L., D.K.K., N.K.), Incheon National University, Korea; Division of Sport Science (T.L.L., H.L., D.K.K., N.K.), Sport Science Institute & Health Promotion Center, Incheon National University, Korea; Department of Neurology (B.J.), Seoul National University Hospital, Seoul National University College of Medicine, Korea; and Neuromechanical Rehabilitation Research Laboratory (N.K.), Incheon National University, Korea
| | - Nyeonju Kang
- From the Department of Neurology (R.K.), Inha University Hospital, Inha University College of Medicine, Incheon, Korea; Department of Human Movement Science (T.L.L., H.L., D.K.K., N.K.), Incheon National University, Korea; Division of Sport Science (T.L.L., H.L., D.K.K., N.K.), Sport Science Institute & Health Promotion Center, Incheon National University, Korea; Department of Neurology (B.J.), Seoul National University Hospital, Seoul National University College of Medicine, Korea; and Neuromechanical Rehabilitation Research Laboratory (N.K.), Incheon National University, Korea.
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13
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Piers RJ, Farchione TJ, Wong B, Rosellini AJ, Cronin‐Golomb A. Telehealth Transdiagnostic Cognitive Behavioral Therapy for Depression in Parkinson's Disease: A Pilot Randomized Controlled Trial. Mov Disord Clin Pract 2023; 10:79-85. [PMID: 36704072 PMCID: PMC9847300 DOI: 10.1002/mdc3.13587] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 01/29/2023] Open
Abstract
Background Cognitive behavioral therapy (CBT) is an effective treatment for depression in persons with Parkinson's disease (PwPD), but there are significant barriers preventing PwPD from receiving care in person. Telehealth CBT circumvents many of these barriers. Objectives We conducted a pilot randomized controlled trial evaluating the efficacy, feasibility, and acceptability of telehealth transdiagnostic CBT intervention for depression in PwPD. Methods Twelve PwPD with Major Depressive Disorder were enrolled, half randomly assigned to the treatment-immediate condition (TI) and half to the waitlist control condition (WLC). TI and WLC participants received 12 CBT sessions and assessments before treatment, immediately after treatment, and at the 6-week follow-up. Results The intervention was efficacious for treating depression in PwPD, with secondary benefits to anxiety, apathy, learning, memory, and quality of life. Improvements were largely maintained at follow-up. The intervention was highly feasible and acceptable. Conclusions Telehealth transdiagnostic CBT was an effective intervention for PwPD with depression.
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Affiliation(s)
- Ryan J. Piers
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
| | - Todd J. Farchione
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
| | - Bonnie Wong
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
- Department of PsychiatryMassachusetts General HospitalCharlestownMassachusettsUSA
| | - Anthony J. Rosellini
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
| | - Alice Cronin‐Golomb
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
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14
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van Wamelen DJ, Rukavina K, Podlewska AM, Chaudhuri KR. Advances in the Pharmacological and Non-pharmacological Management of Non-motor Symptoms in Parkinson's Disease: An Update Since 2017. Curr Neuropharmacol 2023; 21:1786-1805. [PMID: 35293295 PMCID: PMC10514535 DOI: 10.2174/1570159x20666220315163856] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/19/2022] [Accepted: 03/10/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Non-motor symptoms (NMS) are an important and ubiquitous determinant of quality of life in Parkinson's disease (PD). However, robust evidence for their treatment is still a major unmet need. OBJECTIVE This study aimed to provide an updated review on advances in pharmacological, nonpharmacological, and exercise-based interventions for NMS in PD, covering the period since the publication of the MDS Task Force Recommendations. METHODS We performed a literature search to identify pharmacological, non-pharmacological, and exercise-based interventions for NMS in PD. As there are recent reviews on the subject, we have only included studies from the 1st of January 2017 to the 1st of December 2021 and limited our search to randomised and non-randomised (including open-label) clinical trials. RESULTS We discuss new strategies to manage NMS based on data that have become available since 2017, for instance, on the treatment of orthostatic hypotension with droxidopa, several dopaminergic treatment options for insomnia, and a range of non-pharmacological and exercise-based interventions for cognitive and neuropsychiatric symptoms, pain, and insomnia and excessive sleepiness. CONCLUSION Recent evidence suggests that targeted non-pharmacological treatments, as well as some other NMS management options, may have a significant beneficial effect on the quality of life and need to be considered in the pathways of treatment of PD.
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Affiliation(s)
- Daniel J. van Wamelen
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Katarina Rukavina
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Aleksandra M. Podlewska
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - K. Ray Chaudhuri
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
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15
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Timblin H, Rahmani E, Ryczek CA, Hill CR, Jones JD. Physical inactivity links depressive symptoms and cognitive functioning among individuals with Parkinson's disease. Neuropsychology 2022; 36:505-512. [PMID: 35737532 PMCID: PMC9620779 DOI: 10.1037/neu0000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Parkinson's disease (PD) is a neurodegenerative disorder caused by disruption of dopamine-producing cells. PD is associated with motor symptoms and nonmotor symptoms including depression and cognitive impairment. Past research suggests an association between depression and cognitive impairment in PD. Physical activity may have a therapeutic effect on both depression and cognitive impairment. The present study investigates if physical activity mediates the association between depressive symptoms and cognition in a longitudinal sample of individuals with PD. METHOD Participants include individuals newly diagnosed with PD (N = 487) enrolled in the Parkinson's Progression Marker Initiative (PPMI). Participants completed an array of neuropsychological tests over the course of 5 years, as well as questionnaires of depression and physical activity. Between-person and within-person effects of depression and cognition mediated through physical activity were analyzed using structural equation modeling. RESULTS A significant direct effect demonstrated depression was associated with worse global cognitive functioning. Furthermore, there was a significant indirect within-person effect, indicating that physical activity fully mediated the association between depression and cognition. Individuals who became more depressed over time became less physically active and subsequently experienced cognitive decline over the 5-year period. CONCLUSIONS Findings have implications for prognostic detection and/or the role of physical activity interventions to buffer effects of depression on cognitive impairment among individuals diagnosed with PD. Physical interventions may potentially be implemented among depressed persons to preserve cognitive functioning. Worsened depression early during PD may be a risk factor for inactivity and cognitive diminishment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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16
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Song S, Luo Z, Li C, Huang X, Shiroma EJ, Simonsick EM, Chen H. Depressive symptoms before and after Parkinson’s diagnosis—A longitudinal analysis. PLoS One 2022; 17:e0272315. [PMID: 35905124 PMCID: PMC9337685 DOI: 10.1371/journal.pone.0272315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background Depression is common in Parkinson’s disease (PD). It is however unclear when and how depressive symptoms develop and progress in the course of PD development. Objective To assess how depressive symptoms evolve in PD, using repeated measures. Methods In 2994 older adults, ages 70–79 years, depressive symptoms were assessed 8 times over 11 years using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). For each PD patient at each time point, we calculated the difference between CESD-10 score and its expected value estimated based on data from individuals without PD, and then realigned the time scale in reference to the year of PD diagnosis. We examined longitudinal changes in CESD-10 scores before and after PD diagnosis using a joint modeling approach to account for competing risks of non-participation and death. Results A total of 79 PD patients were identified at enrollment or during the follow-up, with repeatedly assessed depressive symptom data up to 9 years before and after PD diagnosis. We found a monotonic trend of increasing CESD-10 score in PD patients throughout the observational period (p = 0.002). The observed scores became higher than expected approximately 7 years before PD diagnosis and significantly different 1 year before PD diagnosis. Conclusions Increasing depressive symptomatology appears to precede PD diagnosis by a few years.
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Affiliation(s)
- Shengfang Song
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States of America
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States of America
| | - Chenxi Li
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States of America
| | - Xuemei Huang
- Department of Neurology, Hersey Medical Center, Pennsylvania State University, Hersey, PA, United States of America
| | - Eric J. Shiroma
- Intramural Research Program of the National Institute on Aging, Baltimore, MD, United States of America
| | - Eleanor M. Simonsick
- Intramural Research Program of the National Institute on Aging, Baltimore, MD, United States of America
| | - Honglei Chen
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States of America
- * E-mail:
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17
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Prange S, Klinger H, Laurencin C, Danaila T, Thobois S. Depression in Patients with Parkinson's Disease: Current Understanding of its Neurobiology and Implications for Treatment. Drugs Aging 2022; 39:417-439. [PMID: 35705848 PMCID: PMC9200562 DOI: 10.1007/s40266-022-00942-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 12/11/2022]
Abstract
Depression is one of the most frequent and burdensome non-motor symptoms in Parkinson’s disease (PD), across all stages. Even when its severity is mild, PD depression has a great impact on quality of life for these patients and their caregivers. Accordingly, accurate diagnosis, supported by validated scales, identification of risk factors, and recognition of motor and non-motor symptoms comorbid to depression are critical to understanding the neurobiology of depression, which in turn determines the effectiveness of dopaminergic drugs, antidepressants and non-pharmacological interventions. Recent advances using in vivo functional and structural imaging demonstrate that PD depression is underpinned by dysfunction of limbic networks and monoaminergic systems, depending on the stage of PD and its associated symptoms, including apathy, anxiety, rapid eye movement sleep behavior disorder (RBD), cognitive impairment and dementia. In particular, the evolution of serotonergic, noradrenergic, and dopaminergic dysfunction and abnormalities of limbic circuits across time, involving the anterior cingulate and orbitofrontal cortices, amygdala, thalamus and ventral striatum, help to delineate the variable expression of depression in patients with prodromal, early and advanced PD. Evidence is accumulating to support the use of dual serotonin and noradrenaline reuptake inhibitors (desipramine, nortriptyline, venlafaxine) in patients with PD and moderate to severe depression, while selective serotonin reuptake inhibitors, repetitive transcranial magnetic stimulation and cognitive behavioral therapy may also be considered. In all patients, recent findings advocate that optimization of dopamine replacement therapy and evaluation of deep brain stimulation of the subthalamic nucleus to improve motor symptoms represents an important first step, in addition to physical activity. Overall, this review indicates that increasing understanding of neurobiological changes help to implement a roadmap of tailored interventions for patients with PD and depression, depending on the stage and comorbid symptoms underlying PD subtypes and their prognosis.
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Affiliation(s)
- Stéphane Prange
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France. .,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France. .,Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Hélène Klinger
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France
| | - Chloé Laurencin
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France.,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France
| | - Teodor Danaila
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France.,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France
| | - Stéphane Thobois
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France. .,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France. .,Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Univ Lyon, Université Claude Bernard Lyon 1, Oullins, France.
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18
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Bhome R, Zarkali A, Thomas GEC, Iglesias JE, Cole JH, Weil RS. Thalamic white matter macrostructure and subnuclei volumes in Parkinson's disease depression. NPJ Parkinsons Dis 2022; 8:2. [PMID: 35013327 PMCID: PMC8748828 DOI: 10.1038/s41531-021-00270-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 12/20/2021] [Indexed: 12/04/2022] Open
Abstract
Depression is a common non-motor feature of Parkinson's disease (PD) which confers significant morbidity and is challenging to treat. The thalamus is a key component in the basal ganglia-thalamocortical network critical to the pathogenesis of PD and depression but the precise thalamic subnuclei involved in PD depression have not been identified. We performed structural and diffusion-weighted imaging (DWI) on 76 participants with PD to evaluate the relationship between PD depression and grey and white matter thalamic subnuclear changes. We used a thalamic segmentation method to divide the thalamus into its 50 constituent subnuclei (25 each hemisphere). Fixel-based analysis was used to calculate mean fibre cross-section (FC) for white matter tracts connected to each subnucleus. We assessed volume and FC at baseline and 14-20 months follow-up. A generalised linear mixed model was used to evaluate the relationship between depression, subnuclei volume and mean FC for each thalamic subnucleus. We found that depression scores in PD were associated with lower right pulvinar anterior (PuA) subnucleus volume. Antidepressant use was associated with higher right PuA volume suggesting a possible protective effect of treatment. After follow-up, depression scores were associated with reduced white matter tract macrostructure across almost all tracts connected to thalamic subnuclei. In conclusion, our work implicates the right PuA as a relevant neural structure in PD depression and future work should evaluate its potential as a therapeutic target for PD depression.
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Affiliation(s)
- R Bhome
- Dementia Research Centre, University College London, London, UK.
| | - A Zarkali
- Dementia Research Centre, University College London, London, UK
| | - G E C Thomas
- Dementia Research Centre, University College London, London, UK
| | - J E Iglesias
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Cambridge, USA
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, USA
| | - J H Cole
- Dementia Research Centre, University College London, London, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - R S Weil
- Dementia Research Centre, University College London, London, UK
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
- Movement Disorders Consortium, National Hospital for Neurology and Neurosurgery, London, UK
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19
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Chendo I, Silva C, Duarte GS, Prada L, Vian J, Quintão A, Voon V, Ferreira JJ. Frequency of Depressive Disorders in Parkinson's Disease: A Systematic Review and Meta-Analysis. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1409-1418. [PMID: 35491801 DOI: 10.3233/jpd-223207] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Depressive disorders are recognized as a common neuropsychiatric disorder of Parkinson's disease (PD). Reported frequencies vary widely among studies and depend on the diagnostic criteria, the methods of ascertainment used, and the population sampled. OBJECTIVE We aimed to evaluate the frequency of depressive disorders in PD and to investigate the relationship with PD clinical variables. METHODS A systematic review and meta-analysis of observational studies (community-based, prospective and retrospective cohort, case-control, and cross-sectional studies) reporting the frequency of depressive disorders in PD patients. RESULTS Electronic database search wielded 3,536 articles; an additional 91 were identified through citation chaining. 163 full-text articles were assessed for eligibility. Of these, 49 met the inclusion criteria for our analysis. The pooled frequency of depressive disorders was 30.7% (95% confidence interval [CI] 25.6 to 36.2; I2 = 95%; 49 studies; combined n = 10,039). The pooled frequency of major depressive disorder was 14.0% (95% CI 10.5 to 18.5; I2 = 88%; 23 studies; combined n = 5,218). Subgroup/meta-regression analyses were conducted to investigate the relationship between frequency and study inclusion criteria, methodology used for diagnosis, and study design. We found a statistically significant correlation between study design and depressive disorders frequency (ranging from 8% in the community-based study to 44% in the retrospective studies) and a statistically significant positive correlation between mean baseline PD duration and major depressive disorder frequency. CONCLUSION The current meta-analysis found a global frequency of depressive disorders of 30.7% and major depressive disorder of 14.0%. Study design influenced the frequency of depressive disorders in PD. Mean baseline PD duration and major depressive disorder frequency were positively correlated.
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Affiliation(s)
- Ines Chendo
- Psychiatry Department, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- CNS - Campus Neurológico, Torres Vedras, Portugal
| | - Carlos Silva
- Psychiatry Department, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal
| | - Gonçalo S Duarte
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal
| | - Luisa Prada
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal
| | - João Vian
- Department of Psychiatry, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana Quintão
- Department of Psychiatry, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Joaquim J Ferreira
- CNS - Campus Neurológico, Torres Vedras, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal
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20
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Handedness and depression: A meta-analysis across 87 studies. J Affect Disord 2021; 294:200-209. [PMID: 34298226 DOI: 10.1016/j.jad.2021.07.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/07/2021] [Accepted: 07/10/2021] [Indexed: 01/20/2023]
Abstract
Alterations in functional brain lateralization, often indicated by an increased prevalence of left- and/or mixed-handedness, have been demonstrated in several psychiatric and neurodevelopmental disorders like schizophrenia or autism spectrum disorder. For depression, however, this relationship is largely unclear. While a few studies found evidence that handedness and depression are associated, both the effect size and the direction of this association remain elusive. Here, we collected data from 87 studies totaling 35,501 individuals to provide a precise estimate of differences in left-, mixed- and non-right-handedness between depressed and healthy samples and computed odds ratios (ORs) between these groups. Here, an OR > 1 signifies higher rates of atypical handedness in depressed compared to healthy samples. We found no differences in left- (OR = 1.04, 95% CI = [0.95, 1.15], p = .384), mixed- (OR = 1.64, 95% CI = [0.98, 2.74], p = .060) or non-right-handedness (OR = 1.05, 95% CI = [0.96, 1.15], p = .309) between the two groups. We could thus find no link between handedness and depression on the meta-analytical level.
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21
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Longitudinal risk factors for developing depressive symptoms in Parkinson's disease. J Neurol Sci 2021; 429:117615. [PMID: 34492572 DOI: 10.1016/j.jns.2021.117615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite the established importance of identifying depression in Parkinson's disease, our understanding of the factors which place the Parkinson's disease patient at future risk of depression is limited. METHODS Our sample consisted of 874 patients from two longitudinal cohorts, PPMI and PDBP, with median follow-up durations of 7 and 3 years respectively. Risk factors for depressive symptoms at baseline were determined using logistic regression. A Cox regression model was then used to identify baseline factors that predisposed the non-depressed patient to develop depressive symptoms that were sustained for at least one year, while adjusting for antidepressant use and cognitive impairment. Common predictors between the two cohorts were identified with a random-effects meta-analysis. RESULTS We found in our analyses that the majority of baseline non-depressed patients would develop sustained depressive symptoms at least once during the course of the study. Probable REM sleep behavior disorder (pRBD), age, duration of diagnosis, impairment in daily activities, mild constipation, and antidepressant use were among the baseline risk factors for depression in either cohort. Our Cox regression model indicated that pRBD, impairment in daily activities, hyposmia, and mild constipation could serve as longitudinal predictors of sustained depressive symptoms. CONCLUSIONS We identified several potential risk factors to aid physicians in the early detection of depression in Parkinson's disease patients. Our findings also underline the importance of adjusting for multiple covariates when analyzing risk factors for depression.
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22
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Bishnoi R, Badir MC, Surya S, Youssef NA. Predicting Neuropsychiatric Symptoms of Parkinson's Disease with Measures of Striatal Dopaminergic Deficiency. Curr Alzheimer Res 2021; 18:499-504. [PMID: 34455969 DOI: 10.2174/1567205018666210827122133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/09/2021] [Accepted: 08/23/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The role of nigrostriatal dopaminergic neurons degeneration is well established in the pathophysiology of Parkinson's disease. However, it is unclear if and how the degeneration of the dopamine pathways affects the manifestation of the neuropsychiatric symptoms (NPS) of Parkinson's Disease (PD). Dopamine transporter (DAT) imaging, a technique to measure the reduction in dopamine transporters is increasingly used as a tool in the diagnosis of PD. METHODS In this study, we examine if the baseline dopamine transporter density in the striatum measured by the Striatal Binding Ratio (SBR) is associated with the longitudinal onset and/or progression of NPS in PD as measured by part 1 of Movement Disorder Society - Unified Parkinson's Disease Rating Scale, over four years. Data of patients with PD and an abnormal screening present on 123I-ioflupane single-proton emission computed tomography were obtained from Parkinson's Progression Markers Initiative (PPMI) database. Latent Growth Modeling (LGM), a statistical technique that can model the change over time while considering the variability in the rate of change at the individual level, was used to examine the progression of NPS over time. RESULTS The results indicate the SBR did not correlate with the baseline NPS but did correlate with the rate of change of NPS (p<0.001) over the next four years, even after eliminating age-related variance, which can be a significant confounding factor. CONCLUSION In conclusion, this study showed gradual worsening in NPS in patients with Parkinson's disease, which inversely correlates with the density of the dopamine transporters as measured by SBR at baseline.
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Affiliation(s)
- Ram Bishnoi
- Department of Psychiatry & Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Marina C Badir
- Department of Psychiatry & Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Sandarsh Surya
- Department of Psychiatry & Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Nagy A Youssef
- Department of Psychiatry & Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA, United States
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23
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Cheng P, Zhang J, Wu Y, Liu W, Zhu J, Chen Z, Zhang J, Guan S, Sun Y, Wang J. 5-HTTLPR polymorphism and depression risk in Parkinson's disease: an updated meta-analysis. Acta Neurol Belg 2021; 121:933-940. [PMID: 32219696 DOI: 10.1007/s13760-020-01342-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/19/2020] [Indexed: 12/13/2022]
Abstract
The relationship between the 5-hydroxytryptamine transporter gene-linked polymorphic region (5-HTTLPR) and depression in Parkinson's disease (PD) has remained controversial. Therefore, we conducted this meta-analysis to evaluate the relationship between 5-HTTLPR polymorphisms and depression in PD. Relevant online databases were searched for cross-sectional, case-control or cohort studies examining relations between 5-HTTLPR polymorphisms (S/L) and the risk of developing depression of PD using a meta-analysis. Odd ratios (ORs) of 5-HTTLPR polymorphisms (S/L allele genotype) were calculated between depression in PD and PD for each study. Five observational studies were identified. Overall ORs for 5-HTTLPR S-Allele genotype was 1.98 (95% CI 0.92-4.26) in the dominant model, 1.43 (95% CI 1.08-1.90) in the recessive model, 2.64 (95% CI 1.01-6.88) in the additive model, independently. The overall ORs of S-Allele genotype was 1.51 (95% CI 0.63-3.64) for the Caucasian subgroup, and 1.44 (95% CI 1.05-1.98) for the non-Caucasian subgroup in the recessive model. This meta-analysis indicates that the 5-HTTLPR genotype (S/S-Allele) is correlated with an increased depression risk in PD, and this highlights the needs for these people to take some effective approaches (if any) in prevention of depression of PD before its onset.
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Affiliation(s)
- Pengfei Cheng
- Department of Neurology, The First Affiliated Hospital of Jiamusi University, 348 Xuefu Street, Xiangyang District, Jiamusi, 154002, Heilongjiang Province, People's Republic of China.
| | - Junxiang Zhang
- Department of Neurology, The First Affiliated Hospital of Jiamusi University, 348 Xuefu Street, Xiangyang District, Jiamusi, 154002, Heilongjiang Province, People's Republic of China
| | - Yu Wu
- Institute of Clinical Research and Translational Medicine, Gansu Provincial Hospital, Lanzhou, People's Republic of China
| | - Wenting Liu
- Department of Neurology, The First Affiliated Hospital of Jiamusi University, 348 Xuefu Street, Xiangyang District, Jiamusi, 154002, Heilongjiang Province, People's Republic of China
| | - Jiaying Zhu
- Department of Neurology, The First Affiliated Hospital of Jiamusi University, 348 Xuefu Street, Xiangyang District, Jiamusi, 154002, Heilongjiang Province, People's Republic of China
| | - Ze Chen
- School of Basic Medicine, Jiamusi University, Jiamusi, People's Republic of China
| | - Jiarui Zhang
- School of Basic Medicine, Jiamusi University, Jiamusi, People's Republic of China
| | - Songwen Guan
- School of Basic Medicine, Jiamusi University, Jiamusi, People's Republic of China
| | - Yiming Sun
- School of Basic Medicine, Jiamusi University, Jiamusi, People's Republic of China
| | - Jingxia Wang
- School of Basic Medicine, Jiamusi University, Jiamusi, People's Republic of China
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24
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Namdev V, Haneef G, Khan AT, Basith SA, Virani A, Canenguez Benitez JS, Sejdiu A, Mathialagan K, Majumder P. Psychiatric Comorbidities Affect the Hospitalization Course of Parkinson's Disease Patients: A Cross-Sectional Inpatient Study. Cureus 2021; 13:e16255. [PMID: 34373816 PMCID: PMC8346264 DOI: 10.7759/cureus.16255] [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] [Accepted: 07/08/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives We aim to delineate the differences in demographic characteristics and hospitalization outcomes including the severity of illness, hospitalization length of stay (LOS) and cost, utilization of deep brain stimulation (DBS), and disposition in Parkinson’s disease (PD) inpatients with psychiatric comorbidities versus without psychiatric comorbidities. Methods We conducted a cross-sectional study using the Nationwide Inpatient Sample (NIS), included 56,844 PD inpatients (age ≥40 years), and subdivided them by inpatients into those without psychiatric comorbidities (N = 38,629) and with psychiatric comorbidities (N = 18,471). We compared the distributions of demographic characteristics and hospitalization outcomes (severity of illness, utilization ofDBS, and disposition) by performing Pearson’s chi-square test, and we measured the differences in continuous variables (i.e., age, LOS, and cost) by using the independent samples t-test. Results A significantly higher proportion of PD inpatients with psychiatric comorbidities were female (44.4%) and white (83%) and had a moderate loss of functioning (48.8%) compared to those without psychiatric comorbidities. PD inpatients with psychiatric comorbidities had an increased mean LOS (4.7 days vs. 3.7 days, P <0.001) but a lower mean cost ($37,445 vs. $ 41,957, P <0.001). Also, there was a significantly lower utilization of DBS in PD inpatients with psychiatric comorbidities (19.2% vs. 26.9%, P <0.001) compared to those without psychiatric comorbidities, and an adverse disposition of transfer to a skilled nursing facility/intermediate care facility (47.1% vs. 39.6%, P <0.001) compared to PD inpatients without psychiatric comorbidities. Conclusion Although PD patients with psychiatric comorbidities had a moderate loss of functioning, there was significant underutilization of DBS. Meanwhile, psychiatric comorbidities among PD patients led to increased LOS and transfer to skilled facilities.
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Affiliation(s)
- Vaishalee Namdev
- Medicine and Surgery, Mahatma Gandhi Memorial Medical College, Indore, IND
| | - Goher Haneef
- Internal Medicine, University of Health Sciences, Lahore, PAK.,Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, USA
| | - Asma T Khan
- Internal Medicine, Larkin Community Hospital, South Miami, USA
| | - Sayeda A Basith
- Psychiatry and Behavioral Sciences, Medical University of the Americas, Charlestown, KNA
| | - Anuj Virani
- Family Medicine, Windsor University School of Medicine, Cayon, KNA
| | | | - Albulena Sejdiu
- Psychiatry, Saints Cyril and Methodius Hospital, Kumanovo, MKD
| | | | - Pradipta Majumder
- Psychiatry, Drexel University College of Medicine, Philadelphia, USA.,Psychiatry, WellSpan Health, York, USA
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25
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Lopes SR, Khan S, Chand S. The Growing Role of Cognitive Behavior Therapy in the Treatment of Parkinson's Disease. J Geriatr Psychiatry Neurol 2021; 34:310-320. [PMID: 34219525 DOI: 10.1177/08919887211018274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Neuropsychiatric symptoms occur frequently in Parkinson's disease (PD) patients. Pharmacological treatment of the psychiatric symptoms has been found to be inadequate. Cognitive behavior therapy (CBT) is an evidence based form of psychotherapy that is effective in treating a number of psychiatric disorders. In this article we examine the evidence of CBT in treating common psychiatric symptoms seen in PD patients, namely depression, anxiety, insomnia and impulse control behaviors. Most of the studies adapted CBT to address PD related concerns. Caregivers were frequently part of the CBT programs. Among the studies reviewed, randomized controlled trials showed significant effects in treating depression with CBT in PD patients. Studies have also provided preliminary data for effects of CBT on anxiety, impulse-control behaviors and insomnia. There is a need for more well designed studies with sufficient power for CBT to be established as a useful non-pharmacological treatment for psychiatric symptoms in PD.
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Affiliation(s)
- Sneha R Lopes
- Department of Psychiatry and Behavioral Neuroscience, 7547Saint Louis University, St. Louis, MO, USA
| | - Sunna Khan
- Department of Psychiatry and Behavioral Neuroscience, 7547Saint Louis University, St. Louis, MO, USA
| | - Suma Chand
- Department of Psychiatry and Behavioral Neuroscience, 7547Saint Louis University, St. Louis, MO, USA
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26
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Jeong SH, Yoo HS, Chung SJ, Jung JH, Lee YH, Baik K, Sohn YH, Lee PH. Neuropsychiatric Burden Is a Predictor of Early Freezing and Motor Progression in Drug-Naïve Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 11:1947-1956. [PMID: 34151858 DOI: 10.3233/jpd-212660] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are the most common non-motor symptom in Parkinson's disease (PD). OBJECTIVE To investigate the association between the burden of NPS and motor prognosis in patients with PD. METHODS We enrolled 329 drug-naïve patients with PD, who was non-demented and followed-up≥2 years after their first visit to the clinic with baseline dopamine transporter (DAT) imaging and neuropsychiatric inventory (NPI) scores. We performed a survival analysis and a linear mixed model analysis to assess longitudinal motor outcomes according to the NPI total score. RESULTS The Kaplan-Meier analysis showed no difference in the development of levodopa-induced dyskinesia and wearing-off according to the NPI total score. However, higher burden of NPI total score was associated with earlier freezing of gait (FOG) development in the time-dependent Cox regression models after adjusting for age at symptom onset, sex, disease duration, Unified PD Rating Scale motor score, baseline Mini-Mental State Examination score, DAT activity in the posterior putamen and levodopa-equivalent daily dose (LEDD) (Hazard ratio 1.047, p = 0.002). A linear mixed model analysis revealed that patients with a higher NPI total score had a more rapid LEDD increment (NPI×time, p = 0.003). Among 52 patients with PD who eventually developed FOG during the follow-up period, there was a significant correlation between the NPI total score and time with FOG development (γ= -0.472; p = 0.001) after adjusting for confounding factors. CONCLUSION The present study demonstrated that the severity of NPS is a predictor of early freezing and motor progression in patients with PD.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Jin Ho Jung
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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27
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Dhingra A, Janjua AU, Hack L, Waserstein G, Palanci J, Hermida AP. Exploring Nonmotor Neuropsychiatric Manifestations of Parkinson Disease in a Comprehensive Care Setting. J Geriatr Psychiatry Neurol 2021; 34:181-195. [PMID: 32242493 DOI: 10.1177/0891988720915525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Parkinson disease (PD) is a debilitating neurological condition that includes both motor symptoms and nonmotor symptoms (NMS). Psychiatric complaints comprise NMS and are collectively referred to as neuropsychiatric manifestations. Common findings include atypical depressive symptoms, anxiety, psychosis, impulse control disorder, deterioration of cognition, and sleep disturbances. Quality of life (QoL) of patients suffering from NMS is greatly impacted and many times can be more debilitating than motor symptoms of PD. We expand on knowledge gained from treatment models within a comprehensive care model that incorporates multidisciplinary specialists working alongside psychiatrists to treat PD. Insight into background, clinical presentations, and treatment options for patients suffering from neuropsychiatric manifestations of PD are discussed. Identifying symptoms early can help improve QoL, provide early symptom relief, and can assist tailoring treatment plans that limit neuropsychiatric manifestations.
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Affiliation(s)
- Amitha Dhingra
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - A Umair Janjua
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Laura Hack
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Gabriella Waserstein
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Justin Palanci
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Adriana P Hermida
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
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28
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Dobkin RD, Mann SL, Weintraub D, Rodriguez KM, Miller RB, St Hill L, King A, Gara MA, Interian A. Innovating Parkinson's Care: A Randomized Controlled Trial of Telemedicine Depression Treatment. Mov Disord 2021; 36:2549-2558. [PMID: 33710659 DOI: 10.1002/mds.28548] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/29/2021] [Accepted: 02/08/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND For several decades, a myriad of factors have contributed to the inadequate diagnosis and management of depression in Parkinson's disease (PD), leaving up to 60% of significantly symptomatic patients untreated. Poor access to evidence-based neuropsychiatric care is one major barrier to achieving optimal Parkinson's outcomes. OBJECTIVE The goal of this study was to compare the efficacy of individual Parkinson's-informed, video-to-home cognitive-behavioral therapy (experimental group), to clinic-based treatment as usual (control group), for depression in PD. METHOD Ninety United States military veterans with clinical diagnoses of both depression and PD were computer-randomized (1:1) to either the experimental or control group; randomization was stratified by baseline antidepressant use and blind to all other baseline data. The acute treatment period spanned 10 weeks and was followed by a 6-month extension phase. The Hamilton Depression Rating Scale was the a priori primary outcome. Depression treatment response was defined as a score ≤2 on the Clinical Global Impression Improvement Scale. All statistical analyses were intent to treat. RESULTS Video-to-home cognitive-behavioral therapy outperformed clinic-based treatment as usual across three separate depression measures (P < 0.001). Effects were observed at the end of acute treatment and maintained through 6-month follow-up. Number needed to treat (based on treatment response classification) was 2.5 with an absolute risk reduction of 40%. CONCLUSION Video-to-home cognitive-behavioral therapy may be an effective intervention to bypass access barriers to specialized, evidence-based depression care in PD and to address the unmet neuropsychiatric treatment needs of the Parkinson's community. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Roseanne D Dobkin
- Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey, USA.,VA New Jersey Health Care System, Lyons, New Jersey, USA
| | - Sarah L Mann
- VA New Jersey Health Care System, Lyons, New Jersey, USA
| | - Daniel Weintraub
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | | | | | - Lauren St Hill
- VA New Jersey Health Care System, Lyons, New Jersey, USA
| | - Arlene King
- VA New Jersey Health Care System, Lyons, New Jersey, USA
| | - Michael A Gara
- Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
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29
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Honsey BN, Erickson LO, Wyman-Chick KA. Neuropsychological Test Performances and Depression in Early-Stage De Novo Parkinson's Disease. Arch Clin Neuropsychol 2021; 36:112-116. [PMID: 31732731 DOI: 10.1093/arclin/acz067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/01/2019] [Accepted: 10/15/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Evaluate neuropsychological test performance in depressed patients with early-stage Parkinson's disease. METHOD Data from 422 participants from the Parkinson's Progression Marker Initiative were examined. The Geriatric Depression Scale-15 was used to categorize depressed and non-depressed participants. Neuropsychological tests measured verbal learning/memory, processing speed, visuospatial ability, verbal fluency, and working memory. Demographic and clinical variables were compared using independent samples t tests and chi-square analyses.Linear regression models were fit to adjust for age, years of education, and symptom duration. RESULTS The non-depressed group (n = 280) was significantly older; t(246.08) = 2.25, p = .026 and had higher education; t(420) = 2.35, p = .019; and longer duration of PD symptoms; t(170.58) = -2.13, p = .035 than the depressed group (n = 142). The non-depressed group performed better on a working memory task than the depressed group, t(420) = 2.05, p = .041, but the results did not appear to be of clinical significance. There was no significant difference between other cognitive domains. The results were not influenced by age, education, or disease duration. CONCLUSIONS Among patients with early-stage, untreated Parkinson's disease, depression does not appear to affect neuropsychological test performance. Clinicians should demonstrate caution in over-interpreting the influence of depression on cognition in this population.
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Affiliation(s)
- Blair N Honsey
- Doctor of Psychology in Counseling Psychology, Saint Mary's University of Minnesota, 2500 Park Avenue, Minneapolis, MN 55404, USA
| | - Lauren O Erickson
- HealthPartners Institute, 3311 Old Shakopee Road E, Minneapolis, MN 55425, USA
| | - Kathryn A Wyman-Chick
- HealthPartners Institute, 3311 Old Shakopee Road E, Minneapolis, MN 55425, USA.,Neurology/Neuropsychology, HealthPartners Neuroscience Center, 295 Phalen Blvd Mail Stop 41203C, Saint Paul, MN 55130
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30
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Jurcau A, Nunkoo VS. Clinical Markers May Identify Patients at Risk for Early Parkinson's Disease Dementia: A Prospective Study. Am J Alzheimers Dis Other Demen 2021; 36:15333175211021369. [PMID: 34075800 PMCID: PMC10624063 DOI: 10.1177/15333175211021369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The study aims at identifying features predictive of early onset of dementia in Parkinson's disease (PD). METHODS 103 non-demented PD patients were evaluated on various scales at baseline and 89 patients at 3-year follow-up. RESULTS By the end of the study 43.8% of patients developed dementia. The development of dementia was linked to the baseline Mini Mental State Examination score (Pearson coefficient r = .404, p = 0.013), the presence of autonomic dysfunctions (r = -.621, p < 0.001) and insomnia (r = -.526, p = 0.001). A binary logistic regression analysis showed that the development of dementia was correlated strongly with the presence of autonomic dysfunctions (95% CI 2.60 to 52.83, p < 0.001), and insomnia (95% CI 0.60 to 0.95, p = 0.017). CONCLUSION Patients with signs of autonomic dysfunction and insomnia are at higher risk for developing dementia and deserve closer monitoring of cognitive symptoms.
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Affiliation(s)
- Anamaria Jurcau
- Neurology ward, Clinical Municipal Hospital “dr. G Curteanu” Oradea, Oradea, Romania
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Vharoon Sharma Nunkoo
- Neurology ward, Clinical Municipal Hospital “dr. G Curteanu” Oradea, Oradea, Romania
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Kumar S, Avasthi A, Modi M, Grover S. Psychiatric morbidity in patients with idiopathic Parkinson's disease: A cross-sectional study. Ind Psychiatry J 2021; 30:165-174. [PMID: 34483543 PMCID: PMC8395540 DOI: 10.4103/ipj.ipj_8_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/28/2021] [Accepted: 05/08/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence of psychiatric comorbidities in patients with idiopathic Parkinson's disease (IPD). METHODOLOGY Two hundred and thirty-nine patients with IPD were evaluated on Mini-International Neuropsychiatric Interview PLUS (MINI-PLUS). In addition, patients found to have depression as per the MINI-PLUS were evaluated on Beck Depression Inventory. RESULTS One hundred and thirty-five (56.5%) patients had a current psychiatric diagnosis and 59.8% had a lifetime psychiatric diagnosis. As per MINI-PLUS, about two-fifth (39.7%) of patients had suicidality. In 18.8% of patients, suicidality was present in the absence of axis-I psychiatric diagnosis. Among the various psychiatric disorders, the most common disorders included depressive disorders (current: 17.5%; lifetime: 23.8%), anxiety disorders (current: 17.5%; lifetime: 17.5%), and psychotic disorders (current: 11.3%; lifetime: 11.7%). CONCLUSIONS More than half of the patients with Parkinson's disease have psychiatric disorders. High prevalence of psychiatric morbidity calls for close liaison between the neurologist and the psychiatric disorders.
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Affiliation(s)
- Santhosh Kumar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Modi
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Mao J, Huang X, Yu J, Chen L, Huang Y, Tang B, Guo J. Association Between REM Sleep Behavior Disorder and Cognitive Dysfunctions in Parkinson's Disease: A Systematic Review and Meta-Analysis of Observational Studies. Front Neurol 2020; 11:577874. [PMID: 33240202 PMCID: PMC7677514 DOI: 10.3389/fneur.2020.577874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/30/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Rapid eye movement sleep behavior disorder (RBD) is thought to be a prodromal symptom of Parkinson's disease (PD). RBD is also thought to be involved in cognitive decline and dementia in PD. In PD, although the relationship between RBD and cognitive dysfunctions was confirmed by considerable studies, whether RBD was associated with distinct types of cognitive defects is worth of study. Objectives: This systematic review summarizes the evidence relating to cognitive dysfunction in PD patients with RBD (PD-RBD) and those without and explores their specificity to cognitive domains. Methods: A meta-analysis using a random-effects model was performed for 16 different cognitive domains, including global cognitive function, memory (long-term verbal recall, long-term verbal recognition, long-term visual recall, short-term spatial recall, and short-term verbal recall), executive function (general, fluid reasoning, generativity, shifting, inhibition, and updating), language, processing speed/complex attention/working memory, visuospatial/constructional ability, and psychomotor ability. The cognitive difference between the groups of patients was measured as a standardized mean difference (SMD, Cohen's d). PD-RBD patients were classified into Confirmed-RBD (definite diagnosis with polysomnography, PSG) and Probable-RBD (without PSG re-confirmation). In some domains, RBD patients could not be analyzed separately due to the exiguity of primary studies; this analysis refers to such RBD patients as "Mixed-RBD." Results: Thirty-nine studies with 6,695 PD subjects were finally included. Confirmed-RBD patients showed worse performance than those without in global cognitive function, long-term verbal recall, long-term verbal recognition, generativity, inhibition, shifting, language, and visuospatial/constructional ability; Probable-RBD, in global cognitive function and shifting; and Mixed-RBD, in long-term visual recall, short-term spatial recall, general executive function, and processing speed/complex attention/working memory. Conclusion: This meta-analysis strongly suggests a relationship between RBD, Confirmed-RBD in particular, and cognitive dysfunctions in PD patients. Early and routine screening by sensitive and targeted cognitive tasks is necessary for all PD-RBD patients because it may offer the therapeutic time window before they evolve to irreversible dementia.
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Affiliation(s)
- Jingrong Mao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiurong Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jiaming Yu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Lang Chen
- Center for Inflammation and Epigenetics, Houston Methodist Research Institute, Houston, TX, United States
| | - Yuqian Huang
- Center for Inflammation and Epigenetics, Houston Methodist Research Institute, Houston, TX, United States
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jifeng Guo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Park JH, Lee SH, Kim Y, Park SW, Byeon GH, Jang JW. Depressive symptoms are associated with worse cognitive prognosis in patients with newly diagnosed idiopathic Parkinson disease. Psychogeriatrics 2020; 20:880-890. [PMID: 32840032 DOI: 10.1111/psyg.12601] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/17/2020] [Accepted: 07/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although depression is very common in patients with Parkinson disease (PD), only a few studies have investigated the longitudinal effects of initial depression on cognitive decline in these patients. The purpose of this study was to investigate the effect of depression on cognitive functions in patients with PD. METHODS We used data from the Parkinson Progression Markers Initiative (PPMI) to investigate the relationship between depression and PD. Depressive symptoms were measured in patients with PD based on the Geriatric Depression Scale (GDS) or Neuropsychiatric Inventory-Questionnaire (NPI-Q) scores obtained at baseline. We evaluated cognitive decline as whether a patient with PD progressed to PD with mild cognitive impairment (MCI) during a 4-year follow-up period. Multivariate Cox regression analysis was done to know whether depression can predict the conversion to MCI. In addition, a voxel-based morphometric analysis using volumetric brain magnetic resonance imaging was used to compare structural changes related to future cognitive decline as well as to reveal longitudinal effect of baseline depression on cortical atrophy. RESULTS Data from 263 patients with cognitively normal de novo PD who were available for longitudinal cognitive testing were analysed. The multivariate Cox regression analysis revealed that the depressive symptoms were independent risk factors for conversion to MCI in patients with de novo PD after adjusting for covariates (hazards ratio (95% CI)) of depression defined by the GDS (1.753 (1.084-2.835)) and the NPI (1.815 (1.083-3.042)) scores, respectively. The significant structural changes in PD with MCI as well as longitudinal effect of baseline depression on subsequent cortical atrophy were found in multiple areas on the voxel-based morphometric analysis (P < 0.001, family-wise error rate corrected). CONCLUSIONS Our study indicates that the presence of depressive symptoms in patients with early PD is associated with a higher risk of progression to MCI and early depression may reflect subsequent cortical atrophy.
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Affiliation(s)
- Jeong Hoon Park
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, South Korea
| | - Seung Hwan Lee
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, South Korea
| | - Yeshin Kim
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, South Korea
| | - Sang-Won Park
- Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Gi Hwan Byeon
- Department of Psychiatry, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, South Korea
| | - Jae-Won Jang
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, South Korea
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Guo T, Guan X, Zhou C, Gao T, Wu J, Song Z, Xuan M, Gu Q, Huang P, Pu J, Zhang B, Cui F, Xia S, Xu X, Zhang M. Clinically relevant connectivity features define three subtypes of Parkinson's disease patients. Hum Brain Mapp 2020; 41:4077-4092. [PMID: 32588952 PMCID: PMC7469787 DOI: 10.1002/hbm.25110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/23/2020] [Accepted: 06/14/2020] [Indexed: 12/23/2022] Open
Abstract
Parkinson's disease (PD) is characterized by complex clinical symptoms, including classic motor and nonmotor disturbances. Patients with PD vary in clinical manifestations and prognosis, which point to the existence of subtypes. This study aimed to find the fiber connectivity correlations with several crucial clinical symptoms and identify PD subtypes using unsupervised clustering analysis. One hundred and thirty-four PD patients and 77 normal controls were enrolled. Canonical correlation analysis (CCA) was performed to define the clinically relevant connectivity features, which were then used in the hierarchical clustering analysis to identify the distinct subtypes of PD patients. Multimodal neuroimaging analyses were further used to explore the neurophysiological basis of these subtypes. The methodology was validated in an independent data set. CCA revealed two significant clinically relevant patterns (motor-related pattern and depression-related pattern; r = .94, p < .001 and r = .926, p = .001, respectively) among PD patients, and hierarchical clustering analysis identified three neurophysiological subtypes ("mild" subtype, "severe depression-dominant" subtype and "severe motor-dominant" subtype). Multimodal neuroimaging analyses suggested that the patients in the "severe depression-dominant" subtype exhibited widespread disruptions both in function and structure, while the other two subtypes exhibited relatively mild abnormalities in brain function. In the independent validation, three similar subtypes were identified. In conclusion, we revealed heterogeneous subtypes of PD patients according to their distinct clinically relevant connectivity features. Importantly, depression symptoms have a considerable impact on brain damage in patients with PD.
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Affiliation(s)
- Tao Guo
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojun Guan
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cheng Zhou
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ting Gao
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingjing Wu
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhe Song
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Min Xuan
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Quanquan Gu
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiali Pu
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Baorong Zhang
- Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Feng Cui
- Department of Radiology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Shunren Xia
- Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China
| | - Xiaojun Xu
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Why does depression worsen progression and treatment response in the most frequent neurological disorders? Implications for clinical practice. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2018.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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36
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Alcántara Montero A, Sánchez Carnerero C. ¿Por qué la depresión empeora el curso y la respuesta al tratamiento en los trastornos neurológicos más frecuentes? Implicaciones en la práctica clínica. Neurologia 2020; 35:338-340. [DOI: 10.1016/j.nrl.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/11/2018] [Indexed: 12/21/2022] Open
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Conroy SK, Brownlowe KB, McAllister TW. Depression Comorbid With Stroke, Traumatic Brain Injury, Parkinson's Disease, and Multiple Sclerosis: Diagnosis and Treatment. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2020; 18:150-161. [PMID: 33162852 DOI: 10.1176/appi.focus.20200004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Depression is common among patients with neurologic disorders, and it has long been considered more difficult to treat than depression in the general population. In this review, the authors consider challenges in the diagnosis and treatment of depression among patients with stroke, traumatic brain injury, Parkinson's disease, and multiple sclerosis. For each disorder, the authors discuss the epidemiology and time course of depression as well as review the physiologic and psychological etiologies of depression. In addition, for each disorder, they review screening tools and diagnostic considerations, including differential diagnosis; discuss etiological factors, both neurobiological and psychological; and assess evidence for various depression treatments, including pharmacologic, psychosocial, and neuromodulatory therapies. The evidence suggests that depression is common among patients with neurologic disorders and that it is crucial for general psychiatrists to provide treatment for this population.
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Affiliation(s)
- Susan K Conroy
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Conroy, McAllister); Department of Psychiatry, Wexner Medical Center, Ohio State University, Columbus (Brownlowe)
| | - Katherine B Brownlowe
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Conroy, McAllister); Department of Psychiatry, Wexner Medical Center, Ohio State University, Columbus (Brownlowe)
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Conroy, McAllister); Department of Psychiatry, Wexner Medical Center, Ohio State University, Columbus (Brownlowe)
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38
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Dobkin RD, Mann SL, Gara MA, Interian A, Rodriguez KM, Menza M. Telephone-based cognitive behavioral therapy for depression in Parkinson disease: A randomized controlled trial. Neurology 2020; 94:e1764-e1773. [PMID: 32238507 PMCID: PMC7282876 DOI: 10.1212/wnl.0000000000009292] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/18/2019] [Indexed: 01/23/2023] Open
Abstract
Objective To determine whether, for patients with depression and Parkinson disease (PD), telephone-based cognitive-behavioral treatment (T-CBT) alleviates depressive symptoms significantly more than treatment as usual (TAU), we conducted a randomized controlled trial to evaluate the efficacy of a 10-session T-CBT intervention for depression in PD, compared to TAU. Methods Seventy-two people with PD (PWP) were randomized to T-CBT + TAU or TAU only. T-CBT tailored to PWPs’ unique needs was provided weekly for 3 months, then monthly during 6-month follow-up. CBT targeted negative thoughts (e.g., “I have no control”; “I am helpless”) and behaviors (e.g., social withdrawal, excessive worry). It also trained care partners to help PWP practice healthy habits. Blind raters assessed outcomes at baseline, midtreatment, treatment end, and 1 and 6 months post-treatment. Analyses were intent to treat. Results T-CBT outperformed TAU on all depression, anxiety, and quality of life measures. The primary outcome (Hamilton Depression Rating Scale score) improved significantly in T-CBT compared to TAU by treatment end. Mean improvement from baseline was 6.53 points for T-CBT and −0.27 points for TAU (p < 0.0001); gains persisted over 6-month follow-up (p < 0.0001). Improvements were moderated by a reduction in negative thoughts in the T-CBT group only, reflecting treatment target engagement. Conclusions T-CBT may be an effective depression intervention that addresses a significant unmet PD treatment need and bypasses access barriers to multidisciplinary, evidence-based care. Clinicaltrials.gov identifier NCT02505737. Classification of evidence This study provides Class I evidence that for patients with depression and PD, T-CBT significantly alleviated depressive symptoms compared to usual care.
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Affiliation(s)
- Roseanne D Dobkin
- From the Departments of Psychiatry (R.D.D., M.A.G., K.M.R., M.M.) and Neurology (M.M.), Rutgers-Robert Wood Johnson Medical School, Piscataway; and VA New Jersey Health Care System (R.D.D., S.L.M., A.I.), Lyons.
| | - Sarah L Mann
- From the Departments of Psychiatry (R.D.D., M.A.G., K.M.R., M.M.) and Neurology (M.M.), Rutgers-Robert Wood Johnson Medical School, Piscataway; and VA New Jersey Health Care System (R.D.D., S.L.M., A.I.), Lyons
| | - Michael A Gara
- From the Departments of Psychiatry (R.D.D., M.A.G., K.M.R., M.M.) and Neurology (M.M.), Rutgers-Robert Wood Johnson Medical School, Piscataway; and VA New Jersey Health Care System (R.D.D., S.L.M., A.I.), Lyons
| | - Alejandro Interian
- From the Departments of Psychiatry (R.D.D., M.A.G., K.M.R., M.M.) and Neurology (M.M.), Rutgers-Robert Wood Johnson Medical School, Piscataway; and VA New Jersey Health Care System (R.D.D., S.L.M., A.I.), Lyons
| | - Kailyn M Rodriguez
- From the Departments of Psychiatry (R.D.D., M.A.G., K.M.R., M.M.) and Neurology (M.M.), Rutgers-Robert Wood Johnson Medical School, Piscataway; and VA New Jersey Health Care System (R.D.D., S.L.M., A.I.), Lyons
| | - Matthew Menza
- From the Departments of Psychiatry (R.D.D., M.A.G., K.M.R., M.M.) and Neurology (M.M.), Rutgers-Robert Wood Johnson Medical School, Piscataway; and VA New Jersey Health Care System (R.D.D., S.L.M., A.I.), Lyons
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Tsiouris KM, Konitsiotis S, Koutsouris DD, Fotiadis DI. Prognostic factors of Rapid symptoms progression in patients with newly diagnosed parkinson's disease. Artif Intell Med 2020; 103:101807. [PMID: 32143804 DOI: 10.1016/j.artmed.2020.101807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
Tracking symptoms progression in the early stages of Parkinson's disease (PD) is a laborious endeavor as the disease can be expressed with vastly different phenotypes, forcing clinicians to follow a multi-parametric approach in patient evaluation, looking for not only motor symptomatology but also non-motor complications, including cognitive decline, sleep problems and mood disturbances. Being neurodegenerative in nature, PD is expected to inflict a continuous degradation in patients' condition over time. The rate of symptoms progression, however, is found to be even more chaotic than the vastly different phenotypes that can be expressed in the initial stages of PD. In this work, an analysis of baseline PD characteristics is performed using machine learning techniques, to identify prognostic factors for early rapid progression of PD symptoms. Using open data from the Parkinson's Progression Markers Initiative (PPMI) study, an extensive set of baseline patient evaluation outcomes is examined to isolate determinants of rapid progression within the first two and four years of PD. The rate of symptoms progression is estimated by tracking the change of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) total score over the corresponding follow-up period. Patients are ranked according to their progression rates and those who expressed the highest rates of MDS-UPDRS total score increase per year of follow-up period are assigned into the rapid progression class, using 5- and 10-quantiles partition. Classification performance against the rapid progression class was evaluated in a per quantile partition analysis scheme and in quantile-independent approach, respectively. The results shown a more accurate patient discrimination with quantile partitioning, however, a much more compact subset of baseline factors is extracted in the latter, making a more suitable for actual interventions in practice. Classification accuracy improved in all cases when using the longer 4-year follow-up period to estimate PD progression, suggesting that a prolonged patient evaluation can provide better outcomes in identifying rapid progression phenotype. Non-motor symptoms are found to be the main determinants of rapid symptoms progression in both follow-up periods, with autonomic dysfunction, mood impairment, anxiety, REM sleep behavior disorders, cognitive decline and memory impairment being alarming signs at baseline evaluation, along with rigidity symptoms, certain laboratory blood test results and genetic mutations.
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Affiliation(s)
- Kostas M Tsiouris
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, GR15773, Athens, Greece; Unit of Medical Technology and Intelligent Information Systems, Dept. of Material Science and Engineering, University of Ioannina, GR45110, Ioannina, Greece
| | - Spiros Konitsiotis
- Dept. of Neurology, Medical School, University of Ioannina, GR45110, Ioannina, Greece
| | - Dimitrios D Koutsouris
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, GR15773, Athens, Greece
| | - Dimitrios I Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Dept. of Material Science and Engineering, University of Ioannina, GR45110, Ioannina, Greece; Dept. of Biomedical Research, Institute of Molecular Biology and Biotechnology, FORTH, GR45110, Ioannina, Greece.
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Shen W. A tangled web: The reciprocal relationship between depression and educational outcomes in China. SOCIAL SCIENCE RESEARCH 2020; 85:102353. [PMID: 31789192 PMCID: PMC6901113 DOI: 10.1016/j.ssresearch.2019.102353] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 05/05/2023]
Abstract
Research on depression and education usually focuses on a unidirectional relationship. This paper proposes a reciprocal relationship, simultaneously estimating the effects of depression on education and of education on depression. China, which has the world's largest education system, is used as a case study. This paper applies structural equation modeling to three datasets: the China Family Panel Studies, the China Education Panel Survey, and the Gansu Survey of Children and Families. Analyses reveal a reciprocal and negative relationship between depression and educational outcomes. Specifically, early depression reduces later educational achievement, and higher educational achievement also lowers the level of subsequent depression by resulting in less peers' unfriendliness, less pressure from parents' expectations, and less teachers' criticism. More time spent on studies is not associated with higher educational achievement but significantly increases the level of depression. Children from lower SES families bear more pressure and spend more time on studies, which does not correspond to higher educational achievement but rather to higher levels of depression. In the long term, prior depression lowers educational attainment and, after controlling for prior depression, lower educational attainment is also associated with higher levels of subsequent depression. This paper shows that the lower achievers, not the high achievers, bear the major psychological burden of the education system's quest to produce high achievement. This situation reinforces these students' educational disadvantage.
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Affiliation(s)
- Wensong Shen
- Department of Sociology, University of Pennsylvania, 3718 Locust Walk, McNeil Building, Ste. 353, Philadelphia, PA, 19104, USA.
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41
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Roheger M, Kalbe E, Liepelt-Scarfone I. Progression of Cognitive Decline in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2019; 8:183-193. [PMID: 29914040 PMCID: PMC6004891 DOI: 10.3233/jpd-181306] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: Cognitive dysfunction is one of the most prevalent non-motor symptoms in Parkinson’s disease (PD), often experienced as more debilitating for patients and caregivers than motor problems. Therefore, a deeper understanding of the course of cognitive decline and the identification of valid progression markers for Parkinson’s disease dementia (PDD) is essential. Objective: This systematic review summarizes the current state of knowledge on cognitive decline over time by reporting effect sizes of cognitive changes in neuropsychological tests. METHODS: 1368 studies were identified by a PubMed database search and 25 studies by additionally scanning previous literature. After screening all records, including 69 full-text article reviews, 12 longitudinal studies on the progression of cognitive decline in PD met our criteria (e.g., sample size ≥50 patients). Results: Only a few studies monitored cognitive decline over a longer period (>4 years). Most studies focused on the evaluation of change in global cognitive state by use of the Mini-Mental State Examination, whereas the use of neuropsychological tests was highly heterogenic among studies. Only one study evaluated patients’ cognitive performance in all specified domains (executive function, attention & working memory, memory, language, and visual-spatial function) allowing for diagnosis of cognitive impairment according to consensus guidelines. Medium to strong effect sizes could only be observed in studies with follow-up intervals of four years or longer. Conclusions: The results emphasize the need for the assessment of larger PD cohorts over longer periods of follow-up with a comprehensive neuropsychological battery.
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Affiliation(s)
- Mandy Roheger
- Medical Psychology I Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Köln, Germany
| | - Elke Kalbe
- Medical Psychology I Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Köln, Germany
| | - Inga Liepelt-Scarfone
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany.,Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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Weintraub D, Mamikonyan E. The Neuropsychiatry of Parkinson Disease: A Perfect Storm. Am J Geriatr Psychiatry 2019; 27:998-1018. [PMID: 31006550 PMCID: PMC7015280 DOI: 10.1016/j.jagp.2019.03.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 12/16/2022]
Abstract
Affective disorders, cognitive decline, and psychosis have long been recognized as common in Parkinson disease (PD), and other psychiatric disorders include impulse control disorders, anxiety symptoms, disorders of sleep and wakefulness, and apathy. Psychiatric aspects of PD are associated with numerous adverse outcomes, yet in spite of this and their frequent occurrence, there is incomplete understanding of epidemiology, presentation, risk factors, neural substrate, and management strategies. Psychiatric features are typically multimorbid, and there is great intra- and interindividual variability in presentation. The hallmark neuropathophysiological changes that occur in PD, plus the association between exposure to dopaminergic medications and certain psychiatric disorders, suggest a neurobiological basis for many psychiatric symptoms, although psychological factors are involved as well. There is evidence that psychiatric disorders in PD are still under-recognized and undertreated and although psychotropic medication use is common, controlled studies demonstrating efficacy and tolerability are largely lacking. Future research on neuropsychiatric complications in PD should be oriented toward determining modifiable correlates or risk factors and establishing efficacious and well-tolerated treatment strategies.
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Affiliation(s)
- Daniel Weintraub
- Perelman School of Medicine (DW, EM), University of Pennsylvania, Philadelphia; Parkinson's Disease Research, Education and Clinical Center (PADRECC) (DW), Philadelphia Veterans Affairs Medical Center, Philadelphia.
| | - Eugenia Mamikonyan
- Perelman School of Medicine (DW, EM), University of Pennsylvania, Philadelphia
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Galts CP, Bettio LE, Jewett DC, Yang CC, Brocardo PS, Rodrigues ALS, Thacker JS, Gil-Mohapel J. Depression in neurodegenerative diseases: Common mechanisms and current treatment options. Neurosci Biobehav Rev 2019; 102:56-84. [DOI: 10.1016/j.neubiorev.2019.04.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/22/2019] [Accepted: 04/02/2019] [Indexed: 12/19/2022]
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Laurencin C, Thobois S. Malattia di Parkinson e depressione. Neurologia 2019. [DOI: 10.1016/s1634-7072(19)42021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lopez FV, Eglit GML, Schiehser DM, Pirogovsky-Turk E, Litvan I, Lessig S, Filoteo JV. Factor Analysis of the Apathy Scale in Parkinson's Disease. Mov Disord Clin Pract 2019; 6:379-386. [PMID: 31286007 DOI: 10.1002/mdc3.12767] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/07/2019] [Accepted: 03/26/2019] [Indexed: 12/29/2022] Open
Abstract
Background The Apathy Scale (AS), a popular measure of apathy in Parkinson's disease (PD), has been somewhat limited for failing to characterize dimensions of apathy, such as those involving cognitive, behavioral, and emotional apathy symptoms. This study sought to determine whether factors consistent with these apathy dimensions in PD could be identified on the AS, examine the associations between these factors and disease-related characteristics, and compare PD patients and healthy control (HCs) on identified factors. Methods Confirmatory (CFA) and exploratory factor analysis (EFA) were conducted on AS scores of 157 nondemented PD patients to identify AS factors. These factors were then correlated with important disease-related characteristics, and PD and HC participants were compared across these factors. Results Previously proposed AS models failed to achieve an adequate fit in CFA. A subsequent EFA revealed two factors on the AS reflecting joint cognitive-behavioral aspects of apathy (Motivation-Interest-Energy) and emotional apathy symptoms (Indifference). Both factors were associated with anxiety, depression, health-related quality of life, and independent activities of daily living, with Indifference associated more with the latter. In addition, only the Indifference factor was associated with cognitive functioning. PD patients reported higher levels of symptoms than HCs on both factors, with the group difference slightly larger on the Motivation-Interest-Energy factor. Conclusion The AS can be decomposed into two factors reflecting Motivation-Interest-Energy and Indifference symptoms. These factors are differentially associated with clinical variables, including cognition and independent activities of daily living, indicating the importance of evaluating apathy from a multidimensional perspective.
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Affiliation(s)
- Francesca V Lopez
- Veterans Administration San Diego Healthcare System San Diego California USA
| | - Graham M L Eglit
- Department of Psychiatry University of California San Diego La Jolla California USA.,Sam and Rose Stein Institute for Research on Aging University of California San Diego La Jolla California USA
| | - Dawn M Schiehser
- Veterans Administration San Diego Healthcare System San Diego California USA.,Department of Psychiatry University of California San Diego La Jolla California USA
| | - Eva Pirogovsky-Turk
- Department of Psychiatry University of California San Diego La Jolla California USA
| | - Irene Litvan
- Department of Neurosciences University of California San Diego La Jolla California USA
| | - Stephanie Lessig
- Veterans Administration San Diego Healthcare System San Diego California USA.,Department of Neurosciences University of California San Diego La Jolla California USA
| | - J Vincent Filoteo
- Veterans Administration San Diego Healthcare System San Diego California USA.,Department of Psychiatry University of California San Diego La Jolla California USA.,Department of Neurosciences University of California San Diego La Jolla California USA
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Selvaraj S, Piramanayagam S. Impact of gene mutation in the development of Parkinson's disease. Genes Dis 2019; 6:120-128. [PMID: 31193965 PMCID: PMC6545447 DOI: 10.1016/j.gendis.2019.01.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 01/31/2019] [Indexed: 01/09/2023] Open
Abstract
Parkinson's disease (PD) is the second most common age related neurodegenerative disorder worldwide and presents as a progressive movement disorder. Globally seven million to 10 million people have Parkinson's disease. Parkinsonism is typically sporadic in nature. Loss of dopaminergic neurons from substantia nigra pars compacta (SNpc) and the neuronal intracellular Lewy body inclusions are the major cause of PD. Gene mutation and protein aggregation play a pivotal role in the degeneration of dopamine neurons. But the actual cause of dopamine degeneration remains unknown. However, several rare familial forms of PD are associated with genetic loci, and the recognition of causal mutations has provided insight into the disease process. Yet, the molecular pathways and gene transformation that trigger neuronal susceptibility are inadequately comprehended. The discovery of a mutation in new genes has provided a basis for much of the ongoing molecular work in the PD field and testing of targeted therapeutics. Single gene mutation in a dominantly or recessively inherited gene results a great impact in the development of Parkinson's disease. In this review, we summarize the molecular genetics of PD.
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Affiliation(s)
- Suganya Selvaraj
- Computational Biology Lab, Department of Bioinformatics, Bharathiar University, Coimbatore, 641046, India
| | - Shanmughavel Piramanayagam
- Professor, Computational Biology Lab, Department of Bioinformatics, Bharathiar University, Coimbatore, 641046, India
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Achey RL, Yamamoto E, Sexton D, Hammer C, Lee BS, Butler RS, Thompson NR, Nagel SJ, Machado AG, Lobel DA. Prediction of depression and anxiety via patient-assessed tremor severity, not physician-reported motor symptom severity, in patients with Parkinson’s disease or essential tremor who have undergone deep brain stimulation. J Neurosurg 2018; 129:1562-1571. [DOI: 10.3171/2017.8.jns1733] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 08/28/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEDeep brain stimulation (DBS) is an effective therapy for movement disorders such as idiopathic Parkinson’s disease (PD) and essential tremor (ET). However, some patients who demonstrate benefit on objective motor function tests do not experience postoperative improvement in depression or anxiety, 2 important components of quality of life (QOL). Thus, to examine other possible explanations for the lack of a post-DBS correlation between improved objective motor function and decreased depression or anxiety, the authors investigated whether patient perceptions of motor symptom severity might contribute to disease-associated depression and anxiety.METHODSThe authors performed a retrospective chart review of PD and ET patients who had undergone DBS at the Cleveland Clinic in the period from 2009 to 2013. Patient demographics, diagnosis (PD, ET), motor symptom severity, and QOL measures (Primary Care Evaluation of Mental Disorders 9-item Patient Health Questionnaire [PHQ-9] for depression, Generalized Anxiety Disorder 7-item Scale [GAD-7], and patient-assessed tremor scores) were collected at 4 time points: preoperatively, postoperatively, 1-year follow-up, and 2-year follow-up. Multivariable prediction models with solutions for fixed effects were constructed to assess the correlation of predictor variables with PHQ-9 and GAD-7 scores. Predictor variables included age, sex, visit time, diagnosis (PD vs ET), patient-assessed tremor, physician-reported tremor, Unified Parkinson’s Disease Rating Scale part III (UPDRS-III) score, and patient-assessed tremor over time.RESULTSSeventy PD patients and 17 ET patients were included in this analysis. Mean postoperative and 1-year follow-up UPDRS-III and physician-reported tremor scores were significantly decreased compared with preoperative scores (p < 0.0001). Two-year follow-up physician-reported tremor was also significantly decreased from preoperative scores (p < 0.0001). Only a diagnosis of PD (p = 0.0047) and the patient-assessed tremor rating (p < 0.0001) were significantly predictive of depression. A greater time since surgery, in general, significantly decreased anxiety scores (p < 0.0001) except when a worsening of patient-assessed tremor was reported over the same time period (p < 0.0013).CONCLUSIONSPatient-assessed tremor severity alone was predictive of depression in PD and ET following DBS. This finding suggests that a patient’s perception of illness plays a greater role in depression than objective physical disability regardless of the time since surgical intervention. In addition, while anxiety may be attenuated by DBS, patient-assessed return of tremor over time can increase anxiety, highlighting the importance of long-term follow-up for behavioral health features in chronic neurological disorders. Together, these data suggest that the patient experience of motor symptoms plays a role in depression and anxiety—a finding that warrants consideration when evaluating, treating, and following movement disorder patients who are candidates for DBS.
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Affiliation(s)
- Rebecca L. Achey
- 1Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
| | - Erin Yamamoto
- 1Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
| | - Daniel Sexton
- 1Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
| | - Christine Hammer
- 2Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Bryan S. Lee
- 3Department of Neurosurgery, Neurological Institute
| | | | | | - Sean J. Nagel
- 5Center for Neurological Restoration, Department of Neurosurgery, Neurological Institute
| | - Andre G. Machado
- 5Center for Neurological Restoration, Department of Neurosurgery, Neurological Institute
- 6Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio; and
| | - Darlene A. Lobel
- 5Center for Neurological Restoration, Department of Neurosurgery, Neurological Institute
- 6Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio; and
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Crowley EK, Nolan YM, Sullivan AM. Exercise as a therapeutic intervention for motor and non-motor symptoms in Parkinson's disease: Evidence from rodent models. Prog Neurobiol 2018; 172:2-22. [PMID: 30481560 DOI: 10.1016/j.pneurobio.2018.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 10/25/2018] [Accepted: 11/23/2018] [Indexed: 12/11/2022]
Abstract
Parkinson's disease (PD) is characterised by degeneration of dopaminergic neurons of the nigrostriatal pathway, which leads to the cardinal motor symptoms of the disease - tremor, rigidity and postural instability. A number of non-motor symptoms are also associated with PD, including cognitive impairment, mood disturbances and dysfunction of gastrointestinal and autonomic systems. Current therapies provide symptomatic relief but do not halt the disease process, so there is an urgent need for preventative strategies. Lifestyle interventions such as aerobic exercise have shown potential to lower the risk of developing PD and to alleviate both motor and non-motor symptoms. However, there is a lack of large-scale randomised clinical trials that have employed exercise in PD patients. This review will focus on the evidence from studies on rodent models of PD, for employing exercise as an intervention for both motor and non-motor symptoms.
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Affiliation(s)
- E K Crowley
- Department of Anatomy and Neuroscience, University College Cork, Ireland
| | - Y M Nolan
- Department of Anatomy and Neuroscience, University College Cork, Ireland; APC Microbiome Institute, University College Cork, Ireland
| | - A M Sullivan
- Department of Anatomy and Neuroscience, University College Cork, Ireland; APC Microbiome Institute, University College Cork, Ireland.
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Godefroy O, Martinaud O, Narme P, Joseph PA, Mosca C, Lhommée E, Meulemans T, Czernecki V, Bertola C, Labauge P, Verny M, Bellmann A, Azouvi P, Bindschaedler C, Bretault E, Boutoleau-Bretonniere C, Robert P, Lenoir H, Krier M, Roussel M. Dysexecutive disorders and their diagnosis: A position paper. Cortex 2018; 109:322-335. [PMID: 30415091 DOI: 10.1016/j.cortex.2018.09.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 05/01/2018] [Accepted: 09/30/2018] [Indexed: 11/19/2022]
Abstract
Although executive function disorders are among the most prevalent cognitive impairments a consensus on diagnostic criteria has yet to be reached. With a view to harmonizing these criteria, the present position paper (i) focuses on the main dysexecutive disorders, (ii) examines recent approaches in both the behavioral and cognitive domains, (iii) defines diagnostic boundaries for frontal syndrome, (iv) reports on the frequency and profile of the executive function disorders observed in the main brain diseases, and (v) proposes an operationalization of diagnostic criteria. Future work must define the executive processes involved in human adaptive behavior, characterize their impairment in brain diseases, and improve the management of these conditions (including remediation strategies and rehabilitation).
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Affiliation(s)
- Olivier Godefroy
- Department of Neurology and Laboratory of Functional Neurosciences (EA 4559), University Hospital of Amiens, France.
| | | | - Pauline Narme
- Department of Neurology and Laboratory of Functional Neurosciences (EA 4559), University Hospital of Amiens, France; Department of Psychology, Group of Neuropsychology of Aging (EA 4468), University Paris Descartes, France
| | | | - Chrystèle Mosca
- Department of Neurology, CMRR, University Hospital of Grenoble, France
| | - Eugénie Lhommée
- Department of Psychiatry Neurology and Neurological Rehabilitation, Movement Disorders Unit, University Hospital of Grenoble-Alpes, Institut des Neurosciences, GIN, Inserm, U1216, Grenoble, France
| | - Thierry Meulemans
- Department of Psychology, Psychology and Neuroscience of Cognition Research Unit, University of Liège, Belgium
| | - Virginie Czernecki
- Department of Neurology Department, Salpetriere Hospital, Pierre & Marie Curie Paris 6 University, Brain & Spine Institut ICM-UMR, INSERM-UPMC 1127, Paris, France
| | - Céline Bertola
- Department of Rehabilitation, Fondation Hopale, Berck-sur-mer, France
| | - Pierre Labauge
- Department of Neurology, University Hospital of Nimes, France
| | - Marc Verny
- Department of Geriatry Université, Pitié-Salpêtrière Hospital, Pierre et Marie Curie University Paris 6, Biological Adaptation and Aging, INSERM, UMR 8256, Hospital Department Fight Aging and Stress (DHU FAST), Paris, France
| | - Anne Bellmann
- Department of Neuropsychology, CRR-SUVA, Sion, Switzerland
| | - Philippe Azouvi
- Department of Medecine Physique et de Réadaptation, Université de Versailles Saint Quentin, France
| | - Claire Bindschaedler
- Department of of Neuropsychology and Neurorehabilitation, University Hospital of Lausanne, Psychology Faculty of Geneva University, Switzerland
| | - Eric Bretault
- Department of Neurology, General Hospital of Cholet, France
| | | | - Philippe Robert
- Department of CoBTeK Lab, IA, CMRR CHu, University Côte d'Azur, France
| | - Hermine Lenoir
- Department of Geriatry Broca Hospital and Université Paris Descartes, Paris, France
| | - Marianne Krier
- Department of Institut Régional de Médecine Physique et de Réadaptation, Nancy, France
| | - Martine Roussel
- Department of Neurology and Laboratory of Functional Neurosciences (EA 4559), University Hospital of Amiens, France
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Lee Y, Oh JS, Chung SJ, Lee JJ, Chung SJ, Moon H, Lee PH, Kim JS, Sohn YH. The presence of depression in de novo Parkinson's disease reflects poor motor compensation. PLoS One 2018; 13:e0203303. [PMID: 30231066 PMCID: PMC6145582 DOI: 10.1371/journal.pone.0203303] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/18/2018] [Indexed: 11/18/2022] Open
Abstract
Depression frequently accompanies Parkinson's disease and often precedes the onset of motor symptoms. This study aimed to evaluate the impact of depression on motor compensation in patients with de novo Parkinson's disease. This retrospective cohort study analyzed data from 474 non-demented patients with de novo Parkinson's disease (mean age, 64.6±9.8 years; 242 men) who underwent both dopamine transporter PET scan and depression assessment using the Beck Depression Inventory at baseline. Patients were classified into tertiles by Beck Depression Inventory score. At baseline, high-tertile group (Beck Depression Inventory score ≥15, n = 157) showed more severe motor deficits and lower cognitive function than low-tertile group (Beck Depression Inventory score ≤7, n = 158, P = 0.034 and P = 0.008, respectively). Greater motor deficits in high-tertile group than low-tertile group remained significant after controlling for dopamine transporter binding in the posterior putamen, as well as other confounding variables. During follow-up of a median duration of 47 months, high-tertile group received higher levodopa-equivalent doses for symptom control than did low-tertile group after controlling for age, gender, and initial motor deficit severity. These results demonstrate that depression in de novo Parkinson's disease is associated with motor deficit severity at baseline and dose of PD medications during follow-up, suggesting that the presence of depression in de novo Parkinson's disease represents poor motor compensation.
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Affiliation(s)
- Yoonju Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jungsu S. Oh
- Department of Nuclear Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Jung Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Su Jin Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Myongji Hospital, Goyang, South Korea
| | - Hyojeong Moon
- Department of Nuclear Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Young H. Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- * E-mail:
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