1
|
Liu D, Zhang Q, Zhao Z, Chen M, Hou Y, Wang G, Shen H, Zhu H, Ji Y, Ruan L, Lou Z. Benzodiazepine-Receptor Agonist Utilization in Outpatients with Anxiety Disorder: A Retrospective Study Based on Electronic Healthcare Data from a Large General Tertiary Hospital. Healthcare (Basel) 2023; 11:healthcare11040554. [PMID: 36833088 PMCID: PMC9956167 DOI: 10.3390/healthcare11040554] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
Benzodiazepine-receptor agonists (BZRAs), including benzodiazepines (BZDs) and drugs related to BZDs (Z-drugs), are commonly used for anxiety, but often have side effects. We retrospectively investigated the utilization and prescription characteristics of BZRAs for patients with anxiety disorders in a large tertiary care general hospital between 2018 and 2021, based on electronic healthcare records. We also examined the pattern of simultaneous consumption of multiple BZRA drugs, and the diseases coexisting with anxiety that are associated with this. The numbers of patients and BZRA prescriptions increased over the 4 years. Moreover, 7195 prescriptions from 694 patients contained two or more BZRAs, of which 78.08% contained both BZDs and Z-drugs, 19.78% contained multiple BZDs, and 2.14% contained multiple Z-drugs. For anxiety patients with concomitant Alzheimer's disease or Parkinson's disease, and dyslipidemia, they were more likely to consume multiple BZRAs simultaneously, whereas patients with concomitant insomnia, depression, hypertension, diabetes, or tumors were less likely to consume multiple BZRAs (all p < 0.05). Furthermore, older patients who consume multiple BZRAs simultaneously may have higher probabilities of long-term drug use. Better interventions supporting standardized BZD utilization may be needed to minimize the side effects of inappropriate BZRA administration.
Collapse
Affiliation(s)
- Denong Liu
- School of Medicine, Ningbo University, Ningbo 315211, China
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
| | - Qingyu Zhang
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
| | - Zhijia Zhao
- School of Medicine, Ningbo University, Ningbo 315211, China
| | - Mengjia Chen
- Department of Pharmacy, Ningbo Yinzhou No.2 Hospital, Ningbo 315199, China
| | - Yanbin Hou
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
| | - Guanjun Wang
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
| | - Haowei Shen
- School of Medicine, Ningbo University, Ningbo 315211, China
| | - Huaqiang Zhu
- Department of Pharmaceutical Engineering, Zhejiang Pharmaceutical University, Ningbo 315199, China
| | - Yunxin Ji
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
| | - Liemin Ruan
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
- Correspondence: (L.R.); (Z.L.)
| | - Zhongze Lou
- Department of Psychosomatic Medicine, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
- Zhejiang Key Laboratory of Precision Medicine for Atherosclerotic Diseases, Central Laboratory of the Medical Research Center, Zhejiang Regional Medical Center Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315010, China
- Correspondence: (L.R.); (Z.L.)
| |
Collapse
|
2
|
Li XY, Chen MJ, Liang XN, Yao RX, Shen B, Wu B, Li G, Sun YM, Wu JJ, Liu FT, Yang YJ, Wang J. PDQ-8: A Simplified and Effective Tool Measuring Life Quality in Progressive Supranuclear Palsy. JOURNAL OF PARKINSON'S DISEASE 2023; 13:83-91. [PMID: 36591660 PMCID: PMC9912724 DOI: 10.3233/jpd-223553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The self-reported quality of life (QoL) should be carefully listened to in progressive supranuclear palsy (PSP) from the patient-centered perspective. However, there was still a lack of short QoL measurement tool in atypical parkinsonism. OBJECTIVE We aimed to test whether the short Parkinson's Disease Questionnaire-8 (PDQ-8) was effective in assessing QoL in PSP, comparing with Progressive Supranuclear Palsy Quality of Life Scale (PSP-QoL) and Parkinson's Disease Questionnaire-39 (PDQ-39). METHODS 132 patients with clinical diagnosed PSP, including PSP-Richardson syndrome (RS) subtype (n = 71) and PSP-non-RS subtype (n = 61) were recruited for clinical evaluation including QoL assessment. The detailed QoL profiles and possibility of using PDQ-8 were systemically analyzed. The determinants to the QoL were then calculated by multivariate linear regression analysis. RESULTS The PSP-QoL total score summary index (SI) was 22.8 (10.1, 41.1), while the PDQ-8 and PDQ-39 total SI score were 28.1 (12.5, 46.9) and 29.5 (15.4, 49.4). Mobility, activities of daily life, cognition and communication were the main affected QoL subdomains (median SI: 40.0, 31.3, 25.0 and 25.0 respectively). PSP-RS subtype showed more severe damage physically (p<0.001) and mentally (p = 0.002) compared to other subtypes. More importantly, the strong relevance of PDQ-8 and recommended PSP QoL tools were confirmed (p<0.001). In addition, disease severity, depression and daytime sleepiness were proved to be critical determinants for QoL in PSP. CONCLUSIONS PDQ-8 could be an easy, reliable, and valid tool to evaluate QoL in patients with PSP. Besides motor symptoms, more attention should be paid to non-motor impairment such as depression in PSP.
Collapse
Affiliation(s)
- Xin-Yi Li
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ming-Jia Chen
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiao-Niu Liang
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China,Institute of Neurology, Fudan University, Shanghai, China
| | - Rui-Xin Yao
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Bo Shen
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Bin Wu
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Gen Li
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yi-Min Sun
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian-Jun Wu
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Feng-Tao Liu
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu-Jie Yang
- Key Laboratory of Arrhythmias, Ministry of Education, Department of Medical Genetics, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China,Correspondence to: Prof Jian Wang, Department of Neurology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China. Tel.: +86 13321934789; E-mail: and Dr. Yu-Jie Yang, Key Laboratory of Arrhythmias, Ministry of Education, Department of Medical Genetics, Shanghai East Hospital, School of Medicine, Tonji University, Shanghai, China. Tel.: +86 13917793964; E-mail:
| | - Jian Wang
- Department of Neurology, National Research Center for Aging and Medicine, National Center for Neurological Disorders, and State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China,Correspondence to: Prof Jian Wang, Department of Neurology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China. Tel.: +86 13321934789; E-mail: and Dr. Yu-Jie Yang, Key Laboratory of Arrhythmias, Ministry of Education, Department of Medical Genetics, Shanghai East Hospital, School of Medicine, Tonji University, Shanghai, China. Tel.: +86 13917793964; E-mail:
| | | |
Collapse
|
3
|
Zheng HB, Liu B, Shen J, Xie F, Ji QM, Zhu XY. Non-invasive brain stimulation for treating psychiatric symptoms in Parkinson’s disease: A systematic review and meta-analysis. J Clin Neurosci 2022; 106:83-90. [DOI: 10.1016/j.jocn.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022]
|
4
|
Sanchez-Luengos I, Lucas-Jiménez O, Ojeda N, Peña J, Gómez-Esteban JC, Gómez-Beldarrain MÁ, Vázquez-Picón R, Foncea-Beti N, Ibarretxe-Bilbao N. Predictors of health-related quality of life in Parkinson's disease: the impact of overlap between health-related quality of life and clinical measures. Qual Life Res 2022; 31:3241-3252. [PMID: 35842497 PMCID: PMC9546987 DOI: 10.1007/s11136-022-03187-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE This study aimed to determine predictors of health-related quality of life (HRQoL) in Parkinson's disease (PD) and to explore their predictive value before and after controlling overlapping items between HRQoL and clinical variables. METHODS One hundred and eight PD patients underwent motor, anxiety, depression, apathy, fatigue, and neurocognition assessment. HRQoL was assessed by the Parkinson's Disease Questionnaire-39 (PDQ-39). In order to determine predictors of HRQoL in PD, stepwise multiple regression analyses were performed in two ways: before and after removing the emotional well-being dimension from PDQ-39 to control the overlap between depression and anxiety, and HRQoL. RESULTS HRQoL total index was predicted by anxiety, fatigue, motor symptoms, and depression, explaining 26.9%, 7.2%, 2.8%, and 1.9% of the variance. However, after removing overlapping items, HRQoL total index was predicted by fatigue (16.5%), anxiety (6.1%), motor symptoms (3.9%), and neurocognition (2.5%), but not depression. Regarding HRQoL dimensions, mobility and activities of daily living were predicted by fatigue (19.7% and 5%) and UPDRS-III (4% and 10.2%); emotional well-being by fatigue (7.9%); social support by anxiety (12.2%) and UPDRS-III (8.6%); communication by neurocognition (5.3%) and UPDRS-III (3.4%); cognition by anxiety (10.6%) and bodily discomfort by anxiety (23%) and fatigue (4.1%). CONCLUSION These findings showed the importance of identifying and controlling overlapping items of HRQoL and clinical measures to perform an accurate interpretation. HRQoL dimensions showed different predictors before and after controlling the overlap. Based on these results fatigue, anxiety, motor symptoms, and neurocognition, but not depression are the main predictors of HRQoL in PD patients.
Collapse
Affiliation(s)
| | - Olaia Lucas-Jiménez
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Natalia Ojeda
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Javier Peña
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | | | | | | | - Nerea Foncea-Beti
- Department of Neurology, Hospital of Galdakao, Galdakao-Usansolo, Spain
| | - Naroa Ibarretxe-Bilbao
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| |
Collapse
|
5
|
D'Amico R, Impellizzeri D, Genovese T, Fusco R, Peritore AF, Crupi R, Interdonato L, Franco G, Marino Y, Arangia A, Gugliandolo E, Cuzzocrea S, Di Paola R, Siracusa R, Cordaro M. Açai Berry Mitigates Parkinson's Disease Progression Showing Dopaminergic Neuroprotection via Nrf2-HO1 Pathways. Mol Neurobiol 2022; 59:6519-6533. [PMID: 35970975 PMCID: PMC9463222 DOI: 10.1007/s12035-022-02982-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/27/2022] [Indexed: 02/08/2023]
Abstract
The current pharmacological treatment for Parkinson's disease (PD) is focused on symptom alleviation rather than disease prevention. In this study, we look at a new strategy to neuroprotection that focuses on nutrition, by a supplementation with Açai berry in an experimental models of PD. Daily orally supplementation with Açai berry dissolved in saline at the dose of 500 mg/kg considerably reduced motor and non-motor symptom and neuronal cell death of the dopaminergic tract induced by 4 injections of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Furthermore, Açai berry administration reduced α-synuclein aggregation in neurons, enhanced tyrosine hydroxylase and dopamine transporter activities, and avoided dopamine depletion. Moreover, Açai berry administration was able to reduce astrogliosis and microgliosis as well as neuronal death. Its beneficial effects could be due to its bioactive phytochemical components that are able to stimulate nuclear factor erythroid 2-related factor 2 (Nrf2) by counteracting the oxidative stress and neuroinflammation that are the basis of this neurodegenerative disease.
Collapse
Affiliation(s)
- Ramona D'Amico
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres 31, 98166, Messina, Italy
| | - Daniela Impellizzeri
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres 31, 98166, Messina, Italy
| | - Tiziana Genovese
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres 31, 98166, Messina, Italy
| | - Roberta Fusco
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Alessio Filippo Peritore
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres 31, 98166, Messina, Italy
| | - Rosalia Crupi
- Department of Veterinary Sciences, University of Messina, Polo Universitario Dell'Annunziata, 98168, Messina, Italy
| | - Livia Interdonato
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres 31, 98166, Messina, Italy
| | - Gianluca Franco
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres 31, 98166, Messina, Italy
| | - Ylenia Marino
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres 31, 98166, Messina, Italy
| | - Alessia Arangia
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres 31, 98166, Messina, Italy
| | - Enrico Gugliandolo
- Department of Veterinary Sciences, University of Messina, Polo Universitario Dell'Annunziata, 98168, Messina, Italy
| | - Salvatore Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres 31, 98166, Messina, Italy.
- Department of Pharmacological and Physiological Science, Saint Louis University School of Medicine, Saint Louis, MO, 63104, USA.
| | - Rosanna Di Paola
- Department of Veterinary Sciences, University of Messina, Polo Universitario Dell'Annunziata, 98168, Messina, Italy.
| | - Rosalba Siracusa
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres 31, 98166, Messina, Italy
| | - Marika Cordaro
- Department of Biomedical, Dental and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| |
Collapse
|
6
|
Abstract
OBJECTIVE Parkinson's disease (PD) is a neurodegenerative movement disorder that is a result of dopamine depletion in the basal ganglia. Individuals with a PD diagnosis experience motor symptoms (e.g., tremors) and nonmotor symptoms (e.g., cognitive decline). Previous studies suggest that progression of cognitive dysfunction in other neurologic populations can be predicted by cumulative head injuries. The study examined the association between lifelong number of head injuries and nonmotor outcomes (cognitive complaints, depression, and quality of life). METHODS Participants consisted of 3,483 individuals with PD diagnoses who were enrolled in the Fox Insight study. Participants completed a self-report questionnaire to quantify the number of head injuries experienced throughout life. Participants also completed measures of nonmotor outcomes (cognitive complaints, depression, and quality of life) every 6 months over a 3-year period. RESULTS Cognitive complaints were more common among those experiencing more head injuries. Further, more severe depression and greater difficulties in quality of life were reported among individuals experiencing a greater number of head injuries. Additional analyses revealed the effect between cognitive complaints and number of head injuries was driven by individuals who experienced five or more head injuries in their lifetime. CONCLUSIONS Among individuals with PD, a patient report of past head injuries may have prognostic implications for important nonmotor outcomes. Report of multiple head injuries may be particularly concerning.
Collapse
Affiliation(s)
- Jacob D Jones
- Center on Aging, Department of Psychology, California State University San Bernardino, San Bernardino
| | - Holly Timblin
- Center on Aging, Department of Psychology, California State University San Bernardino, San Bernardino
| | - Fawn Baxter
- Center on Aging, Department of Psychology, California State University San Bernardino, San Bernardino
| |
Collapse
|
7
|
Toloraia K, Meyer A, Beltrani S, Fuhr P, Lieb R, Gschwandtner U. Anxiety, Depression, and Apathy as Predictors of Cognitive Decline in Patients With Parkinson's Disease-A Three-Year Follow-Up Study. Front Neurol 2022; 13:792830. [PMID: 35211081 PMCID: PMC8860828 DOI: 10.3389/fneur.2022.792830] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/10/2022] [Indexed: 12/31/2022] Open
Abstract
Objective Anxiety, depression, and apathy are the most common neuropsychiatric symptoms in Parkinson's disease (PD) patients. They impair cognitive functioning and have a profound impact on quality of life. This follow-up study aims to investigate the predictive value of anxiety, depression, and apathy on the development of Mild Cognitive Impairment (MCI) in PD patients. Methods Twenty-nine cognitively unimpaired PD patients (mean age 68.2 SD ± 7.12 years; 13 women) participated in this study. At Baseline (BL) levels of apathy (Apathy Evaluation Scale, AES), depression (Beck Depression Inventory, BDI-II), and anxiety (Beck Anxiety Inventory, BAI), were assessed. Cognitive status was reassessed three years later according to MCI/non-MCI status. For statistics, we used binary logistic regression and receiver operating characteristic curve (ROC) analysis to examine anxiety, apathy, and depression at BL as a predictor of MCI status three years later. Results Eight of the 29 patients developed MCI. Anxiety level at BL was found to predict MCI status at three-year follow-up (OR = 1.20, CI = 1.02–1.41, p = 0.02), while depression (OR = 1.16, CI = 0.93–1.47, p = 0.20) and apathy (OR = 1.06, CI = 0.92–1.23, p = 0.40) did not predict MCI status. The area under the ROC curve (AUC) of BAI for discriminating PD-non-MCI from PD-MCI was 0.79 (CI = 0.61–0.98). The optimal classification threshold yielded a sensitivity of 75.0 % and a specificity of 76.2 %. Neither apathy nor depression at BL discriminated between PD-non-MCI patients from PD-MCI three years later. Conclusions This study shows an association between anxiety and the development of MCI in PD patients, although the association between apathy, depression, and MCI did not reach a significant level.
Collapse
Affiliation(s)
- Ketevan Toloraia
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Antonia Meyer
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Selina Beltrani
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Peter Fuhr
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Roselind Lieb
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Ute Gschwandtner
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
8
|
James-Palmer AM, Daneault JF. Tele-yoga for the management of Parkinson disease: A safety and feasibility trial. Digit Health 2022; 8:20552076221119327. [PMID: 35990111 PMCID: PMC9386843 DOI: 10.1177/20552076221119327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 05/30/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives Despite current standard treatments, persons with Parkinson disease (PD) still experience motor and non-motor symptoms that impact daily function and quality of life, warranting the investigation of additional interventions. Holistic complementary interventions such as yoga have been shown to be beneficial for persons with PD. However, there are multiple barriers to in-person interventions such as transportation difficulties and disease-related mobility impairments which may be mitigated by digital health applications. Therefore, this study’s purpose was to assess the safety and feasibility of a synchronous tele-yoga intervention for persons with PD. Methods Sixteen participants were enrolled in a single group safety and feasibility trial. The entire study was conducted remotely and consisted of a baseline assessment followed by a six-week waiting period, then a second assessment, a six-week tele-yoga intervention period, a post-intervention assessment, a six-week follow-up period, and lastly a follow-up assessment. During the tele-yoga period, participants completed two one-on-one 30-minute tele-yoga sessions weekly for a total of 12 sessions. Primary outcomes included adverse events, adherence, technological challenges, and usability. Secondary outcomes included enjoyment and clinically relevant outcome measures assessing both motor and non-motor symptoms. Results No severe adverse events were attributed to the intervention. Retention was 87.5%, assessment session adherence was 100%, and intervention session adherence was 97%. Technological challenges did not impact feasibility. The intervention was usable and enjoyable. While this study was not powered or designed to assess the efficacy of the intervention, preliminary improvements were shown for some of the clinically relevant outcome measures. Conclusions Overall, this study showed that the implementation of a synchronous one-on-one tele-yoga intervention was safe, feasible, usable, and enjoyable for persons with PD. Randomized control trials investigating its efficacy should be initiated. The study was registered with ClinicalTrials.gov (NCT04240899, https://clinicaltrials.gov/ct2/show/NCT04240899).
Collapse
Affiliation(s)
- Aurora M James-Palmer
- Department of Rehabilitation and Movement Sciences, Rutgers University, Newark, NJ, USA
| | | |
Collapse
|
9
|
Radisavljevic N, Cirstea M, Bauer K, Lo C, Metcalfe-Roach A, Bozorgmehr T, Bar-Yoseph H, Brett Finlay B. Effects of Gut Microbiota Alterations on Motor, Gastrointestinal, and Behavioral Phenotype in a Mouse Model of Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1479-1495. [PMID: 35599496 DOI: 10.3233/jpd-223165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is a multi-system disorder consisting of not only classic motor symptoms but also a variety of non-motor symptoms including gastrointestinal (GI) dysfunction and mood disorders. The gut microbiota has been suggested to play a role in modulating PD motor and non-motor features, although the causality and mechanisms behind these proposed interactions remains largely understudied. OBJECTIVE In this study, we aimed to provide in-depth characterization of an established mouse model of PD (transgenic (TG) SNCA A53T) and experimentally address how changes to the gut microbiota impact the PD-like phenotype. METHODS We profiled the PD-like phenotype of transgenic mice through a panel of motor, GI, and behavioral tests. We then investigated how antibiotic treatment or gut microbial community transfer (via cohousing with wild-type mice) impacted the PD-like phenotype. RESULTS We found that this mouse model demonstrated early (6 weeks of age) motor symptoms when compared to a wild-type control mouse strain. Transgenic mice also exhibited early GI dysfunction, as well as behavioral alterations, including reduced anxiety-like behavior, and increased depression-like and apathy-like behavior. Compared to wild-type mice, the transgenic fecal microbiota was less diverse and compositionally distinct. Interestingly, drastic alterations to the gut microbiota, through antibiotic treatment or cohousing with wild-type mice, had a minimal effect on the motor, GI, and behavioral phenotype of transgenic mice. CONCLUSION We concluded that this mouse model effectively recapitulates motor and non-motor features of PD; however, the gut microbiota appears to exhibit a minor impact on the pathophysiology of this PD model.
Collapse
Affiliation(s)
- Nina Radisavljevic
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
| | - Mihai Cirstea
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Kylynda Bauer
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Christine Lo
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Avril Metcalfe-Roach
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Tahereh Bozorgmehr
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
| | - Haggai Bar-Yoseph
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
| | - B Brett Finlay
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
10
|
Gomes da Costa LV, Trippo KV, Duarte GP, Cruz AO, Filho JO, Ferraz DD. Depressive symptoms in elderly patients with Parkinson's disease: frequency and associated factors. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2019.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims Emotional health is an important factor in clinical and functional manifestations of Parkinson's disease. The aim of this study was to correlate clinical features with depressive symptoms in elderly patients with Parkinson's disease. Methods A cross-sectional study was conducted. The Geriatric Depression Scale 15 was used to evaluate depressive symptoms, the modified Hoehn and Yahr scale was used to describe the symptom progression of Parkinson's disease and the Parkinson's Disease Questionnaire 39 to assess the quality of life. The Pearson correlation and the chi-square test were used. Significance level was set at 5%. Results A total of 81 individuals participated and 48 (60.8%) presented with depressive symptoms. Participants in the moderate stage of Parkinson's disease and women presented a higher frequency of depressive symptoms. Cognition, communication and mobility presented the highest correlation with depressive symptoms. Conclusions The participants presented a high frequency of depressive symptoms that is correlated with a decrease in mobility, communication and cognitive functions. It is recommended that the rehabilitation of elderly people with Parkinson's disease should be performed by a multidisciplinary team, whose objectives are to improve mobility, cognition and communication, which can help reduce depressive symptoms and depression in elderly people with Parkinson's disease.
Collapse
|
11
|
A bidirectional relationship between anxiety, depression and gastrointestinal symptoms in Parkinson's disease. Clin Park Relat Disord 2021; 5:100104. [PMID: 34430845 PMCID: PMC8368023 DOI: 10.1016/j.prdoa.2021.100104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 12/19/2022] Open
Abstract
Gastrointestinal (GI) and mood symptoms are common in Parkinson’s disease. Depression and anxiety are bidirectional risk factors for GI distress. Association between GI and mood symptoms may reflect disrupted Gut-Brain axis.
Introduction Anxiety, depression and gastrointestinal (GI) symptoms are common non-motor symptoms in Parkinson’s disease (PD). Past studies provide evidence of a disrupted microbiome-gut-brain axis in PD, which is associated with certain motor and non-motor symptoms in PD. Additionally, there is evidence of a bidirectional association between mental health and gut health among individuals with GI disorders. The current study examined the bidirectional association between GI symptoms and anxiety/depression among individuals newly diagnosed with PD. Methods We conducted a secondary data analysis of the Parkinson’s Progression Markers Initiative. This included 487 individuals newly diagnosed with PD and followed for up to 5 years. Participants completed questionnaires of anxiety, depression and GI symptoms (Scales for Outcomes in Parkinson’s Disease Autonomic; SCOPA-AUT) at each annual visit. Multilevel models examined the bidirectional-lagged relationship between GI symptoms and anxiety/depression. Results Models provided evidence for a bidirectional relationship between GI symptoms and anxiety/depression. Specifically, more severe GI symptoms predicted more severe anxious/depressive symptoms within the same year and at the following year. There was also evidence of the inverse directionality, meaning that more severe anxiety/depression predicted more severe GI symptoms concurrently and in the following year. Discussion Findings provide preliminary evidence for a cyclical relationship among gut health and mental health in PD. Future studies are needed to examine if the microbiome-gut-brain axis plays a mechanistic role.
Collapse
|
12
|
Su W, Liu H, Jiang Y, Li S, Jin Y, Yan C, Chen H. Correlation between depression and quality of life in patients with Parkinson's disease. Clin Neurol Neurosurg 2021; 202:106523. [PMID: 33581615 DOI: 10.1016/j.clineuro.2021.106523] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/12/2020] [Accepted: 01/23/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To understand the distribution of Parkinson's disease questionnaire-39 (PDQ-39) scores in Parkinson's disease (PD) patients with or without depression, and to analyze the factors that influence the quality of life of PD patients. MATERIALS AND METHODS 300 PD patients were enrolled. Patients' general information and the results of assessments including UPDRS, H-Y, HAMD, HAMA, ADL and PDQ-39 were collected. They were divided into depression group and non-depression group according to HAMD score. The relationship between PD-related depression and quality of life and the factors that influence the quality of life of PD patients were analyzed based on PDQ-39 score. RESULTS 111 patients with depression (37.0 %) and 189 patients without depression (63.0 %) were enrolled. The scores of PDQ-39 summary index (PDQ-39 SI) in the depression group were significantly higher than those in the non-depression group in all domains (P < 0.05). Patients in the depression group had a longer disease duration (6.89 ± 4.70 vs. 5.52 ± 4.12, P < 0.038), a higher UPDRS-III score (30.1 ± 13.55 vs. 25.2 ± 11.73, P < 0.001), and a higher H-Y stage level (2.41 ± 0.853 vs. 2.13 ± 0.707, P < 0.001), compared with patients in the non-depression group. All factors including age, disease duration, UPDRS-III, H-Y stage, HAMD score and HAMA score, may independently affected PDQ-39SI in PD patients, among which HAMD had the greatest effect. HAMD and HAMA were correlated with PDQ-39 in its all eight domains. CONCLUSION PD patients with psychological problems such as anxiety and depression may lead to a significant decline in the quality of life of patients in all domains.
Collapse
Affiliation(s)
- Wen Su
- Research Institute of Neuromuscular and Neurodegenerative Disease, Department of Neurology, Qilu Hospital, Shandong University, Jinan, China; Neurology Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, PR China.
| | - Huijing Liu
- Neurology Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, PR China.
| | - Yanyan Jiang
- Neurology Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, PR China.
| | - Shuhua Li
- Neurology Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, PR China.
| | - Ying Jin
- Neurology Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, PR China.
| | - Chuanzhu Yan
- Research Institute of Neuromuscular and Neurodegenerative Disease, Department of Neurology, Qilu Hospital, Shandong University, Jinan, China.
| | - Haibo Chen
- Neurology Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, PR China.
| |
Collapse
|
13
|
A double-blind, randomized controlled trial of duloxetine for pain in Parkinson's disease. J Neurol Sci 2020; 414:116833. [DOI: 10.1016/j.jns.2020.116833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/31/2022]
|
14
|
Neuropsychiatric aspects of Parkinson disease psychopharmacology: Insights from circuit dynamics. HANDBOOK OF CLINICAL NEUROLOGY 2020; 165:83-121. [PMID: 31727232 DOI: 10.1016/b978-0-444-64012-3.00007-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Parkinson disease (PD) is a neurodegenerative disorder with a complex pathophysiology characterized by the progressive loss of dopaminergic neurons within the substantia nigra. Persons with PD experience several motoric and neuropsychiatric symptoms. Neuropsychiatric features of PD include depression, anxiety, psychosis, impulse control disorders, and apathy. In this chapter, we will utilize the National Institutes of Mental Health Research Domain Criteria (RDoC) to frame and integrate observations from two prevailing disease constructions: neurotransmitter anomalies and circuit physiology. When there is available evidence, we posit how unified translational observations may have clinical relevance and postulate importance outside of PD. Finally, we review the limited evidence available for pharmacologic management of these symptoms.
Collapse
|
15
|
Jones JD, Kurniadi NE, Kuhn TP, Szymkowicz SM, Bunch J, Rahmani E. Depressive symptoms precede cognitive impairment in de novo Parkinson's disease patients: Analysis of the PPMI cohort. Neuropsychology 2019; 33:1111-1120. [PMID: 31343240 PMCID: PMC6823115 DOI: 10.1037/neu0000583] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Nonmotor symptoms, including depression, anxiety, apathy, and cognitive dysfunction, are common in Parkinson's disease (PD). Although a link between mood symptoms and cognitive impairment in PD has been theorized vis-à-vis striatal dopamine depletion, studies have been inconsistent regarding the relationship between mood symptoms and cognitive function. Inconsistencies may reflect the cross-sectional nature of previous studies. The current study examined the bidirectional longitudinal relationship between mood and cognition. METHOD Data were obtained from 310 individuals newly diagnosed with PD, who were followed up to 4 years (baseline, 1st, 2nd, 3rd, and 4th annual follow-ups). Apathy, anxiety, depressive symptoms, motor severity, and neurocognitive functioning were assessed at each annual assessment. The longitudinal relationship between apathy, anxiety, depressive symptoms, and cognition was analyzed with multilevel models. RESULTS Over the 4-year period, more severe depressive symptoms were related to worse performance on tasks of processing speed, verbal learning, and verbal delayed recall. Additionally, there was a significant Depression × Time interaction, suggesting that individuals with more severe depressive symptoms experience more rapid declines in global cognitive functioning and verbal learning. Apathy and anxiety were not significantly related to performance in any cognitive test. Lagged models revealed that changes in depression precede declines in working memory, verbal learning, delayed verbal recall, and global cognition. CONCLUSION Findings suggest depressive symptoms may be a harbinger for future cognitive decline among individuals with PD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
|
16
|
Abstract
Depression and anxiety are common neuropsychiatric manifestations of Parkinson disease. However, they are often under-recognized because the somatic symptoms of depression often overlap with the motor symptoms of Parkinson disease and there is low self-reporting. Clinicians need to be vigilant about early detection and treatment of anxiety and depression in the patient with Parkinson disease. The development of new therapeutic strategies, including diet, exercise, and counseling along with antidepressants provide a holistic approach to management.
Collapse
Affiliation(s)
- Sudeshna Ray
- Booth Gardner Parkinson's Care Center, Evergreen Neuroscience Institute, 12039 NE 128th St, MS-77, Kirkland, WA 98034, USA
| | - Pinky Agarwal
- Booth Gardner Parkinson's Care Center, Evergreen Neuroscience Institute, 12039 NE 128th St, MS-77, Kirkland, WA 98034, USA; University of Washington, Seattle, WA, USA.
| |
Collapse
|
17
|
Ryan M, Eatmon CV, Slevin JT. Drug treatment strategies for depression in Parkinson disease. Expert Opin Pharmacother 2019; 20:1351-1363. [DOI: 10.1080/14656566.2019.1612877] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Melody Ryan
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Courtney V. Eatmon
- Mental Health Clinical Pharmacy Specialist, Lexington Veterans Affairs Healthcare System, Lexington, KY, USA
| | - John T. Slevin
- Departments of Neurology and Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, Lexington, KY, USA
| |
Collapse
|
18
|
Kuhlman GD, Flanigan JL, Sperling SA, Barrett MJ. Predictors of health-related quality of life in Parkinson's disease. Parkinsonism Relat Disord 2019; 65:86-90. [PMID: 31118162 DOI: 10.1016/j.parkreldis.2019.05.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/17/2019] [Accepted: 05/06/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Health-related quality of life in Parkinson's disease may be affected by a wide range of motor and non-motor symptoms. Identifying which symptoms are significant predictors of health-related quality of life in Parkinson's disease prioritizes symptoms for treatment, therapeutic development, and clinical outcomes. OBJECTIVES To determine predictors of health-related quality of life in patients with Parkinson's disease. METHODS We recruited 102 subjects into a prospective study to investigate neuropsychiatric symptoms in Parkinson's disease. Health-related quality of life was measured with the 39-item Parkinson's Disease Questionnaire. Subjects completed the Movement Disorder Society Unified Parkinson's Disease Rating Scale Parts I-IV as well as validated scales to assess anxiety, depression, apathy, cognition, psychosis, impulsive-compulsive disorder, autonomic dysfunction, sleep quality, excessive daytime sleepiness, and rapid eye movement sleep behavior disorder. We used univariate analyses to select clinical predictors to construct a multivariate regression model to determine which predictors were independently associated with worse health-related quality of life. RESULTS In a multivariate linear regression model adjusted for age and gender, higher scores for the International Parkinson and Movement Disorder Society Unified Parkinson's Disease Rating Scale part II as well more severe symptoms of depression, anxiety, apathy, and excessive daytime sleepiness were associated with worse health-related quality of life. The model explained 78% of the variance of health-related quality of life, and the non-motor symptoms explained 49% of the variance. CONCLUSIONS Anxiety, depression, excessive daytime sleepiness, apathy, and impairment in activities of daily living related to motor symptoms were independently associated with worse health-related quality of life.
Collapse
Affiliation(s)
- Greg D Kuhlman
- Department of Neurology, University of Virginia, Charlottesville, VA, USA; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, Department of Medicine, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
| | - Joseph L Flanigan
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Scott A Sperling
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Matthew J Barrett
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
19
|
Ghazi Sherbaf F, Mojtahed Zadeh M, Haghshomar M, Aarabi MH. Posterior limb of the internal capsule predicts poor quality of life in patients with Parkinson's disease: connectometry approach. Acta Neurol Belg 2019. [PMID: 29542093 DOI: 10.1007/s13760-018-0910-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Psychiatric symptoms and motor impairment are major contributions to the poor quality of life in patients with Parkinson's disease (PD). Here, we applied a novel diffusion-weighted imaging approach, diffusion MRI connectometry, to investigate the correlation of quality of life, evaluated by Parkinson's Disease Questionnaire (PDQ39) with the white matter structural connectivity in 27 non-demented PD patients (disease duration of 5.3 ± 2.9 years, H and Y stage = 1.5 ± 0.6, UPDRS-III = 13.7 ± 6.5, indicating unilateral and mild motor involvement). The connectometry analysis demonstrated bilateral posterior limbs of the internal capsule (PLIC) with increased connectivity related to the higher quality of life (FDR = 0.027) in a multiple regression model. The present study suggests for the first time a neural basis of the quality of life in PD in the light of major determinants of poor quality of life in these patients: anxiety, depression, apathy and motor impairment. Results in our sample of non-demented PD patients with relatively mild motor impairment and no apparent sign of depression/anxiety also identify a unique and inexplicable association of the PLIC to the quality of life in PD patients.
Collapse
Affiliation(s)
- Farzaneh Ghazi Sherbaf
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahtab Mojtahed Zadeh
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Haghshomar
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hadi Aarabi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
20
|
Faria SMD, Maximiano-Barreto MA, Morais DD, Chagas MHN. Impacto dos sintomas de ansiedade na qualidade de vida na doença de Parkinson: uma revisão sistemática. JORNAL BRASILEIRO DE PSIQUIATRIA 2019. [DOI: 10.1590/0047-2085000000224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
RESUMO Objetivo: Revisar estudos relacionados ao impacto da ansiedade na qualidade de vida em pacientes com doença de Parkinson. Métodos: Trata-se de uma revisão sistemática realizada nos bancos de dados PubMed, Scopus, Web of Science e PsycINFO, com os descritores: “anxiety”, “Parkinson's disease” e “quality of life”. Foram selecionados 20 artigos publicados em inglês e sem limite de tempo. Resultado: A maioria dos estudos demonstrou correlação direta entre ansiedade e qualidade de vida em indivíduos com doença de Parkinson. Apenas dois estudos não encontraram essa associação. A presença de sintomas de ansiedade parece estar relacionada com a gravidade dos sintomas motores, sexo feminino e idade mais jovem, levando a um impacto maior na qualidade de vida. Conclusão: Os artigos analisados mostraram que a ansiedade tem impacto negativo sobre a qualidade de vida de indivíduos com doença de Parkinson.
Collapse
Affiliation(s)
| | | | | | - Marcos Hortes Nisihara Chagas
- Universidade de São Paulo, Brasil; Universidade Federal de São Carlos, Brasil; Universidade Federal de São Carlos, Brasil
| |
Collapse
|
21
|
Jones JD, Kuhn T, Levine A, Sacktor N, Munro CA, Teplin LA, D'Souza G, Martin EM, Becker JT, Miller EN, Hinkin CH. Changes in cognition precede changes in HRQoL among HIV+ males: Longitudinal analysis of the multicenter AIDS cohort study. Neuropsychology 2019; 33:370-378. [PMID: 30816783 PMCID: PMC6666308 DOI: 10.1037/neu0000530] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Despite treatment-related improvements in morbidity and mortality, HIV-1-infected (HIV+) individuals continue to face a wide range of HIV-associated medical and HIV-associated neurocognitive disorders. Little is known about the impact of cognitive impairment on patients' health-related quality of life (HRQoL). To address this, the current study examined the longitudinal relationship between cognitive functioning and HRQoL among HIV+ individuals. METHOD The sample consisted of 1,306 HIV+ men enrolled in the Multicenter AIDS Cohort Study. Participants received biannual assessments of cognitive functioning (including tests of processing speed, executive functioning, attention/working memory, motor functioning, learning, and memory) and completed questionnaires assessing HRQoL and depression. Multilevel models were used to examine the longitudinal and cross-lagged relationship between HRQoL and cognition, independent of depression and HIV disease severity. RESULTS There was a significant relationship between HRQoL and cognitive functioning both between and within subjects. Specifically, individuals who reported better HRQoL reported better cognitive functioning, and longitudinal change in cognition was positively related to change in HRQoL. There was a significant unidirectional-lagged relationship; cognition predicted HRQoL at subsequent visits, but HRQoL did not predict cognitive functioning at subsequent visits. Furthermore, analyses of severity of neurocognitive impairment revealed that transition to a more severe stage of cognitive impairment was associated with a decline in HRQoL. CONCLUSIONS Overall, the current study suggests that changes in HRQoL are partially driven by changes in cognitive functioning. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
|
22
|
Wang S, Mao S, Xiang D, Fang C. Association between depression and the subsequent risk of Parkinson's disease: A meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2018; 86:186-192. [PMID: 29859854 DOI: 10.1016/j.pnpbp.2018.05.025] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Observational studies, including recent large cohort studies, have reported an association between depression and the risk of Parkinson's disease (PD); however, conclusions were inconsistent. Clarifying this relation might improve the understanding of risk factors for and the disease mechanisms in PD. Therefore, we performed a meta-analysis to examine whether depression is associated with an increased risk of PD. METHODS A literature search in the PubMed, EMBASE, Scopus, PsycINFO and Web of Science databases was undertaken through March 2018, looking for observational studies evaluating the association between depression and the risk of PD. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analyses and sensitivity analyses were also performed. RESULTS A random-effects meta-analysis of 5 cohort studies and 6 case-control studies demonstrated a significant positive association between depression and a subsequent risk of PD (RR, 2.20; 95% CI, 1.87-2.58), and it was consistent across subgroups. Furthermore, sensitivity analysis confirmed the stability of the results; visual examination of funnel plots and Begg's and Egger's tests showed no evidence of publication bias. CONCLUSIONS Our meta-analysis demonstrated that persons with depression exhibited an increased risk of a subsequent PD diagnosis. The pathophysiological and psychological mechanisms underlying this association are still unclear and warrant further research.
Collapse
Affiliation(s)
- Shun Wang
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Shanping Mao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China.
| | - Dan Xiang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Congcong Fang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| |
Collapse
|
23
|
Szymkowicz SM, Dotson VM, Jones JD, Okun MS, Bowers D. Symptom Dimensions of Depression and Apathy and Their Relationship With Cognition in Parkinson's Disease. J Int Neuropsychol Soc 2018; 24:269-282. [PMID: 29032789 PMCID: PMC5820218 DOI: 10.1017/s1355617717001011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Both depression and apathy, alone and in combination, have been shown to negatively affect cognition in patients with Parkinson's disease (PD). However, the influence of specific symptom dimensions of depression and apathy on cognition is not well understood. The current study investigated the relationship between symptom dimensions of depression and apathy, based on factors identified in Kirsch-Darrow et al. (2011), and memory and executive function in PD. METHODS A sample of 138 non-demented individuals with PD (mean age=64.51±7.43 years) underwent neuropsychological testing and completed the Beck Depression Inventory, 2nd Edition, and Apathy Scale. Separate hierarchical regression models examined the relationship between symptom dimensions of depression and apathy ("pure" depressive symptoms, "pure" apathy, loss of interest/pleasure [anhedonia], and somatic symptoms) and three cognitive domain composites: immediate verbal memory, delayed verbal memory, and executive function. RESULTS After adjusting for general cognitive status and the influence of the other symptom dimensions, "pure" depressive symptoms were negatively associated with the delayed verbal memory composite (p<.034) and somatic symptoms were positively associated with the executive function composite (p<.026). No symptom dimensions were significantly related to the immediate verbal memory composite. CONCLUSIONS Findings suggest that specific mood symptoms are associated with delayed verbal memory and executive function performance in non-demented patients with PD. Further research is needed to better understand possible mechanisms through which specific symptom dimensions of depression and apathy are associated with cognition in PD. (JINS, 2018, 24, 269-282).
Collapse
Affiliation(s)
- Sarah M. Szymkowicz
- Department of Clinical & Health Psychology, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
| | - Vonetta M. Dotson
- Department of Clinical & Health Psychology, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jacob D. Jones
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, CA, USA
| | - Michael S. Okun
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
- Center for Movement Disorders & Neurorestoration, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical & Health Psychology, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
- Center for Movement Disorders & Neurorestoration, College of Medicine, University of Florida, Gainesville, FL, USA
| |
Collapse
|
24
|
Sun Q, Wang T, Jiang TF, Huang P, Wang Y, Xiao Q, Liu J, Chen SD. Clinical Profile of Chinese Long-Term Parkinson's Disease Survivors With 10 Years of Disease Duration and Beyond. Aging Dis 2018; 9:8-16. [PMID: 29392077 PMCID: PMC5772861 DOI: 10.14336/ad.2017.0204] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/04/2017] [Indexed: 12/05/2022] Open
Abstract
Background Parkinson’s disease (PD) patients with 10 years or more survival (PD-10) are not well characterized. The aim of this study was to evaluate the main issues facing PD-10 patients and identify factors that independently contributed to quality of life (QoL). Methods A group of 121 PD-10 patients recruited from outpatient clinics participated in this cross-sectional study. Data on demographic and clinical factors were collected. Multiple linear regression analyses were conducted to identify determinants of poor QoL. Results The entire PD-10 patients had disease duration ranging from 10 to 23 years, with 84.2% of the total cohort skewed to between 10 and 15 years’ duration. The PD-10 patients had great frequency of left-sided onset, increased motor and non-motor symptoms as well as inferior QoL. The more advanced stage of disease in PD-10 patients was associated with motor phenotype, freezing of gait, higher UPDRS sub-scores and levodopa equivalent dose, less balanced confidence, fatigue, anxiety, depression, reduced quality of life and worse Timed Up & Go performance. Self-reported mood symptoms, decreased balance confidence and reduced daily activities were the three factors most closely associated with poorer QoL, but excessive daytime sleepiness and long disease duration additionally contributed to the explanatory power. Conclusions This is the first report to investigate the clinical characteristics of Chinese PD-10 patients. Our study may elucidate an important clue for understanding PD-10 patients in clinical practice and identifying patients with PD at risk for reduced QoL.
Collapse
Affiliation(s)
- Qian Sun
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Tian Wang
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Tian-Fang Jiang
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Pei Huang
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Ying Wang
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Qin Xiao
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Jun Liu
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Sheng-Di Chen
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| |
Collapse
|
25
|
Chen K, Yang YJ, Liu FT, Li DK, Bu LL, Yang K, Wang Y, Shen B, Guan RY, Song J, Wang J, Wu JJ. Evaluation of PDQ-8 and its relationship with PDQ-39 in China: a three-year longitudinal study. Health Qual Life Outcomes 2017; 15:170. [PMID: 28838316 PMCID: PMC5571489 DOI: 10.1186/s12955-017-0742-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/16/2017] [Indexed: 01/15/2023] Open
Abstract
Background Parkinson’s disease is characterized by motor and non-motor symptoms with wide ranging impacts on the health-related quality of life. The 39-item Parkinson’s disease Questionnaire (PDQ-39) is the most widely used PD-specific health-related quality-of-life questionnaire. The short-form 8-item Parkinson’s disease Questionnaire (PDQ-8) was found to produce results similar to that of the PDQ-39 cross-culturally. However, there is no evaluation of the PDQ-8 in the mainland of China. Methods In this longitudinal study, 283 patients with Parkinson’s disease were recruited. The PDQ-39, the PDQ-8 and other scales were administered. Patients attended the clinic once annually for three years to complete the scales. Results The PDQ-8 was found to have good validity and reliability. There was a strong correlation between the summary indices of the PDQ-8 and the PDQ-39 (r=0.93, P<0.001). Results suggested that the PDQ-8 was also associated with other clinical scales of mobility, depression and cognition. The convergent validity and discriminant validity of the PDQ-8 were demonstrated by item-to-dimension correlations. There was acceptable internal consistency of the PDQ-8 (Cronbach’s α: 0.80; Item-scale correlation efficient: 0.56–0.72). The PDQ-8 replicated the results of the PDQ-39 well at all follow-up time points (intraclass correlation coefficient: 0.96–0.98). In addition, there was good test-retest reliability of the PDQ-8. Conclusion The PDQ-8 is a valid and reliable instrument assessing health-related quality of life for PD patients in the mainland of China. Electronic supplementary material The online version of this article (doi:10.1186/s12955-017-0742-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kui Chen
- Department of Neurology & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Yu-Jie Yang
- Department of Neurology & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Feng-Tao Liu
- Department of Neurology & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China.,Department of Neurology, Huashan Hospital North, Fudan University, Shanghai, China
| | - Da-Ke Li
- Department of Neurology & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Lu-Lu Bu
- Department of Neurology & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Ke Yang
- Department of Neurology & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Ying Wang
- Department of Neurology & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Bo Shen
- Department of Neurology & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Rong-Yuan Guan
- Department of Neurology & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Jie Song
- Department of Neurology & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Jian Wang
- Department of Neurology & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
| | - Jian-Jun Wu
- Department of Neurology & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China. .,Department of Neurology, Jing'an District Centre Hospital of Shanghai, Shanghai, China.
| |
Collapse
|
26
|
Balestrino R, Martinez-Martin P. Neuropsychiatric symptoms, behavioural disorders, and quality of life in Parkinson's disease. J Neurol Sci 2017; 373:173-178. [DOI: 10.1016/j.jns.2016.12.060] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 12/27/2016] [Indexed: 02/09/2023]
|
27
|
Balestrino R, Martinez-Martin P. Reprint of "Neuropsychiatric symptoms, behavioural disorders, and quality of life in Parkinson's disease". J Neurol Sci 2017; 374:3-8. [PMID: 28109579 DOI: 10.1016/j.jns.2017.01.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 12/27/2016] [Indexed: 02/05/2023]
Abstract
Parkinson's disease is a complex neurodegenerative disorder characterized by motor and non-motor symptoms, with neuropsychiatric manifestations among the most frequent non-motor symptoms. Health-related quality of life is a patient-reported outcome that reflects the impact of the disease on physical, mental, and social wellbeing, and on other aspects of patient' life. Although older studies on health-related quality of life in Parkinson's disease mainly investigated the role of the motor impairment, recent research focused on non-motor symptoms has highlighted the critical role that behavioural disturbances due to neuropsychiatric symptoms play in determining health related quality of life. A considerable number of studies have demonstrated the importance of depression as a determinant of health-related quality of life in this population, but less evidence is available regarding the role of other neuropsychiatric symptoms such as anxiety, apathy, psychosis, and impulse control disorders. This narrative review analyses recent literature on this topic, focusing on studies in which neuropsychiatric symptoms were investigated as potential determinants of quality of life using regression techniques, including discussion of the assessment tools used.
Collapse
Affiliation(s)
- Roberta Balestrino
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124 Torino, Italy
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain.
| |
Collapse
|
28
|
Schrag A, Taddei RN. Depression and Anxiety in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:623-655. [DOI: 10.1016/bs.irn.2017.05.024] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
29
|
Cognitive Function in Parkinson's Disease Patients with and without Anxiety. Neurol Res Int 2016; 2016:6254092. [PMID: 27800180 PMCID: PMC5075302 DOI: 10.1155/2016/6254092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/06/2016] [Accepted: 09/18/2016] [Indexed: 01/30/2023] Open
Abstract
Research on the implications of anxiety in Parkinson's disease (PD) has been neglected despite its prevalence in nearly 50% of patients and its negative impact on quality of life. Previous reports have noted that neuropsychiatric symptoms impair cognitive performance in PD patients; however, to date, no study has directly compared PD patients with and without anxiety to examine the impact of anxiety on cognitive impairments in PD. This study compared cognitive performance across 50 PD participants with and without anxiety (17 PDA+; 33 PDA−), who underwent neurological and neuropsychological assessment. Group performance was compared across the following cognitive domains: simple attention/visuomotor processing speed, executive function (e.g., set-shifting), working memory, language, and memory/new verbal learning. Results showed that PDA+ performed significantly worse on the Digit Span forward and backward test and Part B of the Trail Making Task (TMT-B) compared to the PDA− group. There were no group differences in verbal fluency, logical memory, or TMT-A performance. In conclusion, anxiety in PD has a measurable impact on working memory and attentional set-shifting.
Collapse
|
30
|
Aerobic Exercise Improves Mood, Cognition, and Language Function in Parkinson's Disease: Results of a Controlled Study. J Int Neuropsychol Soc 2016; 22:878-889. [PMID: 27655232 DOI: 10.1017/s135561771600076x] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Parkinson's disease (PD) results in a range of non-motor deficits that can affect mood, cognition, and language, and many of these issues are unresponsive to pharmacological intervention. Aerobic exercise can improve mood and cognition in healthy older adults, although only a few studies have examined exercise effects on these domains in PD. The current study assesses the effects of aerobic exercise on aspects of cognition, mood, and language production in people with PD. METHODS This study compares the effects of aerobic exercise to stretch-balance training and a no-contact control group in participants with idiopathic PD. The aerobic and stretch-balance groups trained three times a week for 16 weeks, while controls continued normal activities. Outcome measures included disease severity, mood, cognition (speed of processing, memory, and executive function), and language production (picture descriptions). Cognition and language were assessed in single and dual task conditions. RESULTS Depressive symptoms increased only in the control group (p<.02). Executive function improved in the aerobic exercise group only in the single task (p=.007) and declined in controls in the dual task. Completeness of picture descriptions improved significantly more in the aerobic group than in the stretch-balance group (p<.02). CONCLUSIONS Aerobic exercise is a viable intervention for PD that can be protective against increased depressive symptoms, and can improve several non-motor domains, including executive dysfunction and related aspects of language production. (JINS, 2016, 22, 878-889).
Collapse
|
31
|
Anxiety in early Parkinson's disease: Validation of the Italian observer-rated version of the Parkinson Anxiety Scale (OR-PAS). J Neurol Sci 2016; 367:158-61. [PMID: 27423582 DOI: 10.1016/j.jns.2016.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/31/2016] [Accepted: 06/03/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Anxiety disorders are common in Parkinson's Disease (PD) and their identification is relevant even at early stages. The Parkinson Anxiety Scale (PAS) evaluates anxiety in PD; it was used only in the original validation study in PD patients mainly at 2-3 stages of Hoehn & Yahr system (H&Y). The study aimed to investigate psychometric properties of observer-rated version of the PAS (OR-PAS), prevalence rate of anxiety and its features, compared with diagnostic criteria in early PD patients. METHODS A sample of 101 PD patients with H&Y:1-2 underwent the OR-PAS. To assess convergent and divergent validity, PD patients underwent Beck Anxiety Inventory, and scales assessing depression, apathy, anhedonia and cognition. To diagnose anxiety disorders, Mini International Neuropsychiatric Inventory was used as gold standard. A "receiver operating characteristics" curve was obtained; positive and negative predictive values were calculated for different cut-off points of the OR-PAS and its subscales. RESULTS There was no missing data, no floor and ceiling effects; mean score was 12.2±10.1; Cronbach's alpha was 0.899. The OR-PAS showed good convergent and divergent validity. Maximum discrimination was obtained with a cut-off score of 8.5. The anxiety occurred in 59 patients (58.4%). CONCLUSION The OR-PAS is a reliable and valid screening instrument for assessing anxiety in patients at early PD. Anxiety was found in 58.4% of PD patients, demonstrating that anxiety occurs even at early stages.
Collapse
|
32
|
Jones JD, Mangal P, Lafo J, Okunm MS, Bowers D. Mood Differences Among Parkinson's Disease Patients With Mild Cognitive Impairment. J Neuropsychiatry Clin Neurosci 2016; 28:211-6. [PMID: 26792098 PMCID: PMC4956595 DOI: 10.1176/appi.neuropsych.15090221] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Studies with healthy elderly adults suggest that apathy, depression, and anxiety are more common among individuals with mild cognitive impairment (MCI). This study examined differences in mood/amotivational symptoms among patients with Parkinson's disease (PD) with and without MCI. Patients with PD (N=214) underwent neurocognitive evaluations including assessment of apathy (Apathy Scale), depression (Beck Depression Inventory-II), and trait anxiety (State-Trait Anxiety Inventory trait scale). Trait anxiety and depression were more severe in patients with PD with MCI. Delineation of MCI into amnestic and nonamnestic subtypes revealed greater depression, apathy, and anxiety among patients with PD with amnestic MCI relative to cognitively intact patients with PD. Patients with PD and MCI report greater mood symptoms compared to patients with PD who are cognitively intact.
Collapse
Affiliation(s)
- Jacob D. Jones
- Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville, FL,Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, University of Florida, Gainesville, FL
| | - Paul Mangal
- Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville, FL,Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, University of Florida, Gainesville, FL
| | - Jacob Lafo
- Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville, FL,Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, University of Florida, Gainesville, FL
| | - Michael S. Okunm
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL,Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, University of Florida, Gainesville, FL
| | - Dawn Bowers
- Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville, FL,Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL,Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, University of Florida, Gainesville, FL
| |
Collapse
|
33
|
Heterogeneous Determinants of Quality of Life in Different Phenotypes of Parkinson's Disease. PLoS One 2015; 10:e0137081. [PMID: 26335773 PMCID: PMC4559401 DOI: 10.1371/journal.pone.0137081] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 08/12/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Health-related quality of life (HRQoL) is considered a very important outcome indicator in patients with Parkinson's disease (PD). A broad list of motor and non-motor features have been shown to affect HRQoL in PD, however, there is a dearth of information about the complexity of interrelationships between determinants of HRQoL in different PD phenotypes. We aimed to find independent determinates and the best structural model for HRQoL, also to investigate the heterogeneity in HRQoL between PD patients with different phenotypes regarding onset-age, progression rate and dominant symptom. METHODS A broad spectrum of demographic, motor and non-motor characteristics were collected in 157 idiopathic PD patients, namely comorbidity profile, nutritional status, UPDRS (total items), psychiatric symptoms (depression, anxiety), fatigue and psychosocial functioning through physical examination, validated questionnaires and scales. Structural equation model (SEM) and multivariate regressions were applied to find determinants of Parkinson's disease summary index (PDSI) and different domains of HRQoL (PDQ-39). RESULTS Female sex, anxiety, depression and UPDRS-part II scores were the significant independent determinants of PDSI. A structural model consisting of global motor, global non-motor and co-morbidity indicator as three main components was able to predict 89% of the variance in HRQoL. In older-onset and slow-progression phenotypes, the motor domain showed smaller contribution on HRQoL and the majority of its effects were mediated through non-motor features. Comorbidity component was a significant determinant of HRQoL only among older-onset and non-tremor-dominant PD patients. Fatigue was not a significant indicator of non-motor component to affect HRQoL in rapid-progression PD. CONCLUSIONS Our findings showed outstanding heterogeneities in the pattern and determinants of HRQoL among PD phenotypes. These factors should be considered during the assessments and developing personalized interventions to improve HRQOL in PD patients with different phenotypes or prominent feature.
Collapse
|
34
|
Wang L, Zhong Z, Hu J, Rong X, Liu J, Xiao S, Liu Z. Sertraline plus deanxit to treat patients with depression and anxiety in chronic somatic diseases: a randomized controlled trial. BMC Psychiatry 2015; 15:84. [PMID: 25879863 PMCID: PMC4403889 DOI: 10.1186/s12888-015-0449-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 03/19/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patients in chronic somatic diseases are often accompanied with depression and anxiety, remission of which may be observed in the third or fourth week after applying common antidepressant medications. We investigate the efficacy and safety of sertraline plus deanxit on patients with depression and anxiety in chronic somatic diseases. METHODS 75 Patients who met the criteria were randomly assigned to deanxit group or placebo group: sertraline (75 mg/day) plus deanxit (one piece/day) (N = 38), or sertraline (75 mg/day) plus placebo (one piece/day) (N = 37) for 2 weeks, both groups received sertraline (75 mg/day) in the following 2 weeks. Changes from baseline to day 4, day 8, day 15, and day 29 in Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A) total scores were the efficacy measures. Adverse events were monitored and registered systematically during the trial. RESULTS Response rates for HAM-D scores in deanxit group and placebo group were significantly different on day 8(55.26% ± 2.56% VS 24.32% ± 2.19%, p = 0.006) and day 15(78.95% ± 3.89% VS 40.54% ± 4.18%, p = 0.001), while no statistical differences were observed on day 4 and day 29. Respectively, response rates for HAM-A scores on day 4 (34.21% ± 2.21% VS 8.11% ± 1.37%, p = 0.006), day 8 (57.89% ± 3.56% VS 18.92% ± 2.68%, p = 0.001) and day 15 (78.95% ± 4.37% VS 43.24% ± 4.68%, p = 0.002), favoring the deanxit group. However, HAM-A scores were not remarkably different at the end point. The overall safety profile of both groups was favorable with no distinct differences. CONCLUSIONS The efficacy was exhibited in the deanxit group, with evidence for similar safety. The rapid onset of sertraline plus short-term deanxit indicated that it might be an inspiring strategy to manage depression and anxiety within the first two weeks in chronic somatic diseases.
Collapse
Affiliation(s)
- Limin Wang
- Department of Neurology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, 510080, Guangzhou, Guangdong Province, P P China.
| | - Zhuoyuan Zhong
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 510120, Guangzhou, China.
| | - Jingyang Hu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 510120, Guangzhou, China.
| | - Xiaoming Rong
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 510120, Guangzhou, China.
| | - Jun Liu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 510120, Guangzhou, China.
| | - Songhua Xiao
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 510120, Guangzhou, China.
| | - Zhonglin Liu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 510120, Guangzhou, China.
| |
Collapse
|
35
|
Jones JD, Marsiske M, Okun MS, Bowers D. Latent growth-curve analysis reveals that worsening Parkinson's disease quality of life is driven by depression. Neuropsychology 2014; 29:603-9. [PMID: 25365564 DOI: 10.1037/neu0000158] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Parkinson's disease (PD) is a neurodegenerative disorder resulting in a wide variety of symptoms. The current study examined the influence of apathy, depression and motor symptoms on quality of life (QoL) in PD patients. Information was drawn from an 18-month period. METHOD Participants (N = 397) were assessed for apathy (Apathy Scale; Starkstein et al., 1992), depression (Beck Depression Inventory-II; Beck, Steer, Ball & Ranieri, 1996), motor severity (Unified Parkinson's Disease Rating Scale, Part III; UPDRS; Fahn, Elton & Committee, 1987), and QoL (Parkinson's Disease Questionnaire-39; Jenkinson, Fitzpatrick, Peto, Greenhall, & Hyman,1997) at 3 time points: an initial clinical evaluation (baseline), a 6-month follow-up, and an 18-month follow-up. Latent growth-curve models were used to determine the influence of apathy, depression, and motor symptoms on QoL trajectories. RESULTS Greater difficulties with QoL at baseline showed the strongest relationship to more severe depression symptoms, followed by more severe motor symptoms, younger age, and less education (all p values < .001). Worsening of QoL over the 18-month period was only predicted by a worsening of depression (p = .003). The relationship between QoL and depression symptoms remained significant in a subsample of nondepressed PD patients. CONCLUSION Overall, findings from the current study suggest that self-reported QoL among PD patients is primarily related to depression. Future efforts to improving clinical care of PD patients may benefit by focusing on improving psychosocial adjustment or treatments targeting depression.
Collapse
Affiliation(s)
- Jacob D Jones
- Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida
| | - Michael S Okun
- Department of Neurology, McKnight Brain Institute, University of Florida
| | - Dawn Bowers
- Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida
| |
Collapse
|