Depressive symptoms in Parkinson's disease: a comparison with disabled control subjects

Psychological Factors Associated With Fear of Falling Avoidance Behavior in Parkinson's Disease: The Role of Depression, Anxiety, and Catastrophizing

PURPOSE

The purpose of this study was to examine the relationship between psychological factors (depression, anxiety, and catastrophizing) and fear of falling avoidance behavior (FFAB) among individuals with Parkinson's disease (PD).

METHODS

A secondary analysis of cross-sectional data from 59 individuals with PD using hierarchical multiple regression.

RESULTS

Disease severity (Movement Disorder Society - Unified PD Rating Scale) and catastrophizing (Consequences of Falling Questionnaire (CoF)) explained approximately 48.2% of the variance in the FFAB Questionnaire scores (P < .001). Catastrophizing was the only significant psychological variable (P < .001). The damage to identity subscale of the CoF was significant in the final model (P < .001).

CONCLUSIONS

Catastrophizing about the consequences of falls explained the largest portion of variability in FFAB after controlling for disease severity. Catastrophizing about the immediate consequences of falling may play a prominent role in FFAB and may be a potential treatment target for mitigating FFAB.

Depression in Parkinson's Disease: A Narrative Review

Parkinson's disease (PD) is a progressive neurodegenerative age-related disorder that affects the central nervous system (CNS) and is characterized by uncontrollable movements such as shaking, stiffness, and loss of balance and coordination. Depression is a common non-motor manifestation of PD, but unfortunately, depression remains unrecognized and often undertreated. The underlying pathophysiology of depression in PD is complicated, and many studies have been conducted to know the exact cause, but the question remains unanswered.

In this article, we discuss various pathophysiologies by which depression occurs in PD. The most widely accepted theories are neuroinflammation and monoamine oxidase theory. This article also explored the pharmacological treatment of depression in PD; this involves standard antidepressant therapy such as tricyclic antidepressants (TCA), serotonin-norepinephrine reuptake inhibitors (SNRI), selective serotonin reuptake inhibitors (SSRI), and monoamine oxidase inhibitors (MAO); non-pharmacological treatments such as electroconvulsive therapy (ECT), cognitive-behavioral therapy (CBT) have also been discussed. However, physicians hesitate to prescribe antidepressants to patients with PD due to concerns about harmful drug-drug interactions between antidepressants and antiparkinsonian drugs. Despite the complicated link between PD and depression, the co-administration of antidepressants and antiparkinsonian drugs is safe and beneficial when appropriately managed. However, early recognition and initiation of treatment of depression in PD reduces the longitudinal course and improves the cross-sectional picture. This review article also explored the clinical and diagnostic findings and impact on the quality of life of depression in PD.

Depression in Patients with Parkinson's Disease: Current Understanding of its Neurobiology and Implications for Treatment

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.

Modeling dopamine dysfunction in autism spectrum disorder: From invertebrates to vertebrates

Autism Spectrum Disorder (ASD) is a highly heterogeneous neurodevelopmental disorder characterized by deficits in social communication and by patterns of restricted interests and/or repetitive behaviors. The Simons Foundation Autism Research Initiative's Human Gene and CNV Modules now list over 1000 genes implicated in ASD and over 2000 copy number variant loci reported in individuals with ASD. Given this ever-growing list of genetic changes associated with ASD, it has become evident that there is likely not a single genetic cause of this disorder nor a single neurobiological basis of this disorder. Instead, it is likely that many different neurobiological perturbations (which may represent subtypes of ASD) can result in the set of behavioral symptoms that we called ASD. One such of possible subtype of ASD may be associated with dopamine dysfunction. Precise regulation of synaptic dopamine (DA) is required for reward processing and behavioral learning, behaviors which are disrupted in ASD. Here we review evidence for DA dysfunction in ASD and in animal models of ASD. Further, we propose that these studies provide a scaffold for scientists and clinicians to consider subcategorizing the ASD diagnosis based on the genetic changes, neurobiological difference, and behavioral features identified in individuals with ASD.

Mood in Parkinson's disease: From early- to late-stage disease

BACKGROUND

Although depression is known to be frequent in Parkinson's disease (PD), it is unclear how mood can change and/or impact on patient's quality of life (QoL) over time. Our aim was to analyze the frequency of depression, mood related factors and the contribution of mood to a patient's QoL perception in regard to disease duration.

METHODS

PD patients recruited from the COPPADIS cohort from January 2016 to November 2017 were included in this cross-sectional study. Three groups were defined: <5 years (Group A); from 5 to <10 years (Group B); ≥10 years (Group C). Analysis with well-planned linear regression models was conducted to determine how different factors contribute to mood (Beck Depression Inventory-II [BDI-II] as dependent variable), to health-related QoL (39-item Parkinson's Disease Questionnaire [PDQ-39SI] as dependent variable) and to global QoL (European Health Interview Survey - Quality of Life Eight-Item Index [EUROHIS-QOL8] as dependent variable).

RESULTS

Six hundred and sixty-three PD patients (62.6 ± 8.9 years old, 59.6% males) were included: Group A, 50.1% (n = 332); Group B, 33.3% (n = 221) and Group C, 16.6% (n = 110). There were no differences between the three groups in terms of the frequency of depressive symptoms nor the frequency of depression type (major vs. minor vs. subthreshold) (p = 0.729). However, the unique percent variance of PDQ-39SI and EUROHIS-QOL8 explained by BDI-II total score was 2 (23.7%) and threefold (26.9%), respectively, in Group C compared to the other two groups. EUROHIS-QOL8 total score provided the highest unique contribution to mood (16.8%).

CONCLUSIONS

Although depression-type frequency does not appear to change over time in PD; the contribution of mood on QoL perception is greater in patients with longer disease duration.

Is Attention-Deficit/Hyperactivity Disorder a Risk Syndrome for Parkinson's Disease?

Recent epidemiological evidence indicates that diagnosis of attention-deficit/hyperactivity disorder (ADHD) is associated with increased risk for diseases of the basal ganglia and cerebellum, including Parkinson's disease (PD). The evidence reviewed here indicates that deficits in striatal dopamine are a shared component of the causal chains that produce these disorders. Neuropsychological studies of adult ADHD, prodromal PD, and early-stage PD reveal similar deficits in executive functions, memory, attention, and inhibition that are mediated by similar neural substrates. These and other findings are consistent with the possibility that ADHD may be part of the PD prodrome. The mechanisms that may mediate the association between PD and ADHD include neurotoxic effects of stimulants, other environmental exposures, and Lewy pathology. Understanding the nature of the association between PD and ADHD may provide insight into the etiology and pathogenesis of both disorders. The possible contribution of stimulants to this association may have important clinical and public health implications.

Association between physical disability and incidence of depressive symptoms in older Mexican adults

Introducción.

Las limitaciones funcionales asociadas con el proceso de envejecimiento pueden conducir al desarrollo de síntomas depresivos e incrementar la vulnerabilidad de los adultos mayores.

Objetivo.

Estimar la asociación entre la discapacidad física y la incidencia de síntomas depresivos clínicamente significativos en adultos mayores mexicanos.

Materiales y métodos.

Se hizo un estudio retrospectivo de cohorte con datos provenientes de la Encuesta Nacional sobre Salud y Envejecimiento en México (ENASEM). La muestra analítica (n=6.780) incluyó a adultos mayores de 50 años que contaran con mediciones de las variables principales y que no presentaran síntomas depresivos clínicamente significativos en la ronda cero. Estos síntomas se evaluaron con la escala CESD-9 y, la discapacidad, mediante el reporte de limitaciones para la realización de actividades básicas o instrumentales de la vida diaria. Se hicieron análisis descriptivos, bivariados y multivariados, utilizando el modelo de regresión logística y ajustando según las variables sociodemográficas, las condiciones de salud, las adversidades de la infancia, la participación social y los eventos vitales estresantes.

Resultados.

La incidencia de síntomas depresivos clínicamente significativos fue de 25,75 % (IC₉₅% 24,70-26,80). Comparados con aquellas personas sin limitaciones para las actividades instrumentales, se encontró un incremento del 68 % en el riesgo para el desarrollo de dichos síntomas (IC₉₅% 1,10-2,57; p=0,015). En el modelo de actividades básicas de la vida diaria, la razón de probabilidad (odds ratio, OR) para su desarrollo fue de 1,36 (1,01-1,81; p=0,039), ambos ajustados por variables de confusión.

Conclusión.

Las limitaciones en la vida diaria son un factor de riesgo importante para el desarrollo de síntomas depresivos clínicamente significativos en personas con seguimiento de dos años.

The prevalence of psychiatric symptoms before the diagnosis of Parkinson's disease in a nationwide cohort: A comparison to patients with cerebral infarction

Objectives

Psychiatric symptoms (PS) can be non-motor features in Parkinson’s disease (PD) which are common even in the prodromal, untreated phase of the disease. Some PS, especially depression and anxiety recently became known predictive markers for PD. Our objective was to explore retrospectively the prevalence of PS before the diagnosis of PD.

Methods

In the framework of the Hungarian Brain Research Program we created a database from medical and medication reports submitted for reimbursement purposes to the National Health Insurance Fund in Hungary, a country with 10 million inhabitants and a single payer health insurance system. We used record linkage to evaluate the prevalence of PS before the diagnosis of PD and compared that with patients with ischemic cerebrovascular lesion (ICL) in the period between 2004–2016 using ICD-10 codes of G20 for PD, I63-64 for ICL and F00-F99 for PS. We included only those patients who got their PD, ICL and psychiatric diagnosis at least twice.

Results

There were 79 795 patients with PD and 676 874 patients with ICL. Of the PD patients 16% whereas of those with ischemic cerebrovascular lesion 9.7% had a psychiatric diagnosis before the first appearance of PD or ICL (p<0.001) established in psychiatric care at least twice. The higher rate of PS in PD compared to ICL remained significant after controlling for age and gender in logistic regression analysis. The difference between PD and ICL was significant for Mood disorders (F30-F39), Organic, including symptomatic, mental disorders (F00-F09), Neurotic, stress-related and somatoform disorders (F40-F48) and Schizophrenia, schizotypal and delusional disorders (F20-F29) diagnosis categories (p<0.001, for all).

Discussion

The higher rate of psychiatric morbidity in the premotor phase of PD may reflect neurotransmitter changes in the early phase of PD.

Depression et Maladie de Parkinson: étude d’une série de 135 parkinsoniens

Objective:

La fréquence de la dépression au cours de la maladie de Parkinson (MP) conduit à s’interroger sur les difficultés du diagnostic et sur les liens entre la dépression et l’histoire naturelle de la maladie.

Méthodes:

Une série consécutive de 135 sujets atteints d’une MPidiopathique a été examinée sur le plan psychiatrique (DSM-III-R, échelle de dépression de Goldberg), neurologique (en distinguant les signes “axiaux” des autres signes parkinsoniens), neuropsychologique ( et en particulier tests frontaux).

Résultats:

Plus de la moitié des sujets ont une dépression qui apparaît plus fréquente dans les formes akinétiques et les formes fluctuantes de la maladie. Les sujets déprimés n’ont pas de déficit cognitif plus marqué mais leurs scores aux tests frontaux sont plus élevés. En outre les signes axiaux de la maladie (instabilité posturale, rigidité axiale) sont plus marqués chez les parkinsoniens déprimés, suggérant un lien entre la dépression et les lésions non dopaminergiques de la maladie. Alors que le ralentissement, les troubles de l’appétit et du sommeil, la fatigue peuvent être observés même chez des parkinsoniens non dépressifs, la séparation de la population parkinsonienne en plusieurs groupes montre que certains symptômes ne sont jamais rencontrés chez les parkinsoniens non dépressifs: il en est ainsi apparu que “l’impression que la vie ne vaut pas la peine d’être vécue”, “la perte d’espoir pour l’avenir”, “l’impression de ne pas être à la hauteur, de ne rien faire de bien”, “la baisse d’énergie”, “la tristesse matinale” caractérisent la dépression parkinsonienne. La dépression parkinsonienne revêt deux grandes formes cliniques. La première est la plus riche en manifestations somatiques: troubles du sommeil, fatigue matinale; elle correspond aux dépressions les plus sévères avec une absence d’espoir pour l’avenir , une perte de confiance en soi. La seconde est pauvre en manifestations somatiques alors que l’apathie y est très fréquente ainsi que le ralentissement.

Conclusions:

Cette étude permet ainsi de préciser les symptômes de la dépression parkinsonienne qui doit être mieux reconnue pour être plus souvent traitée. Les liens entre la dépression et les signes axiaux de la maladie expliquent sans doute pourquoi la L-dopa et les agonistes dopaminergiques améliorent les signes moteurs de la dépression sans agir le plus souvent sur les manifestations dépressives.

Patterns and Predictors of Depression Treatment among Older Adults with Parkinson's Disease and Depression in Ambulatory Care Settings in the United States

Little is known regarding depression treatment patterns and predictors among older adults with comorbid Parkinson's disease and depression (dPD) in the United States (US). The objective of this study was to assess the patterns and predictors of depression treatment among older adults with dPD in the US. We adopted a cross-sectional study design by pooling multiple-year data (2005-2011) from the National Ambulatory Medical Care Survey (NAMCS) and the outpatient department of the National Hospital Ambulatory Medical Care Survey (NHAMCS). The final study sample consisted of visits by older adults with dPD. Depression treatment was defined as antidepressant use with or without psychotherapy. To identify predictors of depression treatment, multivariate logistic regression analysis was conducted adjusting for predisposing, enabling, and need factors. Individuals with dPD and polypharmacy were 74% more likely to receive depression treatment (odds ratio = 1.743, 95% CI 1.376-2.209), while dPD subjects with comorbid chronic conditions were 44% less likely (odds ratio = 0.559, 95% CI 0.396-0.790) to receive depression treatment. Approximately six out of ten older adults with PD and depression received depression treatment. Treatment options for dPD are underutilized in routine clinical practice, and further research should explore how overall medical complexity presents a barrier to depression treatment.

Psychiatric comorbidity in Wilson's disease

Wilson's disease (WD) is a relatively rare autosomal recessive inherited disorder causing copper accumulation in different organs, mainly the liver and brain. Psychiatric disturbances represent a diagnostic and therapeutic issue in WD. A search for relevant articles was carried out on PubMed/Medline, Scopus, and Google Scholar, for papers focused on psychiatric disorders in WD published between 1985-2016. Ninety-two articles were included in this review, showing the findings from 35 observational and case-control studies and 57 case reports. This study discussed the findings on the prevalence of psychiatric symptoms in WD, their impact on the life of those diagnosed, and the efficacy of available treatments on the psychiatric outcomes of WD. Psychiatric disorders are confirmed frequent in WD, with a high prevalence of mood disorders, and contribute to worse Quality-of-Life and psychosocial outcomes. Because specific therapies for WD lead to a good life expectancy, adherence to medicaments and clinical monitoring should be warranted by a multidisciplinary approach, including a hepathologic, neurologic, and psychiatric careful evaluation and education of those affected and their relatives.

Discordance Between Physician Assessment and Patient-Reported Depressive Symptoms in Parkinson Disease

OBJECTIVE

To assess concordance between physician assessment and patient-reported symptoms when screening for depression in Parkinson disease (dPD).

BACKGROUND

Depression in Parkinson disease is highly prevalent (∼40%) and has a significant impact on quality of life and disability, yet physician recognition and treatment remain inadequate.

METHODS

One thousand seventy-six patients with PD completed the Brief Symptom Inventory-18 (BSI-18), a screening questionnaire for psychiatric symptoms, which was compared to item #3 (depression) on the Unified Parkinson's Disease Rating Scale (UPDRS).

RESULTS

The mean BSI-18 depression score was 51.4 (9.7). Of the 170 (16%) patients screening positive for dPD on the BSI-18, 104 (61%) were not recognized as depressed by neurologists on the UPDRS. Factors associated with lower neurologist recognition included male gender, better mental health quality of life, and lack of antidepressant use.

CONCLUSION

More than 60% of patients screening positive for depression on self-report were not recognized by neurologists on the UPDRS. A patient-reported screening tool for depression may improve recognition and management of dPD.

[Anxiety and depressive disorders in Parkinson's disease]

This review presents the most recent data of worldwide research on anxiety and depressive disorders in patients with Parkinson's disease. Their characteristics and epidemiology, pathogenetic and clinical features, methods of diagnosis and treatment are presented. Depression occurs in 40-50% of patients with PD, anxiety in 17-43% of patients. Pramipexole, a dopamine agonist, is only one drug recommended for depression treatment. Nortriptyline and desipramine, belonging to the group of tricyclic antidepressants (TCAs), are considered to be possibly effective. There are no clear recommendations for treatment of anxiety. In general, methods of therapy of anxiety and depressive disorders in PD are not well understood which determines the conduct of large-scale studies in the future.

Neuropsychiatric symptoms in untreated Parkinson's disease

Neuropsychiatric and cognitive symptoms are common in Parkinson's disease (PD) and may precede and exceed motor symptoms as major factors impacting disease course and quality of life. Neuropsychiatric symptoms (NPS) in PD are various and are attributed to pathologic changes within multiple brain regions, to psychological stress, and to adverse effects of dopamine replacement therapy. Sleep disorders and mood symptoms such as apathy, depression, and anxiety may antedate the development of motor symptoms by years, while other NPS such as impulse control disorders, psychosis, and cognitive impairment are more common in later stages of the disease. Few studies report on NPS in the early, untreated phase of PD. We reviewed the current literature on NPS in PD with a focus on the early, drug-naive stages of PD. Among these early disease stages, premotor and early motor phases were separately addressed in our review, highlighting the underlying pathophysiological mechanisms as well as epidemiological characteristics, clinical features, risk factors, and available techniques of clinical assessment.

The roles of resilience and nonmotor symptoms in adjustment to Parkinson’s disease

Resilience contributes to better chronic disease adjustment but is understudied in Parkinson’s disease. Although nonmotor symptoms affect quality of life, their effect on other aspects of Parkinson’s disease adjustment is less understood. Hierarchical regression analyses from a cross-sectional survey of 138 community-dwelling adults with Parkinson’s disease (mean (standard deviation) age = 64.15(10.09) years) investigated relationships between nonmotor symptoms and resilience on depression, apathy, life satisfaction, and quality of life. After controlling for demographic variables, functional status, and nonmotor symptoms, resilience was associated with all adjustment variables. Nonmotor symptoms were associated with depression and worse quality of life. Nonmotor symptoms and resilience appear to play critical roles in Parkinson’s disease adjustment.

Impact of Depression on Progression of Impairment and Disability in Early Parkinson's Disease

BACKGROUND

Depression is one of the most common nonmotor symptoms associated with Parkinson's disease (PD), yet the impact of depression on progression of disease is unclear.

OBJECTIVE

The aim of this study was to prospectively characterize the relationship between depressive symptoms and measures of disease progression in a large sample of patients with early, medically treated PD.

METHODS

Baseline and longitudinal Beck Depression Inventory (BDI) scores from participants in the NINDS Exploratory Trials in PD Long Term Study 1 were correlated with changes in multiple measures of disease severity over 5 years. Multivariate analysis of predictors of change in BDI was performed.

RESULTS

Of 1,741 participants, 746 completed 5-year assessments and were included. Mean age was 62.00 years (standard deviation [SD]: 9.22) and mean disease duration was 1.69 years (SD, 1.16). Mean BDI score was 6.24 (SD, 5.02) at baseline and 8.57 (SD, 6.60) at 5 years. Baseline BDI score was strongly associated with rate of change in all examined measures of disease severity. In multivariate analysis, BDI 5-year change was associated with change in UPDRS Part I (excluding depression item; P < 0.01), 33-item Parkinson's Disease Questionnaire (P < 0.01), EuroQOL Five Dimensional Questionnaire (P = 0.02), and Total Functional Capacity (P < 0.01), but was not associated with motor or cognitive measures. This model explained 68.8% of the variance 5-year change of the BDI score.

CONCLUSIONS

Worse baseline BDI scores are associated with a decline in multiple measures of disease severity in PD. Worsening of BDI at 5 years was associated with worsening in UPDRS Part I and quality-of-life measures, but not with motor or cognitive measures.

A randomized clinical trial to evaluate the effects of rasagiline on depressive symptoms in non-demented Parkinson's disease patients

BACKGROUND AND PURPOSE

Depressed mood is a common psychiatric problem associated with Parkinson's disease (PD), and studies have suggested a benefit of rasagiline treatment.

METHODS

ACCORDO (see the ) was a 12-week, double-blind, placebo-controlled trial to evaluate the effects of rasagiline 1 mg/day on depressive symptoms and cognition in non-demented PD patients with depressive symptoms. The primary efficacy variable was the change from baseline to week 12 in depressive symptoms measured by the Beck Depression Inventory (BDI-IA) total score. Secondary outcomes included change from baseline to week 12 in cognitive function as assessed by a comprehensive neuropsychological battery; Parkinson's disease quality of life questionnaire (PDQ-39) scores; Apathy Scale scores; and Unified Parkinson's Disease Rating Scale (UPDRS) subscores.

RESULTS

One hundred and twenty-three patients were randomized. At week 12 there was no significant difference between groups for the reduction in total BDI-IA score (primary efficacy variable). However, analysis at week 4 did show a significant difference in favour of rasagiline (marginal means difference ± SE: rasagiline -5.46 ± 0.73 vs. placebo -3.22 ± 0.67; P = 0.026). There were no significant differences between groups on any cognitive test. Rasagiline significantly improved UPDRS Parts I (P = 0.03) and II (P = 0.003) scores versus placebo at week 12. Post hoc analyses showed the statistical superiority of rasagiline versus placebo in the UPDRS Part I depression item (P = 0.04) and PDQ-39 mobility (P = 0.007) and cognition domains (P = 0.026).

CONCLUSIONS

Treatment with rasagiline did not have significant effects versus placebo on depressive symptoms or cognition in PD patients with moderate depressive symptoms. Although limited by lack of correction for multiple comparisons, post hoc analyses signalled some improvement in patient-rated cognitive and depression outcomes.

Parkinson's Disease, Depression, and Quality-of-Life

BACKGROUND

Depression is the most common psychiatric disorder associated with Parkinson's disease (PD) but is often under diagnosed and under treated leading to worsening of symptoms and deterioration of the quality-of-life of the people suffering from this disease.

AIMS

The current study aims to determine the correlation between depression and health-related quality-of-life (HRQOL) domains in patients with PD.

MATERIALS AND METHODS

A sample of 65 consecutive patients attending the specialty Parkinson's clinic was assessed by a psychiatrist as part of the treatment protocol. Diagnosis of depression was done using the International Classification of Diseases-10 by a psychiatrist and depression was scored using the Geriatric Depression Scale (GDS). QOL-BREF Malayalam version was used to assess quality-of-life in the patients.

STATISTICAL ANALYSIS

One-way ANOVA was used to find the difference in the quality-of-life experienced by different age categories, duration of the disease, psychiatric co-morbidity. Independent sample t-test was used to find the difference in the quality-of-life experienced by genders, co morbid conditions and to find the difference in the scores on GDS and domains of WHO QOL BREF. Association of H and Y staging and duration of Parkinsonism with GDS Scores were computed using Pearson's Chi-square test.

RESULTS AND CONCLUSIONS

There was a significant association of female gender and depression with the physical and psychological domains of QOL while the duration and staging of PD did not have any association with QOL Domains. Depression thus emerges as one of the main predictors of poor quality-of-life in PD.

Prevalence of depression in Parkinson's disease patients in Ethiopia

BACKGROUND

Parkinson's disease (PD) is associated with cognitive and psychiatric disturbances including depression, anxiety, psychotic symptoms and sleep disturbances. These psychiatric manifestations have a negative impact on disease course and the medical management of PD patients. Major depression has a greater negative impact on patients' quality of life than abnormal motor function, and is associated with faster cognitive decline and progression of motor deficits. Thus, the objective of this study was to determine the prevalence and pattern of depression in PD outpatients in Ethiopia. We determined the age range in which depression in PD patients is most common, the most common symptoms of depression, and the epidemiologic confounders associated with depression in PD patients.

METHODS

We conducted a cross-sectional point prevalence study of all PD patients attending the follow-up clinics of the departments of neurology at Black Lion Teaching and Zewuditu Memorial Hospitals in Addis Ababa, Ethiopia, from May 2013 to August 2013. We collected information using a structured questionnaire which assessed demographic information, clinical history, and neurologic function.

RESULT

Of the 101 patients surveyed, the prevalence of depression was 58/101(57.4%). Of these patients, 1 of 58(1.7%) was on antidepressant medications. These low proportions likely indicate a low index of suspicion and under treatment of depression in PD outpatients.

CONCLUSION

In Ethiopian PD outpatients, depression is under recognized and undertreated. We recommend routine use of screening tools. In those who screen positive for depression, treatment is warranted. Further studies are needed to confirm these findings, and to increase our understanding of specific signs and symptoms of depression in the context of PD.

Major depressive disorder in Parkinson's disease: a cross-sectional study from Sri Lanka

BACKGROUND

Depression is common in Parkinson's disease (PD), and has a significant impact on the functional level of those affected. It is well studied in Western populations but data from Asia is limited. This study aims to estimate the prevalence of depression among PD patients attending a tertiary care outpatient clinic in Sri Lanka and identify potential risk factors.

METHODS

One hundred and four consecutive idiopathic PD patients as defined by the United Kingdom Parkinson's Disease Society Brain Bank Diagnostic Criteria were recruited to the study. An interviewer administered questionnaire, the Hoehn-Yahr staging scale and the Schwab-England Activities of Daily Living Scale (SEADL) were used for assessment. Depression was diagnosed through a semi-structured clinical interview based on DSM-IV-TR criteria and all subjects were rated with the Montgomery-Asberg Depression Rating Scale (MADRS).

RESULTS

The prevalence of depression in the study population was 37.5%. Among the depressed 12 (30.8%) had mild depression, 21 (53.8%) moderate depression and 6 (15.4%) had severe depression. Depression was significantly associated with the stage of PD, functional impairment, civil status, educational level, caregiver dependence and concomitant diabetes mellitus.

CONCLUSION

A significant proportion of PD patients suffers from depression. The prevalence rate of depression in the sample was similar to that reported in previous studies. Depression in PD is significantly associated with functional impairment.

Depression and Parkinson's disease: current knowledge

Depressive disturbances are common in patients with Parkinson's disease (PD) and influence many other clinical aspects of the disease. In addition to causing inherent emotional distress, depressive disorders negatively impact quality of life, motor and cognitive deficits, functional disability, and other psychiatric comorbidities in patients with PD. Knowledge of the pathophysiology of PD depression remains limited. However, clinical studies demonstrate the efficacy of medications and psychotherapies for PD depression, underscoring the importance of their timely detection and concerted management.

A matter of motion or an emotional matter? Management of depression in Parkinson’s disease

Depression is one of the most frequent comorbidities occurring in Parkinson's disease, affecting up to 50% of patients. Depression is associated with severe negative symptoms and has been shown to contribute to an increased rate of decline of both cognitive and motor function, profoundly impacting on the patient's quality of life. The symptoms of depression overlap with the motor features of Parkinson's disease, making detection difficult. Moreover, the lack of specialized screening tools means that depression remains undiagnosed and untreated in a high percentage of patients. However, depression in Parkinson's disease, when identified early, can be effectively treated with a variety of antidepressant medications, improving quality of life and preserving daily function. The focus of this review is to provide an overview of current knowledge regarding depression in Parkinson's disease, followed by a practical discussion addressing the issues of the detection, diagnosis and treatment.

Nonmotor symptoms of Parkinson’s disease

Nonmotor symptoms occur commonly in Parkinson's disease (PD) patients and are frequently under-recognized and undertreated. Symptoms include sleep abnormalities, fatigue, autonomic disturbances, mood disorders and cognitive dysfunction. Early recognition and treatment of nonmotor symptoms in PD is critical to providing optimal management. A new screening questionnaire and the revised Unified PD Rating Scale should assist healthcare providers to better identify and evaluate these symptoms. This article reviews the identification and treatment of nonmotor symptoms in PD.

Depression in Parkinson's disease: identification and management

Depression is a common psychiatric comorbidity in Parkinson's disease (PD) and contributes to significant impairments in cognitive, functional, motor, and social performance. This results in reduced quality of life, higher levels of care dependency, and increased caregiver burden. When treating depression, it is important to ensure that the patient's response to treatment will be adequately monitored. This can be accomplished in neurology or primary care settings, or in clinical settings with interdisciplinary treatment teams. Mental health services should be engaged early as a component of ongoing comprehensive care. This article reviews a general approach to treating the pharmacotherapy of depression in PD. Ultimately, clinicians should rely on empiric assessments of known risks and putative benefits to guide treatment decisions and should include a targeted and individualized multimodal approach that utilizes psychotherapeutic interventions along with pharmacologic therapies.

Depressive symptoms in Parkinson's disease and in non-neurological medical illnesses

BACKGROUND

Patients with neurological and non-neurological medical illnesses very often complain of depressive symptoms that are associated with cognitive and functional impairments. We compared the profile of depressive symptoms in Parkinson's disease (PD) patients with that of control subjects (CS) suffering from non-neurological medical illnesses.

METHODS

One-hundred PD patients and 100 CS were submitted to a structured clinical interview for identification of major depressive disorder (MDD) and minor depressive disorder (MIND), according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR), criteria. The Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory (BDI) were also administered to measure depression severity.

RESULTS

When considering the whole groups, there were no differences in depressive symptom frequency between PD and CS apart from worthlessness/guilt, and changes in appetite reduced rates in PD. Further, total scores and psychic and somatic subscores of HDRS and BDI did not differ between PD and CS. After we separated PD and CS in those with MDD, MIND, and no depression (NODEP), comparing total scores and psychic/somatic subscores of HDRS and BDI, we found increased total depression severity in NODEP PD and reduced severity of the psychic symptoms of depression in MDD PD, with no differences in MIND. However, the severity of individual symptom frequency of depression was not different between PD and CS in MDD, MIND, and NODEP groups.

CONCLUSION

Although MDD and MIND phenomenology in PD may be very similar to that of CS with non-neurological medical illnesses, neurological symptoms of PD may worsen (or confound) depression severity in patients with no formal/structured DSM-IV-TR, diagnosis of depressive mood disorders. Thus, a thorough assessment of depression in PD should take into consideration the different impacts of neurological manifestations on MDD, MIND, and NODEP.

Cognitive dysfunction and depression in Parkinson's disease: what can be learned from rodent models?

Parkinson's disease (PD) has for decades been considered a pure motor disorder and its cardinal motor symptoms have been attributed to the loss of dopaminergic (DAergic) neurons in the substantia nigra pars compacta and to nigral Lewy body pathology. However, there has more recently been a shift in the conceptualization of the disease, and its pathological features have now been recognized as involving several other areas of the brain and indeed even outside the central nervous system. There are a corresponding variety of intrinsic non-motor symptoms such as autonomic dysfunction, cognitive impairment, sleep disturbances and neuropsychiatric problems, which cannot be explained exclusively by nigral pathology. In this review, we will focus on cognitive impairment and affective symptoms in PD, and we will consider whether, and how, these deficits can best be modelled in rodent models of the disorder. As only a few of the non-motor symptoms respond to standard DA replacement therapies, the quest for a broader therapeutic approach remains a major research effort, and success in this area in particular will be strongly dependent on appropriate rodent models. In addition, better understanding of the different models, as well as the advantages and disadvantages of the available behavioural tasks, will result in better tools for evaluating new treatment strategies for PD patients suffering from these neuropsychological symptoms.

Quality of Life and Psychiatric Symptoms in Wilson's Disease: the Relevance of Bipolar Disorders

INTRODUCTION

Wilson's disease is an inherited disorder caused by a gene located on chromosome 13, which involved copper transportation across cell membranes. The disease can cause a reduced incorporation of copper into ceruloplasmin resulting in accumulation of this metal in the liver, central nervous system, kidneys and other organs. The objective is to define the frequencies of psychiatric disorders in WD, the amount of impairment of Quality of Life [QoL] in patients with WD and the relevance of the psychiatric disorders in the QoL of people suffering by WD.

METHODS

This is a systematic review. The search of the significant articles was carried out in PubMed using specific key words.

RESULTS

Such other neurological diseases, WD is characterized by chronic course and need of treatments, impairment of functional outcomes and high frequency of psychiatric symptoms, although a specific association between Bipolar Disorders and WD was recently found. Despite this, since today few studies are carried on WD patients' quality of life related to psychiatric symptoms. Some new reports showed a link between presence of Bipolar Disorders diagnosis, cerebral damage and low Qol.

CONCLUSION

Prospective studies on large cohorts are required to establish the effective impact of psychiatric disorders comorbidity, particularly Bipolar Disorders, on quality of life in WD and to clarify the causal link between brain damage, psychiatric disorders and worsening of QoL.

Components of depression in Parkinson disease

Depression is a clinically heterogeneous disorder common in Parkinson disease (PD). The goal of this study was to characterize PD depression in terms of components, including negative affect, apathy, and anhedonia. Ninety-five, nondemented individuals with idiopathic PD underwent a diagnostic interview and psychological battery. Twenty-seven patients (28%) met Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition [DSM-IV]) criteria for a current depressive episode. The best-fitting confirmatory factor analysis model had 3 factors (negative affect, apathy, and anhedonia). Apathy loaded most strongly onto a second-order factor representing global psychological disturbance. All factors are uniquely associated with depression status. Negative affect exhibited the strongest relationship. Psychological disturbance in PD is heterogeneous and can produce symptoms of apathy, anhedonia, and negative affect. Apathy appears to be the core neuropsychiatric feature of PD, whereas negative affect (eg, dysphoria) seems to be most pathognomonic of depression. Future studies should examine the specific neural correlates and treatment response patterns unique to these 3 components.

Bipolar disorders and Wilson's disease

BACKGROUND

The aim of this study was to determine the risk for Bipolar Disorder (BD) in Wilson's disease (WD) and to measure the impaired Quality of Life (QL) in BD with WD using standardized psychiatric diagnostic tools and a case control design.

METHODS

This was a case control study. The cases were 23 consecutive patients with WD treated at the University Hospital in Cagliari, Italy, and the controls were 92 sex- and age-matched subjects with no diagnosis of WD who were randomly selected from a database used previously for an epidemiological study. Psychiatric diagnoses according to DSM-IV criteria were determined by physicians using structured interview tools (ANTAS-SCID). QL was measured by means of SF-12.

RESULTS

Compared to controls, WD patients had lower scores on the SF-12 and higher lifetime prevalence of DSM-IV major depressive disorders (OR = 5.7, 95% CI 2.4-17.3) and bipolar disorders (OR = 12.9, 95% CI 3.6-46.3). BD was associated with lower SF-12 in WD patients.

CONCLUSIONS

This study was the first to show an association between BD and WD using standardized diagnostic tools and a case control design. Reports in the literature about increased schizophrenia-like psychosis in WD and a lack of association with bipolar disorders may thus have been based on a more inclusive diagnosis of schizophrenia in the past. Our findings may explain the frequent reports of loss of emotional control, hyperactivity, loss of sexual inhibition, and irritability in WD patients. This study was limited by a small sample size.

Depressive symptoms in Parkinson disease: degree of association and rate of agreement of clinician-based and self-report measures

Depression in Parkinson disease (PD) is associated with faster disease progression, lower activities of daily living, and more severe cognitive impairment. Even mild symptoms of depression may impact outcomes in patients with PD. Nevertheless, a low rate of agreement has been reported between patient and clinician ratings of depression, suggesting that clinicians may underestimate depression in patients with PD. However, to accurately compare the rates of agreement, comparable estimates are needed so that patient and clinician ratings have similar meaning (eg, mild, moderate, severe, etc). The purpose of this study was to examine this question by investigating the degree of association and rate of agreement of levels of symptom severity among self-report and clinician ratings using established cutoffs that correspond to more comparable estimates of these levels for both patient and clinician. Our findings suggest that patient's self-report of depressive symptoms was significantly correlated with clinician-based report irrespective of the stage of disease. Moreover, patients demonstrated a 72% rate of agreement with clinicians in classifying symptoms as asymptomatic, mildly symptomatic, or fully symptomatic, a rate significantly higher than the rate of 35% previously reported. This difference in rate of agreement may be accounted for using varying criteria for severity levels across the studies. Findings suggest that clinician and patient reports show a high rate of agreement across a range of depressive symptoms and that self-report measures may provide a relatively efficient means of detecting depressive symptoms especially if patients are disinclined to initiate their report.

Mechanisms of antidepressant action: an integrated dopaminergic perspective

The molecular mechanisms that cause and maintain the major depressive disorder (MDD) are currently unknown. Consistently, antidepressant treatments are characterized by insufficient success rates. This causes high social costs and severe personal sufferings. In the present review we analyze some of the paradigms that are used to explain MDD, particularly from the perspective of the dopaminergic (DA) system. DA has been more classically associated with psychosis and substance abuse disorders, even though a role of DA in MDD has been proposed as well and some antidepressants with DA profile exist. In the present work, we review some of the molecular mechanisms that underpin MDD from the perspective of the dopaminergic system, in the hope of unifying some of the major theories of MDD - the monoaminergic, inflammatory, epigenetics, neurotrophin and anti-apoptotic theories. Several shared components of these theories are highlighted, partially accounted by the functions of the DA system (see supplementary video).

Assessment methods and factors associated with depression in Parkinson's disease

Depression is a common problem experienced by patients with Parkinson's disease (PD). Identifying depression in PD is difficult and the determinants of depression in PD are complex and debatable. Here we review our recent studies which have (i) examined the validity of current depression rating scales in PD, (ii) introduced a self-reported and validated strategy to identify a lifetime history of depression in PD, and (iii) investigated genetic and non-genetic factors associated with depression in the context of PD. Our research showed PD-specific cut-off values suitable to use for the Hamilton Depression Scales (HAMD and HDI) and the Geriatric Depression Scale (GDS-15) when dichotomising patients with and without a current depression. Using the GDS-15 specific cut-off scores and a number of self-reported questions that screen for a lifetime history of depression, we developed a novel method to dichotomise PD patients according to current depression or a past history of depression. This method was applied in a large-scale study examining the factors associated with depression in PD. We clarified that the severity of PD is positively related to depression. We also showed that a number of other clinical factors including a longer duration of PD, a younger PD onset age, frequent falls, a history of anxiety disorder and memory problems were associated with depression in PD. In addition to these clinical factors, we observed associations between depression, and lower education levels, a history of smoking and a regular use of non-aspirin bases NSAIDs or analgesics. No associations were found between depression in PD and common genetic variations examined across the serotonin and dopamine transporter genes. Our studies provide a focus for future intervention strategies.

Factors associated with depression in Parkinson's disease

BACKGROUND

Depression is common in Parkinson's disease (PD) and contributes significantly to a reduced quality of life in PD patients. The determinants of depression in PD are complex and poorly understood. We investigated the factors associated with depression in PD.

METHODS

PD patients were recruited from Neurology clinics. A validated method was used to screen for a lifetime history of depression. 'Depressed' patients were identified by a score of >6 in the Geriatric Depression Scale (GDS-15) or by having had prescribed treatment for depression. 'Never depressed' patients were recognised by a score of <5 in the GDS-15 with no signs of a history of depression. A newly developed and validated questionnaire was used to collect other information.

RESULTS

Depression was identified in 66% of the 639 PD patients who met the inclusion criteria. Depression was associated with an increased severity of illness as evidenced by higher Unified PD Rating Scale scores and a higher Hoehn and Yahr stage. Other clinical factors associated with disease severity were also more frequently observed in depressed patients. Similar to findings in non-PD samples, depressed PD patients were more likely to have a lower education level, a history of smoking and to regularly use non-aspirin based NSAIDs or analgesics. Comorbidities such as anxiety, memory problems, hallucinations, sleep disturbances and postural hypotension were more common in depressed PD patients.

LIMITATIONS

To avoid patient exhaustion of over-surveying, some factors within the psychological domain were not examined.

CONCLUSION

Our results provide a focus for future intervention strategies.

Parkinson's disease: the quintessential neuropsychiatric disorder

Although diagnosed by characteristic motor features, Parkinson's disease may be preceded, and is frequently accompanied by, a wide range of cognitive and neuropsychiatric features. In addition to the most commonly studied disorders of dementia, depression, and psychosis, other relatively common and clinically significant psychiatric complications include impulse control disorders, anxiety symptoms, disorders of sleep and wakefulness, and apathy. These problems may be underrecognized and are frequently undertreated. The emergent focus on nonmotor aspects of Parkinson's disease over the past quarter of a century is highlighted by a nonlinear increase in the number of articles published devoted to this topic. Although the development of newer antidepressants, atypical antipsychotics, and cholinesterase inhibitors in recent years has had a positive benefit on the management of these troublesome and distressing symptoms, responses are frequently suboptimal, and this remains an area of major unmet therapeutic need.

Apathy and depression in Parkinson disease

The purpose of this study was to investigate the prevalence and clinical correlates of apathy and depression in Parkinson disease (PD), and to clarify whether apathy can be dissociated from depression. One hundred fifty patients with PD completed the Beck Depression Inventory Second Edition (BDI-II), Starkstein's Apathy Scale (AS), and a quality of life (QOL) battery. Hoehn and Yahr (HY) staging, the Unified Parkinson's Disease Rating Scale (UPDRS), and the Mini-Mental State Examination (MMSE) were performed on the same day. Apathy (AS score > or = 16) was diagnosed in 60% of patients and depression (BDI-II score > or = 14) in 56%. Apathy coexisted with depression in 43% of patients, compared with depression without apathy in 13% and apathy without depression in 17%. Apathy scale score was significantly correlated with UPDRS scores, HY stage, and age, whereas BDI-II score was correlated only with UPDRS scores. Both AS and BDI-II scores were negatively correlated with QOL. However, multiple regression analysis revealed that depression was strongly and negatively associated with emotional well-being and communication, whereas apathy was mainly associated with cognition and stigma. These findings suggest that apathy and depression may be separable in PD, although both are common in patients with PD and are associated with QOL.

Brainstem pathology and non-motor symptoms in PD

Parkinson's disease (PD) is considered a multisystem disorder involving dopaminergic, noradrenergic, serotoninergic, and cholinergic systems, characterized by motor and non-motor symptoms. The causes of the non-motor symptoms in PD are multifactorial and unlikely to be explained by single lesions. However, several evidence link them to damage of specific brainstem nuclei. Numerous brainstem nuclei are engaged in fundamental homeostatic mechanisms, including gastrointestinal regulation, pain perception, mood control, and sleep-wake cycles. In addition, these nuclei are locally interconnected in a complex manner and are subject to supraspinal control. The objective of this review is to provide a better overview of the current knowledge about the consequences of the involvement of specific brainstem nuclei to the most prevalent non-motor symptoms occurring in PD. The multidisciplinary efforts of research directed to these non-nigral brainstem nuclei, in addition to the topographical and chronological spread of the disease - especially in the prodromal stages of PD, are discussed.

Parkinson's disease and suicide: a profile of suicide victims with Parkinson's disease in a population-based study during the years 1988-2002 in Northern Finland

OBJECTIVE

We studied the prevalence of hospital-treated Parkinson's disease (PD) among suicide victims and the profile of these persons, taking into account suicide attempts, timing of depression and comorbid somatic diseases.

METHODS

The database of this study consisted of suicide victims aged 50 years of age or older (n = 555) during a fourteen-year period in the province of Oulu in Northern Finland.

RESULTS

Hospital-treated Parkinson's disease occurred in 1.6% of the subjects, indicating a rather low prevalence of suicide in this group of patients. The persons with PD had attempted suicide earlier in 44% of the cases, while the corresponding percentage for other victims in older age was 9.9% (p = 0.009 Fischer exact test).

CONCLUSIONS

Based on the case characteristics of our study the profile of PD person who completed suicide was as follows: male subject with recently diagnosed disease, living in rural area, having multiple physical illnesses, and having attempted suicide earlier. Psychiatric consultation is thus highly recommended for the PD patients with this disease profile.

Nonmotor manifestations of Parkinson's disease

Parkinson's disease (PD) is the second most common neurodegenerative disease after Alzheimer's disease. Traditionally, attention has focused on the motor symptomatology of PD, but it is now appreciated that the nonmotor symptoms affecting neuropsychiatric, sleep, autonomic, and sensory domains occur in up to 88% of PD patients and can be an important source of disability. Nonmotor manifestations of PD play a significant role in the impairment of disease-related quality of life. The cause of nonmotor manifestations of PD is multifactorial, but to a large extent, these manifestations are related to the nature of the neurodegenerative process and the widespread nondopaminergic neuropathological changes associated with the disease. Recognition of nonmotor disability is essential not only for ascertaining the functional status of patients but also for better appreciating the nature of the neurodegenerative process in PD. In addition, a number of nonmotor manifestations can precede the onset of motor symptoms in PD and can be used as screening tools allowing for early disease identification and for trials of possible disease-modifying interventions. This article reviews depression, sleep, and autonomic dysfunction in PD.

Psychiatric symptoms in Parkinson's disease

Parkinson's disease (PD) is a neurodegenerative disorder which is often reduced to a mere dysfunction of motor performance. Non-motor symptoms, however, are frequent impairments in PD and result in a major impact on the patients and their caregivers. The major neuropsychiatric comorbidities depression, anxiety, and psychotic symptoms are briefly discussed. Additionally, a brief outlook on deep brain stimulation and its effect on psychiatric symptoms is provided. Several studies did show that neuropsychiatric symptoms are underdiagnosed and consecutively treated inadequately. All in all more attention should be directed to the detection and treatment of psychiatric symptoms in PD patients in routine clinical settings.

Cognitive neuroscience and brain imaging in bipolar disorder

Bipolar disorder is characterized by a combination of state-related changes in psychological functíon that are restricted to illness episodes, coupled with trait-related changes that persist through periods of remission, irrespective of symptom status. This article reviews studies that have investigated the brain systems involved in these state-and trait-related changes, using two techniques: (i) indirect measures of neurocognitive function, and (ii) direct neuroimaging measures of brain function during performance of a cognitive task. Studies of neurocognitive function in bipolar disorder indicate deficits in three core domains: attention, executive function, and emotional processing. Functional imaging studies implicate pathophysiology in distributed neural circuitry that includes the prefrontal and anterior cingulate cortices, as well as subcortical limbic structures including the amygdala and the ventral striatum. Whilst there have been clear advances in our understanding of brain changes in bipolar disorder, there are limited data in bipolar depression, and there is limited understanding of the influence of clinical variables including medication status, illness severity, and specific symptom dimensions.

Circadian variation of core body temperature in Parkinson disease patients with depression: a potential biological marker for depression in Parkinson disease

BACKGROUND

The biological rhythm in comorbidity of depression and Parkinson disease (PD) is still unclear. For early diagnosis or clarification of the pathologic condition of comorbidity of depression and PD, the present study investigated the presence of circadian rhythm abnormalities in patients with depression.

METHODS

We measured the rectal temperature (RT) in 30 PD patients with or without depression during 48 consecutive hours using the maximum entropy method (MEM) and least-squares method (COSINOR). The presence of major or minor depression was evaluated by the Mini International Neuropsychiatric Interview based on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders, and the Hamilton Depression Scale.

RESULTS

The RT rhythms of patients without depression predominately showed a circadian rhythm. However, 2 of 6 patients with depression showed an infradian rhythm using MEM. COSINOR revealed that PD patients with depression showed lower amplitudes of core body temperature (p = 0.012) and higher minimum RT (p = 0.031) relative to those of patients without depression.

CONCLUSION

PD patients with depression show an altered RT circadian rhythm. The results suggest that the characteristics of core body temperature could be potentially used as a biological marker for depression in PD.

Frequency and treatment of depressive symptoms in a Parkinson's disease registry

Purpose of this cross-sectional study was to estimate the occurrence of depressive symptoms, as related to other clinical data, in a sample of Parkinson's disease (PD) patients (n=226). Furthermore, we examined the medical care of depressive symptoms in this sample. H&Y stages, cognitive status, sleeping disorders, and dysphagia resulted as significant predictors for depression. Prevalence of depressive symptoms was 35.4%. Only 25.0% of patients suffering from moderate to severe depressive symptoms were prescribed antidepressants. This study supports the view that depression may be underrecognized and undertreated in PD patients. A significant proportion of patients continues to experience depressive symptoms despite antidepressive medication. Recognition and treatment of depression remains a challenge for management of PD. Possible coexisting depressive symptoms should be revealed and assessed by standardized interviews in everyday clinical routine. Large scale randomized controlled trials examining efficacy and safety of antidepressants in PD patients are urgently required.

Depression in Parkinson's disease: health risks, etiology, and treatment options

Depression is found in about 30%-40% of all patients with Parkinson's disease (PD), but only a small percentage (about 20%) receive treatment. As a consequence, many PD patients suffer with reduced health-related quality of life. To address quality of life in depressed PD patients, we reviewed the literature on the health correlates of depression in PD (eg, cognitive function), etiology of depression in PD, and treatment options (ie, antidepressants, electroconvulsive therapy, and psychotherapy). The current review is unique in its focus on psychosocial aspects, as well as neuropathological factors, of depression in PD. Overall, we conclude that neurochemical (eg, serotonin) and psychosocial factors (eg, coping style, self-esteem, and social support) contribute to the affective disturbances found in this neuropsychiatric population. Therefore, we recommend that a multidisciplinary (eg, pharmacotherapeutic, psychoeducational, and/or psychotherapeutic) approach to treatment be taken with depressed PD patients.

Treatment with antiparkinson and antidepressant drugs: a register-based, pharmaco-epidemiological study

Depressive symptoms and major depression are frequent in patients with Parkinson's disease (PD). However, a systematic knowledge about the treatment with antidepressant drugs among PD patients is missing. We estimated the frequency of antidepressant drug treatment in a national sample of persons treated with antiparkinson drugs (APDs). All persons treated with APDs were identified in the national Danish Prescription database. The subsequent risk of treatment with antidepressants was estimated and compared with the risks for two large control groups. The study period was 5 years. In total, 1,029,737 persons were included. Persons who got APDs had significantly increased rate ratios (RR) of subsequent antidepressant drug treatment compared with an unexposed control group (RR: 2.10 (95% CI: 2.04-2.16)) and with persons who got anti-diabetic drugs [RR: 1.58 (95% CI: 1.51-1.65)]. Persons treated with APDs have higher frequency of antidepressant drug treatment than have controls. With the reservation that data on drug consumption cannot be directly transferred into conclusions about specific diseases, the present study supports results from other population-based studies of an association between PD and depression.

Impact of psychogenic movement disorders versus Parkinson's on disability, quality of life, and psychopathology

Patients with psychogenic movement disorders (PMD) often report severe impairment, yet the impact of PMD on disability and quality of life has not been examined. We compared 66 patients with PMD and 704 patients with Parkinson's disease (PD) on measures of disability (Older Americans Resources and Services Scale, OARS); quality of life (QOL; SF-12v2 Health Survey) and psychiatric symptomatology (Brief Symptom Inventory 18, BSI-18). On the total OARS, PMD and PD patients reported similar levels of disability (17.6 +/- 6.6, 19.8 +/- 10.9, P = 0.490 at "best" function and 24.1 +/- 11.2, 26.2 +/- 14.3, P = 0.497 at their "worst" function). PMD patients reported similar Physical Health QOL to PD patients (38.9 +/- 14.5, 39.8 +/- 11.6, P = 0.652) but worse mental health QOL (41.6 +/- 13.4 vs. 48.9 +/- 11.0, P < 0.001). On the BSI-18, PMD patients reported higher levels of distress on the Global Symptom Index (62.03 +/- 9.6 vs. 53.7 +/- 9.9, P < 0.001) and on Anxiety, Depression and Somatization subscales (PMD vs. PD scores: Anxiety 58.9 +/- 12.0 vs. 52.3 +/- 10.1, P < 0.001; Depression 58.8 +/- 11.9 vs. 51.3 +/- 10.3, P < 0.001; Somatization 60.5 +/- 11.0 vs. 54.7 +/- 8.7, P < 0.001). Thus, severity of disability reported by the PMD group was equal to that seen in a progressive neurodegenerative condition. Quality of life and mental health implications of PMD were also evident. PMD impacts several aspects of patient function and daily life.

Characteristics of depression in Parkinson's disease: Evaluating with Zung's Self-Rating Depression Scale

The purpose of the study was to elucidate characteristics of depression in Parkinson's disease (PD). Fifty-eight PD patients were evaluated with Zung's Self-Rating Depression Scale (SDS) and the Unified Parkinson's Disease Rating Scale (UPDRS). Scores for "suicidal ideation" on the SDS correlated with posture and gait disturbances on the UPDRS. Twenty-six patients with spinocerebellar degeneration (SCD) were also evaluated with the SDS. SDS scores for "indecisiveness" and "constipation" were significantly higher in PD patients than SCD patients. Our results suggest that depression is common in disabled persons but PD patients might have a characteristic clinical presentation.