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Jellinger KA. The pathobiological basis of depression in Parkinson disease: challenges and outlooks. J Neural Transm (Vienna) 2022; 129:1397-1418. [PMID: 36322206 PMCID: PMC9628588 DOI: 10.1007/s00702-022-02559-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
Depression, with an estimated prevalence of about 40% is a most common neuropsychiatric disorder in Parkinson disease (PD), with a negative impact on quality of life, cognitive impairment and functional disability, yet the underlying neurobiology is poorly understood. Depression in PD (DPD), one of its most common non-motor symptoms, can precede the onset of motor symptoms but can occur at any stage of the disease. Although its diagnosis is based on standard criteria, due to overlap with other symptoms related to PD or to side effects of treatment, depression is frequently underdiagnosed and undertreated. DPD has been related to a variety of pathogenic mechanisms associated with the underlying neurodegenerative process, in particular dysfunction of neurotransmitter systems (dopaminergic, serotonergic and noradrenergic), as well as to disturbances of cortico-limbic, striato-thalamic-prefrontal, mediotemporal-limbic networks, with disruption in the topological organization of functional mood-related, motor and other essential brain network connections due to alterations in the blood-oxygen-level-dependent (BOLD) fluctuations in multiple brain areas. Other hypothetic mechanisms involve neuroinflammation, neuroimmune dysregulation, stress hormones, neurotrophic, toxic or metabolic factors. The pathophysiology and pathogenesis of DPD are multifactorial and complex, and its interactions with genetic factors, age-related changes, cognitive disposition and other co-morbidities awaits further elucidation.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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2
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Hu S, Huang S, Ma J, Li D, Zhao Z, Zheng J, Li M, Wang Z, Sun W, Shi X. Correlation of Decreased Serum Pituitary Adenylate Cyclase-Activating Polypeptide and Vasoactive Intestinal Peptide Levels With Non-motor Symptoms in Patients With Parkinson's Disease. Front Aging Neurosci 2021; 13:689939. [PMID: 34566619 PMCID: PMC8457255 DOI: 10.3389/fnagi.2021.689939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/16/2021] [Indexed: 12/05/2022] Open
Abstract
Objective: Pituitary adenylate-cyclase activating polypeptide (PACAP) and vasoactive intestinal peptide (VIP) are two neuropeptides that exhibit anti-inflammatory and neuroprotective properties, modulating the production of cytokines and chemokines, and the behavior of immune cells. However, the relationship between PACAP and VIP levels and Parkinson’s disease (PD) are not clear. The aim of the current study was to evaluate serum PACAP and VIP levels in PD patients and to analysis the correlation between neuropeptide levels and non-motor symptoms. Methods: In this cross-sectional study, we enrolled 72 patients with idiopathic PD and 71 healthy volunteers. Serum PACAP and VIP levels were measured using an enzyme-linked immunosorbent assay (ELISA) kit. Non-motor symptoms were assessed with the Non-Motor Symptoms Scale (NMSS) for PD, including total and single-item scores. Results: The serum PACAP levels of PD patients were significantly lower than those of healthy controls [(76.02 ± 43.78) pg/ml vs. (154.96 ± 76.54) pg/ml, P < 0.001]; and the serum VIP levels of PD patients were also significantly lower than those of healthy controls [(109.56 ± 15.39) pg/ml vs. (136.46 ± 24.16) pg/ml, P < 0.001]. PACAP levels were inversely correlated only with the score on NMSS item five, assessing Attention/memory (r = −0.276, P < 0.05) and lower serum PACAP levels were detected in the cognitive dysfunction subgroup than in the cognitively intact subgroup [(61.87 ± 32.66) pg/ml vs. (84.51 ± 47.59) pg/ml, P < 0.05]; meanwhile, VIP levels were inversely correlated with the NMSS total score (r = −0.285, P < 0.05) and the single-item scores for item one, assessing Cardiovascular (r = −0.257, P < 0.05) and item three, assessing Mood/cognition (r = −0.373, P < 0.05), and lower serum VIP levels were detected in the anxiety subgroup and depression subgroup than in the non-anxiety subgroup and non-depression subgroup, respectively [(107.45 ± 15.40) pg/ml vs. (116.41 ± 13.67) pg/ml, P < 0.05]; [(104.45 ± 15.26) pg/ml vs. (113.43 ± 14.52) pg/ml, P < 0.05]. Conclusion: The serum PACAP and VIP levels of PD patients were significantly lower than those of healthy controls. The non-motor symptoms significantly negatively correlated with serum PACAP level was cognitive dysfunction, while mood disorder was significantly correlated with serum VIP level.
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Affiliation(s)
- Shiyu Hu
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China.,Department of Neurology, People's Hospital of Henan University, Zhengzhou, China
| | - Shen Huang
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China.,Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianjun Ma
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China.,Department of Neurology, People's Hospital of Henan University, Zhengzhou, China.,Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongsheng Li
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China.,Department of Neurology, People's Hospital of Henan University, Zhengzhou, China.,Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhenxiang Zhao
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China.,Department of Neurology, People's Hospital of Henan University, Zhengzhou, China.,Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinhua Zheng
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China.,Department of Neurology, People's Hospital of Henan University, Zhengzhou, China.,Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Mingjian Li
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China.,Department of Neurology, People's Hospital of Henan University, Zhengzhou, China
| | - Zhidong Wang
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China.,Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenhua Sun
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China.,Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoxue Shi
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, China.,Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, China
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3
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van Wamelen DJ, Sringean J, Trivedi D, Carroll CB, Schrag AE, Odin P, Antonini A, Bloem BR, Bhidayasiri R, Chaudhuri KR. Digital health technology for non-motor symptoms in people with Parkinson's disease: Futile or future? Parkinsonism Relat Disord 2021; 89:186-194. [PMID: 34362670 DOI: 10.1016/j.parkreldis.2021.07.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There is an ongoing digital revolution in the field of Parkinson's disease (PD) for the objective measurement of motor aspects, to be used in clinical trials and possibly support therapeutic choices. The focus of remote technologies is now also slowly shifting towards the broad but more "hidden" spectrum of non-motor symptoms (NMS). METHODS A narrative review of digital health technologies for measuring NMS in people with PD was conducted. These digital technologies were defined as assessment tools for NMS offered remotely in the form of a wearable, downloadable as a mobile app, or any other objective measurement of NMS in PD that did not require a hospital visit and could be performed remotely. Searches were performed using peer-reviewed literature indexed databases (MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane CENTRAL Register of Controlled Trials), as well as Google and Google Scholar. RESULTS Eighteen studies deploying digital health technology in PD were identified, for example for the measurement of sleep disorders, cognitive dysfunction and orthostatic hypotension. In addition, we describe promising developments in other conditions that could be translated for use in PD. CONCLUSION Unlike motor symptoms, non-motor features of PD are difficult to measure directly using remote digital technologies. Nonetheless, it is currently possible to reliably measure several NMS and further digital technology developments are underway to offer further capture of often under-reported and under-recognised NMS.
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Affiliation(s)
- Daniel J van Wamelen
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; Parkinson's Foundation Centre of Excellence at King's College Hospital, Denmark Hill, London, United Kingdom; Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, the Netherlands.
| | - Jirada Sringean
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Dhaval Trivedi
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; Parkinson's Foundation Centre of Excellence at King's College Hospital, Denmark Hill, London, United Kingdom
| | - Camille B Carroll
- Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Anette E Schrag
- Department of Clinical and Movement Neurosciences, University College London, London, United Kingdom
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Angelo Antonini
- Movement Disorders Unit, Department of Neuroscience, University of Padua, Padua, Italy
| | - Bastiaan R Bloem
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, the Netherlands
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - K Ray Chaudhuri
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; Parkinson's Foundation Centre of Excellence at King's College Hospital, Denmark Hill, London, United Kingdom
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Dhingra A, Janjua AU, Hack L, Waserstein G, Palanci J, Hermida AP. Exploring Nonmotor Neuropsychiatric Manifestations of Parkinson Disease in a Comprehensive Care Setting. J Geriatr Psychiatry Neurol 2021; 34:181-195. [PMID: 32242493 DOI: 10.1177/0891988720915525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Parkinson disease (PD) is a debilitating neurological condition that includes both motor symptoms and nonmotor symptoms (NMS). Psychiatric complaints comprise NMS and are collectively referred to as neuropsychiatric manifestations. Common findings include atypical depressive symptoms, anxiety, psychosis, impulse control disorder, deterioration of cognition, and sleep disturbances. Quality of life (QoL) of patients suffering from NMS is greatly impacted and many times can be more debilitating than motor symptoms of PD. We expand on knowledge gained from treatment models within a comprehensive care model that incorporates multidisciplinary specialists working alongside psychiatrists to treat PD. Insight into background, clinical presentations, and treatment options for patients suffering from neuropsychiatric manifestations of PD are discussed. Identifying symptoms early can help improve QoL, provide early symptom relief, and can assist tailoring treatment plans that limit neuropsychiatric manifestations.
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Affiliation(s)
- Amitha Dhingra
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - A Umair Janjua
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Laura Hack
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Gabriella Waserstein
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Justin Palanci
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Adriana P Hermida
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
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Treatment Options for Motor and Non-Motor Symptoms of Parkinson's Disease. Biomolecules 2021; 11:biom11040612. [PMID: 33924103 PMCID: PMC8074325 DOI: 10.3390/biom11040612] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/29/2021] [Accepted: 04/15/2021] [Indexed: 12/11/2022] Open
Abstract
Parkinson’s disease (PD) usually presents in older adults and typically has both motor and non-motor dysfunctions. PD is a progressive neurodegenerative disorder resulting from dopaminergic neuronal cell loss in the mid-brain substantia nigra pars compacta region. Outlined here is an integrative medicine and health strategy that highlights five treatment options for people with Parkinson’s (PwP): rehabilitate, therapy, restorative, maintenance, and surgery. Rehabilitating begins following the diagnosis and throughout any additional treatment processes, especially vis-à-vis consulting with physical, occupational, and/or speech pathology therapist(s). Therapy uses daily administration of either the dopamine precursor levodopa (with carbidopa) or a dopamine agonist, compounds that preserve residual dopamine, and other specific motor/non-motor-related compounds. Restorative uses strenuous aerobic exercise programs that can be neuroprotective. Maintenance uses complementary and alternative medicine substances that potentially support and protect the brain microenvironment. Finally, surgery, including deep brain stimulation, is pursued when PwP fail to respond positively to other treatment options. There is currently no cure for PD. In conclusion, the best strategy for treating PD is to hope to slow disorder progression and strive to achieve stability with neuroprotection. The ultimate goal of any management program is to improve the quality-of-life for a person with Parkinson’s disease.
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A randomized controlled double-blind study of rotigotine on neuropsychiatric symptoms in de novo PD. NPJ PARKINSONS DISEASE 2020; 6:41. [PMID: 33319786 PMCID: PMC7738499 DOI: 10.1038/s41531-020-00142-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/30/2020] [Indexed: 12/25/2022]
Abstract
Management of apathy, depression and anxiety in Parkinson’s disease (PD) represents a challenge. Dopamine agonists have been suggested to be effective. This multicenter, randomized (1:1), double-blind study assessed the 6-month effect of rotigotine versus placebo on apathy, depression and anxiety in de novo PD. The primary outcome was the change of apathy, measured with the LARS. The secondary outcomes were the change in depression and anxiety, measured with BDI-2 and STAI-trait and state. Forty-eight drug-naive PD patients were included. The primary outcome was not reached, with a surprisingly high placebo effect on apathy (60%). There was no significant difference in the change of depression at 6 months between rotigotine and placebo. Trait-anxiety was significantly improved by rotigotine compared to placebo (p = 0.04). Compared to placebo, low dose rotigotine significantly improved trait anxiety, but not apathy and depression. The major placebo effect on apathy points towards the importance of a multidisciplinary and tight follow-up in the management of neuropsychiatric symptoms.
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7
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Ryu DW, Kim JS, Yoo SW, Oh YS, Lee KS. The Impact of Impulsivity on Quality of Life in Early Drug-Naïve Parkinson's Disease Patients. J Mov Disord 2019; 12:172-176. [PMID: 31390856 PMCID: PMC6763718 DOI: 10.14802/jmd.19004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/29/2019] [Indexed: 12/30/2022] Open
Abstract
Objective Impulse control disorders (ICDs) in Parkinson’s disease (PD) are mostly related to dopamine replacement therapy (DRT); however, drug-naïve PD patients have also frequently experienced impulsivity. This phenomenon makes clinicians hesitate treating patients with DRT. In this study, we assessed the effect of impulsivity on quality of life (QOL) in drug-naïve PD patients. Methods Two hundred three newly diagnosed, nonmedicated PD patients were enrolled, and they received structured clinical interviews, physical examinations and validated questionnaires to evaluate motor and nonmotor symptoms and QOL. Impulsivity was evaluated using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease-Rating Scale (QUIP-RS). Results Thirty-eight patients (18.7%) had impulsivity with QUIP-RS scores ≥ 1 and 4 patients (2.0%) were diagnosed with combined ICDs. Motor and nonmotor symptoms were significantly correlated with the Parkinson’s Disease Questionnaire-39 summary index. Female sex and QUIP-RS scores were also correlated with QOL in drug-naïve PD patients. Conclusion The results of the present study showed that impulsivity negatively influences QOL in early drug-naïve PD patients. In addition, more severe motor and nonmotor symptoms were also associated with lower QOL. Such findings complicate treatment but provide valuable information for managing early PD.
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Affiliation(s)
- Dong-Woo Ryu
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Won Yoo
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon-Sang Oh
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwang-Soo Lee
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Fastame MC, Hitchcott PK, Corona F, Pilloni G, Porta M, Pau M, Penna MP. Memory, Subjective Memory and Motor Functioning in Non-Demented Elders With and Without Parkinson's Disease. EUROPES JOURNAL OF PSYCHOLOGY 2019; 15:404-420. [PMID: 33574963 PMCID: PMC7871757 DOI: 10.5964/ejop.v15i2.1672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/07/2018] [Indexed: 01/01/2023]
Abstract
Parkinson's Disease (PD) is a progressive neurological condition characterized by motor and non-motor symptoms impacting life quality. The main aim of the current study was to investigate the effect of PD on objective (i.e., working memory and semantic memory) and subjective memory (i.e., self-reported seriousness of forgetting, mnemonic usage and actual memory efficiency) controlling for the effect of depressive symptomatology. The relationship of working memory performance to gait and mobility indices was also examined, as well as the factors predicting subjective memory were explored. Fifty-four community-dwelling adults (mean age = 72.3 years, SD = 8.8) were recruited in Sardinia, an Italian island located in the Mediterranean Sea. Specifically, 27 non-demented adults with mild, early-stage PD were matched for years of education, age, and gender with a sample of healthy individuals. Participants completed a test battery assessing objective memory, subjective memory, and depressive symptoms, and an instrumental analysis of gait and functional mobility was performed. Participants with PD had poorer objective memory across all indices measured and displayed a restricted set of gait and posture impairments. Working memory performance was selectively related to gait and posture measures. Moreover, participants with PD had lower trust in their memory efficiency relative to the past than the control healthy group. Finally, 22% of the variance in seriousness of the consequences of forgetting was predicted by education and general cognitive efficiency. Overall, the present findings confirm the presence of changes in both objective and subjective memory in PD, independent from depressive symptoms.
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Affiliation(s)
- Maria Chiara Fastame
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, Cagliari, Italy
| | - Paul Kenneth Hitchcott
- Department of Surgery, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Federica Corona
- Department of Mechanical, Chemical and Material Engineering, University of Cagliari, Cagliari, Italy
| | - Giuseppina Pilloni
- Department of Mechanical, Chemical and Material Engineering, University of Cagliari, Cagliari, Italy
| | - Micaela Porta
- Department of Mechanical, Chemical and Material Engineering, University of Cagliari, Cagliari, Italy
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Material Engineering, University of Cagliari, Cagliari, Italy
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Hitchcott PK, Fastame MC, Corona F, Pilloni G, Porta M, Pau M, Conti R, Penna MP. Self-reported physical and mental health and motor functioning in elders with and without Parkinson's disease. PSYCHOL HEALTH MED 2019; 24:788-798. [PMID: 30729806 DOI: 10.1080/13548506.2019.1574355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Parkinson's Disease (PD) is a neurological disorder characterized by motor symptoms and other clinical conditions, such as cognitive impairment, negative mood, anxiety. The present study explored the impact of PD on self-reported physical and mental health, objective cognition and postural control. The relationship among these variables was examined in order to understand the impact on quality of life. Fifty-four participants, 27 with and 27 without PD, were recruited in Sardinia - an area with an atypical prevalence of PD and psychological characteristics that might mitigate the impact of PD on life quality. Participants completed objective tests of cognitive ability and postural control and self-report measures of physical and mental health. The detrimental effect of PD was evident across all outcomes. Self-reported physical and mental health were both related to postural control. Variance in perceived physical health was explained, not only by PD itself and postural control but also by participation in leisure activities. Self-report outcomes related to life quality are related not only by motor disturbances associated with PD but also with lifestyle activities. In conclusion, social contexts promoting socially-oriented activities, such as that found in Sardinia, may, therefore, mitigate some of the detrimental consequences of PD.
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Affiliation(s)
- Paul Kenneth Hitchcott
- a Department of Pedagogy, Psychology, Philosophy , University of Cagliari , Cagliari , Italy
| | - Maria Chiara Fastame
- a Department of Pedagogy, Psychology, Philosophy , University of Cagliari , Cagliari , Italy
| | - Federica Corona
- b Department of Mechanical, Chemical and Materials Engineering , University of Cagliari , Cagliari , Italy
| | - Giuseppina Pilloni
- b Department of Mechanical, Chemical and Materials Engineering , University of Cagliari , Cagliari , Italy
| | - Micaela Porta
- b Department of Mechanical, Chemical and Materials Engineering , University of Cagliari , Cagliari , Italy
| | - Massimiliano Pau
- b Department of Mechanical, Chemical and Materials Engineering , University of Cagliari , Cagliari , Italy
| | - Rachele Conti
- a Department of Pedagogy, Psychology, Philosophy , University of Cagliari , Cagliari , Italy
| | - Maria Pietronilla Penna
- a Department of Pedagogy, Psychology, Philosophy , University of Cagliari , Cagliari , Italy
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Bloem BR, Pfeijffer IL, Krack P. Art for better health and wellbeing. BRITISH MEDICAL JOURNAL 2018. [DOI: 10.1136/bmj.k5353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Béreau M, Fleury V, Bouthour W, Castrioto A, Lhommée E, Krack P. Hyperdopaminergic behavioral spectrum in Parkinson's disease: A review. Rev Neurol (Paris) 2018; 174:653-663. [DOI: 10.1016/j.neurol.2018.07.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 07/22/2018] [Accepted: 07/24/2018] [Indexed: 02/08/2023]
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Abbes M, Lhommée E, Thobois S, Klinger H, Schmitt E, Bichon A, Castrioto A, Xie J, Fraix V, Kistner A, Pélissier P, Seigneuret É, Chabardès S, Mertens P, Broussolle E, Moro E, Krack P. Subthalamic stimulation and neuropsychiatric symptoms in Parkinson's disease: results from a long-term follow-up cohort study. J Neurol Neurosurg Psychiatry 2018; 89:836-843. [PMID: 29436490 DOI: 10.1136/jnnp-2017-316373] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Reports on behavioural outcomes after subthalamic nucleus deep brain stimulation in Parkinson's disease are controversial and limited to short-term data. Long-term observation in a large cohort allows a better counselling and management. METHODS To determine whether a long-term treatment with subthalamic stimulation induces or reduces impulse control behaviours, neuropsychiatric fluctuations and apathy, 69 patients treated with subthalamic stimulation are prospectively and retrospectively assessed using Ardouin Scale of Behavior in Parkinson's Disease before and after 3-10 years of stimulation. RESULTS At a mean follow-up of 6 years, all impulse control disorders and dopaminergic addiction were significantly decreased, apart from eating behaviour and hypersexuality. Neuropsychiatric fluctuations also significantly improved (ON euphoria: 38% of the patients before surgery and 1% after surgery, P<0.01; OFF dysphoria: 39% of the patients before surgery and 10% after surgery, P<0.01). However, apathy increased (25% of the patients after surgery and 3% before, P<0.01). With the retrospective analysis, several transient episodes of depression, apathy, anxiety and impulse control disorders occurred. CONCLUSIONS Bilateral subthalamic nucleus stimulation was overall very effective in improving impulse control disorders and neuropsychiatric fluctuations in parkinsonian patients in the long term despite a counteracting frequent apathy. Transient episodes of impulse control disorders still occurred within the follow-up. These findings recommend a close follow-up in parkinsonian patients presenting with neuropsychiatric symptoms before deep brain stimulation surgery. CLINICAL TRIAL REGISTRATION NCT01705418;Post-results.
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Affiliation(s)
- Marie Abbes
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France
| | - Eugénie Lhommée
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Stéphane Thobois
- Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Université de Lyon, Lyon, France.,Neurologie C, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France.,Centre de Neurosciences Cognitives, CNRS, UMR 5229, Bron, France
| | - Hélène Klinger
- Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Université de Lyon, Lyon, France.,Neurologie C, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France.,Centre de Neurosciences Cognitives, CNRS, UMR 5229, Bron, France
| | - Emmanuelle Schmitt
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Amélie Bichon
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Anna Castrioto
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Jing Xie
- Institut du vieillissement, Hospices Civils de Lyon, Hôpital des Charpennes, Lyon, France
| | - Valérie Fraix
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Andrea Kistner
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Pierre Pélissier
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Éric Seigneuret
- Department of Neurosurgery, CHU Grenoble Alpes, Grenoble, France
| | - Stéphan Chabardès
- Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France.,Department of Neurosurgery, CHU Grenoble Alpes, Grenoble, France
| | - Patrick Mertens
- Neurochirurgie A, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France
| | - Emmanuel Broussolle
- Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Université de Lyon, Lyon, France.,Neurologie C, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France.,Centre de Neurosciences Cognitives, CNRS, UMR 5229, Bron, France
| | - Elena Moro
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France
| | - Paul Krack
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Université Grenoble Alpes, Grenoble, France.,Inserm U1216, Grenoble, France.,Department of Clinical Neuroscience, Faculty University of Geneva, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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13
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Skorvanek M, Martinez-Martin P, Kovacs N, Zezula I, Rodriguez-Violante M, Corvol JC, Taba P, Seppi K, Levin O, Schrag A, Aviles-Olmos I, Alvarez-Sanchez M, Arakaki T, Aschermann Z, Benchetrit E, Benoit C, Bergareche-Yarza A, Cervantes-Arriaga A, Chade A, Cormier F, Datieva V, Gallagher DA, Garretto N, Gdovinova Z, Gershanik O, Grofik M, Han V, Kadastik-Eerme L, Kurtis MM, Mangone G, Martinez-Castrillo JC, Mendoza-Rodriguez A, Minar M, Moore HP, Muldmaa M, Mueller C, Pinter B, Poewe W, Rallmann K, Reiter E, Rodriguez-Blazquez C, Singer C, Valkovic P, Goetz CG, Stebbins GT. Relationship between the MDS-UPDRS and Quality of Life: A large multicenter study of 3206 patients. Parkinsonism Relat Disord 2018; 52:83-89. [PMID: 29625875 DOI: 10.1016/j.parkreldis.2018.03.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/08/2018] [Accepted: 03/27/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND The relationship between Health-Related Quality of Life (HRQoL) and MDS-UPDRS has not been fully studied so far. The aim of this study was to evaluate the relationship between all MDS-UPDRS components and HRQoL in a representative international cohort of PD patients. METHODS We collected demographic and disease-related data as well as MDS-UPDRS and PDQ8 scales. Data were analyzed using correlations between PDQ8 and all MDS-UPDRS items, subsequently two hierarchical multiple regressions were performed, first between the scores of the MDS-UPDRS Parts and PDQ8 and second between individual items from those Parts demonstrating significant relationship to PDQ8 scores in the first regression. LASSO regression analyses were performed to evaluate the relationship between PDQ8 and all individual MDS-UPDRS items. RESULTS A total of 3206 PD patients were included in the study. In the first regression analysis, PDQ8 was significantly related to MDS-UPDRS parts I and II, but not to III and IV. In the second regression model, significant contributions to PDQ8 were found for Part I items Fatigue, Pain, Depressed mood, Apathy; and Part II items Dressing, Doing hobbies, Freezing, Speech and Tremor. In the LASSO analysis, six Part I, seven Part II, three Part III and one Part IV items contributed to PDQ8 scores. The five items most significantly related to the model were Depressed mood, Dressing, Apathy, Pain and Fatigue. CONCLUSIONS This is so far the largest study related to HRQoL issues in PD. Restrictions in activities of daily living and non-motor symptoms significantly contribute to HRQoL in PD.
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Affiliation(s)
- Matej Skorvanek
- Dept. of Neurology, P. J. Safarik University, Kosice, Slovak Republic; Dept. of Neurology, University Hospital L. Pasteur, Kosice, Slovak Republic; Centre of Experimental, Translational and Clinical Medicine, Technology and Innovation Park, P. J. Safarik University, Kosice, Slovak Republic.
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Norbert Kovacs
- Dept. of Neurology, University of Pécs, Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
| | - Ivan Zezula
- Inst. of Mathematics, P. J. Safarik University, Kosice, Slovak Republic
| | | | - Jean-Christophe Corvol
- Sorbonne Universités, UPMC Univ Paris 06, INSERM UMRS_1127, CIC_1422, CNRS UMR_7225, AP-HP, ICM, Hôpital Pitié-Salpêtrière, Département des maladies du système nerveux, F-75013, Paris, France
| | - Pille Taba
- Dept. of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Klaus Seppi
- Dep. of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Oleg Levin
- Dept. of Neurology, Russian Medical Academy of Postgraduate Education, Moscow, Russia
| | - Anette Schrag
- Dept. of Clinical Neuroscience, UCL Institute of Neurology, London, UK
| | - Iciar Aviles-Olmos
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK
| | | | - Tomoko Arakaki
- Dept. of Neurology, Hospital Ramos Mejia, Buenos Aires, Argentina
| | | | - Eve Benchetrit
- Sorbonne Universités, UPMC Univ Paris 06, INSERM UMRS_1127, CIC_1422, CNRS UMR_7225, AP-HP, ICM, Hôpital Pitié-Salpêtrière, Département des maladies du système nerveux, F-75013, Paris, France
| | - Charline Benoit
- Sorbonne Universités, UPMC Univ Paris 06, INSERM UMRS_1127, CIC_1422, CNRS UMR_7225, AP-HP, ICM, Hôpital Pitié-Salpêtrière, Département des maladies du système nerveux, F-75013, Paris, France
| | | | - Amin Cervantes-Arriaga
- Clinical Neurodegenerative Diseases Research Unit, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Anabel Chade
- Movement Disorders Unit, Institute of Neurosciences, Favaloro University, INECO, Buenos Aires, Argentina
| | - Florence Cormier
- Sorbonne Universités, UPMC Univ Paris 06, INSERM UMRS_1127, CIC_1422, CNRS UMR_7225, AP-HP, ICM, Hôpital Pitié-Salpêtrière, Département des maladies du système nerveux, F-75013, Paris, France
| | - Veronika Datieva
- Dept. of Neurology, Russian Medical Academy of Postgraduate Education, Moscow, Russia
| | | | - Nelida Garretto
- Dept. of Neurology, Hospital Ramos Mejia, Buenos Aires, Argentina
| | - Zuzana Gdovinova
- Dept. of Neurology, P. J. Safarik University, Kosice, Slovak Republic; Dept. of Neurology, University Hospital L. Pasteur, Kosice, Slovak Republic
| | - Oscar Gershanik
- Movement Disorders Unit, Institute of Neurosciences, Favaloro University, INECO, Buenos Aires, Argentina
| | - Milan Grofik
- Dept. of Neurology, Comenius University, Martin, Slovak Republic
| | - Vladimir Han
- Dept. of Neurology, P. J. Safarik University, Kosice, Slovak Republic; Dept. of Neurology, University Hospital L. Pasteur, Kosice, Slovak Republic
| | | | - Monica M Kurtis
- Movement Disorders Program, Dept. of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | - Graziella Mangone
- Sorbonne Universités, UPMC Univ Paris 06, INSERM UMRS_1127, CIC_1422, CNRS UMR_7225, AP-HP, ICM, Hôpital Pitié-Salpêtrière, Département des maladies du système nerveux, F-75013, Paris, France
| | | | | | - Michal Minar
- 2nd Dept. of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Henry P Moore
- Dept. of Neurology, University of Miami, Miami, FL, USA
| | - Mari Muldmaa
- Dept. of Neurology, North Estonian Medical Center, Tallinn, Estonia
| | - Christoph Mueller
- Dep. of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernadette Pinter
- Dep. of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Dep. of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Karin Rallmann
- Dept. of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Eva Reiter
- Dep. of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Carlos Singer
- Dept. of Neurology, University of Miami, Miami, FL, USA
| | - Peter Valkovic
- 2nd Dept. of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Christopher G Goetz
- Dept. of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Glenn T Stebbins
- Dept. of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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14
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Jellinger KA. Neuropathology of Nonmotor Symptoms of Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:13-62. [PMID: 28802920 DOI: 10.1016/bs.irn.2017.05.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Parkinson's disease (PD), a multiorgan neurodegenerative disorder associated with α-synuclein deposits throughout the nervous system and many organs, is clinically characterized by motor and nonmotor features, many of the latter antedating motor dysfunctions by 20 or more years. The causes of the nonmotor manifestations such as olfactory, autonomic, sensory, neuropsychiatric, visuospatial, sleep, and other disorders are unlikely to be related to single lesions. They are mediated by the involvement of both dopaminergic and nondopaminergic systems, and diverse structures outside the nigrostriatal system that is mainly responsible for the motor features of PD. The nonmotor alterations appear in early/prodromal stages of the disease and its further progression, suggesting a topographical and chronological spread of the lesions. This lends further support for the notion that PD is a multiorgan proteinopathy, although the exact relationship between presymptomatic and later developing nonmotor features of PD and neuropathology awaits further elucidation.
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15
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Shanahan J, Morris ME, Bhriain ON, Volpe D, Lynch T, Clifford AM. Dancing for Parkinson Disease: A Randomized Trial of Irish Set Dancing Compared With Usual Care. Arch Phys Med Rehabil 2017; 98:1744-1751. [PMID: 28336345 DOI: 10.1016/j.apmr.2017.02.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 02/10/2017] [Accepted: 02/19/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the feasibility of a randomized controlled study design and to explore the benefits of a set dancing intervention compared with usual care. DESIGN Randomized controlled design, with participants randomized to Irish set dance classes or a usual care group. SETTING Community based. PARTICIPANTS Individuals with idiopathic Parkinson disease (PD) (N=90). INTERVENTIONS The dance group attended a 1.5-hour dancing class each week for 10 weeks and undertook a home dance program for 20 minutes, 3 times per week. The usual care group continued with their usual care and daily activities. MAIN OUTCOME MEASURES The primary outcome was feasibility, determined by recruitment rates, success of randomization and allocation procedures, attrition, adherence, safety, willingness of participants to be randomized, resource availability, and cost. Secondary outcomes were motor function (motor section of the Unified Parkinson's Disease Rating Scale), quality of life (Parkinson's Disease Questionnaire-39), functional endurance (6-min walk test), and balance (mini-BESTest). RESULTS Ninety participants were randomized (45 per group). There were no adverse effects or resource constraints. Although adherence to the dancing program was 93.5%, there was >40% attrition in each group. Postintervention, the dance group had greater nonsignificant gains in quality of life than the usual care group. There was a meaningful deterioration in endurance in the usual care group. There were no meaningful changes in other outcomes. The exit questionnaire showed participants enjoyed the classes and would like to continue participation. CONCLUSIONS For people with mild to moderately severe PD, set dancing is feasible and enjoyable and may improve quality of life.
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Affiliation(s)
- Joanne Shanahan
- Department of Clinical Therapies, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.
| | - Meg E Morris
- Healthscope, Northpark Private Hospital & La Trobe University Center for Sport and Exercise Medicine Research, School Allied Health, Melbourne, VIC, Australia
| | - Orfhlaith Ni Bhriain
- Irish World Academy of Music and Dance, Faculty of Arts Humanities and Social Sciences, University of Limerick, Limerick, Ireland
| | - Daniele Volpe
- Department of Neurorehabilitation, Casa di Cura Villa Margherita, Vicenza, Italy
| | - Tim Lynch
- Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Amanda M Clifford
- Department of Clinical Therapies, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
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16
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Pramipexole restores depressed transmission in the ventral hippocampus following MPTP-lesion. Sci Rep 2017; 7:44426. [PMID: 28290500 PMCID: PMC5349604 DOI: 10.1038/srep44426] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/07/2017] [Indexed: 12/18/2022] Open
Abstract
The hippocampus has a significant association with memory, cognition and emotions. The dopaminergic projections from both the ventral tegmental area and substantia nigra are thought to be involved in hippocampal activity. To date, however, few studies have investigated dopaminergic innervation in the hippocampus or the functional consequences of reduced dopamine in disease models. Further complicating this, the hippocampus exhibits anatomical and functional differentiation along its dorso-ventral axis. In this work we investigated the role of dopamine on hippocampal long term potentiation using D-amphetamine, which stimulates dopamine release, and also examined how a dopaminergic lesion affects the synaptic transmission across the anatomic subdivisions of the hippocampus. Our findings indicate that a 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine induced dopaminergic lesion has time-dependent effects and impacts mainly on the ventral region of the hippocampus, consistent with the density of dopaminergic innervation. Treatment with a preferential D3 receptor agonist pramipexole partly restored normal synaptic transmission and Long-Term Potentiation. These data suggest a new mechanism to explain some of the actions of pramipexole in Parkinson´s disease.
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17
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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]
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18
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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.
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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.
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19
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Nonmotor Fluctuations in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:947-971. [DOI: 10.1016/bs.irn.2017.05.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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20
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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]
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21
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Martinez-Martin P. What is quality of life and how do we measure it? Relevance to Parkinson's disease and movement disorders. Mov Disord 2016; 32:382-392. [PMID: 27911002 DOI: 10.1002/mds.26885] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/30/2016] [Accepted: 11/06/2016] [Indexed: 12/13/2022] Open
Abstract
Health-related quality of life is a patient-reported outcome that complements clinical evaluation and provides information about disease activity and effects of the treatment. The objective of this review is to present the conceptual framework, the measures, and some of their most relevant applications in the field of Parkinson's disease and movement disorders. Health-related quality of life is a subjective, individual, and multidimensional construct, and its main dimensions are physical, mental, and social, besides global perceptions of health and personal domains. Health-related quality of life measurement is carried out by means of questionnaires or scales, ideally self-applied by patients, and has a diversity of important applications for clinical practice, research, and health policy. Movement disorders and Parkinson's disease are complex conditions impacting all components of patients' health-related quality of life. The use of health-related quality of life tools provides important information on a variety of aspects that are important to patients while complementing clinical evaluations. In particular, studies using this kind of assessment can identify and monitor the most important health-related quality of life determinant factors, allowing tailored assistance and prioritized interventions. In addition, maintaining or improving the patients' health-related quality of life is an objective of care for chronic diseases and, therefore, it has to be monitored over time and as an outcome of clinical trials. Several methods are available for the interpretation of the change in scores of health-related quality of life measures, although a definitive agreement on the most appropriate method is yet to be determined. Presently, health-related quality of life assessment is an important outcome for research and management of chronic conditions such as Parkinson's disease and other movement disorders. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Pablo Martinez-Martin
- National Center of Epidemiology and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Carlos III Institute of Health, Madrid, Spain
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22
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Martínez-Fernández R, Schmitt E, Martinez-Martin P, Krack P. The hidden sister of motor fluctuations in Parkinson's disease: A review on nonmotor fluctuations. Mov Disord 2016; 31:1080-94. [PMID: 27431515 DOI: 10.1002/mds.26731] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 06/13/2016] [Accepted: 06/19/2016] [Indexed: 12/29/2022] Open
Abstract
Only a few years after the introduction of levodopa, the first descriptions of motor fluctuations and dyskinesia related to dopaminergic therapy appeared. In PD, attention turned to their management, that had dampened the euphoria of the "levodopa miracle." It soon became clear that neuropsychiatric, autonomic, and sensory features also tend to develop fluctuations after chronic exposure to l-dopa. The diversity of fluctuating nonmotor symptoms, their largely subjective nature, coupled with a frequent lack of insight led to difficulties in identification and quantification. This may explain why, despite the high impact of nonmotor symptoms on patient autonomy and quality of life, evaluation of nonmotor fluctuations is not part of clinical routine. In view of the lack of specific validated assessment tools, detailed anamnesis should ideally be coupled with an evaluation in both ON and OFF drug conditions. The mechanisms of nonmotor fluctuations are not well understood. It is thought that they share dopaminergic presynaptic pharmacokinetic and postsynaptic pharmacodynamic mechanisms with the classical motor complications, but involve different neural pathways. Although symptoms fluctuate with dopaminergic treatment, serotonine and norepinephrine denervation, as well as interactions between neurotransmitter systems, probably contribute to their diversity. The lack of validated tools for assessment of these phenomena explains the almost complete absence of treatment studies. Management, largely resulting from expert opinion, includes psychiatric follow-up, nondopaminergic drugs, and advanced dopaminergic treatment, including drug delivery pumps and DBS. This review aims to provide a starting point for the understanding, diagnosis, and management of nonmotor fluctuations. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Emmanuelle Schmitt
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes and Grenoble Institut des Neurosciences, INSERM U386, Grenoble, France
| | - Pablo Martinez-Martin
- National Center of Epidemiology, Carlos III Institute of Health and CIBERNED, Madrid, Spain
| | - Paul Krack
- Neurology Division, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
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23
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Herath TB, Withana M, Rodrigo C, Gamage R, Gamage C. Prevalence and associations for symptoms of depression in patients with Parkinson's disease: a Sri Lankan experience. Int J Ment Health Syst 2016; 10:47. [PMID: 27313660 PMCID: PMC4910221 DOI: 10.1186/s13033-016-0079-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 06/07/2016] [Indexed: 12/30/2022] Open
Abstract
Background The prevalence and associations for depression in patients with Parkinson’s disease vary widely between studies. This reflects the influence of cultural, demographic and socioeconomic confounders within communities that make generalizations invalid. Therefore it is important to identify unique attributes within a community on this phenomenon. This is the first study from Sri Lanka on the prevalence and associations for co-morbid depression in patients with Parkinson’s disease. Methods We conducted this cross sectional study at the Institute of Neurology, National Hospital of Sri Lanka. All patients with a diagnosis of idiopathic Parkinson’s disease followed up at the movement disorder clinic of the institute were enrolled. The patients were interviewed by investigators (medical practitioners) with an interviewer administered questionnaire that collected data on (a) demography, (b) clinical symptoms of Parkinson’s disease and (c) socioeconomic background. Symptoms of depression were assessed with Hamilton rating scale for depression. Results We enrolled 75 patients [males; 54 (75 %), mean age; 63.6 years, SD ± 6.8]. Forty-six (61.3 %) patients had been either formally diagnosed with depression or showed symptoms of depression. Bradykinesia, monthly income below Rs. 10,000 and having a family history of depression were significantly associated with a diagnosis of life-time post Parkinson’s disease depression (p < 0.05). Conclusion Given the potential benefit in treatment (for depression), all patients with Parkinson’s disease should be screened for depression regularly. HAM-D would be a good screening tool for this purpose as it has good reliability, validity and can be administered within a reasonable time limit.
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Affiliation(s)
- Tharaka B Herath
- Institute of Neurology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Milinda Withana
- University Medical Unit, National Hospital of Sri Lanka, Colombo 10, Sri Lanka
| | - Chaturaka Rodrigo
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Ranjani Gamage
- Institute of Neurology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Chanika Gamage
- Institute of Neurology, National Hospital of Sri Lanka, Colombo, Sri Lanka
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