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Zhao B, Liu H, Li H, Shang X. Abnormal functional connectivity of the amygdala is associated with depressive symptoms in patients with multiple system atrophy. Neuropsychiatr Dis Treat 2018; 14:3133-3142. [PMID: 30532544 PMCID: PMC6247974 DOI: 10.2147/ndt.s178657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Depressive symptoms are frequent nonmotor symptoms that occur in multiple system atrophy (MSA) patients. However, possible changes that can present in the amygdala (AMY) functional connectivity (FC) of the brain in MSA patients with depressive symptoms (DMSA patients) remain largely unknown. MATERIALS AND METHODS Resting-state functional magnetic resonance imaging scans were obtained from 29 DMSA patients, 28 MSA patients without depression symptoms (NDMSA patients), and 34 healthy controls (HCs). FC was analyzed by defining the bilateral AMY as the seed region. Correlation analysis was performed between the FC and clinical scores. RESULTS When compared with NDMSA patients, DMSA patients showed increased bilateral AMY FC in the left middle frontal gyrus (MFG) and decreased right AMY FC in the left middle occipital gyrus. Moreover, the AMY FC values in the left middle frontal cortex were positively correlated with the Hamilton Depression Rating Scale-17 item scores. Furthermore, relative to the HCs, DMSA patients presented decreased bilateral AMY FC values in the visuospatial cortex, sensorimotor networks, and limbic areas. CONCLUSION Depressive symptoms are associated with AMY-MFG FC anomalies in MSA patients. We propose that the middle frontal cortex may play an important role in the neuropathophysiology of depression in MSA patients.
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Affiliation(s)
- Bin Zhao
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China, .,Department of Neurology, Shenyang Fifth People Hospital, Shenyang 110023, China
| | - Hu Liu
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Huanhuan Li
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Xiuli Shang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China,
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Conijn JM, Spinhoven P, Meijer RR, Lamers F. Person misfit on the Inventory of Depressive Symptomatology: Low quality self-report or true atypical symptom profile? Int J Methods Psychiatr Res 2017; 26:e1548. [PMID: 27862574 PMCID: PMC6877190 DOI: 10.1002/mpr.1548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 07/21/2016] [Accepted: 09/23/2016] [Indexed: 11/07/2022] Open
Abstract
Person misfit on a self-report measure refers to a response pattern that is unlikely given a theoretical measurement model. Person misfit may reflect low quality self-report data, for example due to random responding or misunderstanding of items. However, recent research in the context of psychopathology suggests that person misfit may reflect atypical symptom profiles that have implications for diagnosis or treatment. We followed-up on Wanders et al. (Journal of Affective Disorders, 180, 36-43, 2015) who investigated person misfit on the Inventory of Depressive Symptomatology (IDS) in the Netherlands Study of Depression and Anxiety (n = 2,981). Our goal was to investigate the extent to which misfit on the IDS reflects low-quality self-report patterns and the extent to which it reflects true atypical symptom profiles. Regression analysis showed that person misfit related more strongly to self-report quality indicators than to variables quantifying theoretically-derived atypical symptom profiles. A data-driven atypical symptom profile explained most variance in person misfit, suggesting that person misfit on the IDS mainly reflects a sample- and questionnaire-specific atypical symptom profile. We concluded that person-fit statistics are useful for detecting IDS scores that may not be valid. Further research is necessary to support the interpretation of person misfit as reflecting a meaningful atypical symptom combination.
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Affiliation(s)
- Judith M Conijn
- Research Institute of Child Development and Education, University of Amsterdam, The Netherlands.,Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Leiden University, Leiden, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob R Meijer
- Faculty of Behavioral and Social Sciences, Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands
| | - Femke Lamers
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center/GGZ inGeest, Amsterdam, The Netherlands
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Trojano L, Papagno C. Cognitive and behavioral disorders in Parkinson's disease: an update. II: behavioral disorders. Neurol Sci 2017; 39:53-61. [PMID: 29038946 DOI: 10.1007/s10072-017-3155-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/10/2017] [Indexed: 12/11/2022]
Abstract
Patients with Parkinson's disease (PD) can experience several behavioral symptoms, such as apathy, agitation, hypersexuality, stereotypic movements, pathological gambling, abuse of antiparkinsonian drugs, and REM sleep behavioral disorders. Psychoses and hallucinations, depression and anxiety disorders, and difficulties in recognizing and experiencing emotions also impair behavior and can cause severe psychosocial problems in patients with PD. Symptoms can be present since early stages of the disease, sometimes even before the appearance of classical motor symptoms, likely in relation to dopamine depletion in basal ganglia and/or to dysfunctions of other neurotrasmitter systems, and others can develop later, in some cases in relation to dopaminergic treatment. In this paper, we review recent literature, with particular attention to the last 5 years, on the main behavioral and emotional disturbances described in PD patients as well as the hypothesized neurofunctional substrate of such impairments. Finally, we provide some suggestions on the most suitable instruments to check and assess PD-associated behavioral defects over time.
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Affiliation(s)
- Luigi Trojano
- Department of Psychology, University of Campania 'Luigi Vanvitelli', Viale Ellittico 31, 81100, Caserta, Italy.
- ICS Maugeri, IRCCS, Telese Terme, Italy.
| | - Costanza Papagno
- CIMeC, University of Trento, Trento, Italy.
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo 1, 02100, Milan, Italy.
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De Risi M, Di Gennaro G, Picardi A, Casciato S, Grammaldo LG, D'Aniello A, Lanni D, Meletti S, Modugno N. Facial emotion decoding in patients with Parkinson's disease. Int J Neurosci 2017; 128:71-78. [DOI: 10.1080/00207454.2017.1366475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | - Angelo Picardi
- Mental Health Unit, National Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy
| | | | | | | | | | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; N.O.C.S.A.E. Hospital, AUSL Modena, Modena, Italy
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Enrici I, Mitkova A, Castelli L, Lanotte M, Lopiano L, Adenzato M. Deep Brain Stimulation of the subthalamic nucleus does not negatively affect social cognitive abilities of patients with Parkinson's disease. Sci Rep 2017; 7:9413. [PMID: 28842656 PMCID: PMC5573348 DOI: 10.1038/s41598-017-09737-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/19/2017] [Indexed: 12/19/2022] Open
Abstract
Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a treatment option for patients with advanced idiopathic PD successful at alleviating disabling motor symptoms. Nevertheless, the effects of STN-DBS on cognitive functions remain controversial and few studies have investigated modification of social cognitive abilities in patients with PD treated with STN-DBS. Here we expanded the typically-investigated spectrum of these abilities by simultaneously examining emotion recognition, and both affective and cognitive Theory of Mind (ToM). By means of a cross-sectional study, 20 patients with PD under dopaminergic replacement therapy, 18 patients with PD treated with STN-DBS, and 20 healthy controls performed the Ekman 60-Faces test, the full version of the Reading the Mind in the Eyes test, and the Protocol for the Attribution of Communicative Intentions. There were no differences between the PD groups (treated and not treated with STN-DBS) on any of the social cognitive tests. Our results suggest that patients with PD who are treated with STN-DBS do not experience detrimental effects on their social cognitive abilities. The present study, the first one examining a wide spectrum of social cognitive abilities after DBS of the STN, suggests that this surgical procedure can be considered safe from this standpoint.
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Affiliation(s)
- Ivan Enrici
- Department of Philosophy and Educational Sciences, University of Turin, Turin, Italy.,Center for Cognitive Science, University of Turin, Turin, Italy.,Neuroscience Institute of Turin, Turin, Italy
| | - Antonia Mitkova
- Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, Ospedale S. Giuseppe, Piancavallo, VCO, Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin, Turin, Italy.
| | - Michele Lanotte
- Department of Neuroscience, University of Turin, Turin, Italy
| | | | - Mauro Adenzato
- Center for Cognitive Science, University of Turin, Turin, Italy.,Neuroscience Institute of Turin, Turin, Italy.,Department of Psychology, University of Turin, Turin, Italy
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Depression may negatively affect the change in freezing of gait following subthalamic nucleus stimulation in Parkinson's disease. Parkinsonism Relat Disord 2017; 44:133-136. [PMID: 28830666 DOI: 10.1016/j.parkreldis.2017.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/30/2017] [Accepted: 08/08/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the influence of preoperative depression on the change in freezing of gait (FOG) following subthalamic nucleus stimulation (STN-DBS) in patients with Parkinson's disease (PD). METHODS One hundred and twelve PD patients were included who received bilateral STN-DBS. Of these, 33 had no preoperative depression (PD-ND) and the other 79 had preoperative depression (PD-D). Each PD-ND patient was matched with one PD-D patient by the propensity score for which sex, age at PD onset, disease duration, UPDRS-III score during off-medication state, levodopa-equivalent daily dose, and mini mental state examination were the independent variables. We compared both a FOG-questionnaire (FOG-Q) and the axial score from UPDRS-III between the two groups over 12-month follow-up. RESULTS During the off-medication state, FOG-Q at 12-month was decreased with STN-DBS in both PD-ND (-52.9%, p < 0.001) and PD-D (-24.2%, p < 0.001) with a significant difference in the change of FOG in favor of PD-ND (p = 0.001). Similarly, there was an improvement in the axial score for both PD-ND (-66.1%, p < 0.001) and PD-D (-45.3%, p < 0.001) at 12-month with a significant difference between the groups. (p = 0.005). During the on-medication state, both the FOG-Q and axial score at 12-month were not improved with STN-DBS in the PD-ND and PD-D with no difference between the groups. CONCLUSIONS Our findings suggest that preoperative depression negatively affects the outcome of FOG following STN-DBS in the off-medication state but not in the on-medication state.
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A Cross-sectional Analysis of the Characteristics of Individuals With Parkinson Disease Who Avoid Activities and Participation Due to Fear of Falling. J Neurol Phys Ther 2017; 41:31-42. [PMID: 27977519 DOI: 10.1097/npt.0000000000000162] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Avoidance behavior can have deleterious consequences on health and quality of life for persons with Parkinson disease (PD); for this reason, it is important to identify potentially mitigable characteristics. We compared the characteristics of individuals with PD who exhibit fear of falling (FOF) avoidance behavior with those who do not. METHODS Fifty-nine participants with PD were classified as avoiders (n = 27) or nonavoiders (n = 32) by using the Fear of Falling Avoidance Behavior Questionnaire and compared across 5 domains: demographic characteristics; PD-specific symptoms (subtype, Movement Disorder Society-Unified Parkinson's Disease Rating Scale [MDS-UPDRS], Hoehn and Yahr Scale, Parkinson's Disease Questionnaire-39 [PDQ-39]); balance and falls (fall history, Berg Balance Scale [BBS], Activities-Specific Balance Confidence [ABC] Scale, Impact of Events Scale, Consequences of Falling Questionnaire [CoFQ]); physical performance (30 Second Sit-to-Stand Test, Timed Up and Go Test, physical activity monitoring); and psychological factors (Zung Anxiety Scale, Beck Depression Inventory [BDI]). RESULTS There were no differences between avoiders and nonavoiders for demographic characteristics and fall history (Ps > 0.272). Avoiders had worse MDS-UPDRS (Ps < 0.014) and PDQ-39 scores (Ps < 0.028). Avoiders had poorer balance performance (BBS, P = 0.003), lower balance confidence (ABC, P < 0.001), and more fall catastrophization (CoFQ, P < 0.001). Avoiders reported more depression (P = 0.015) and anxiety (P = 0.028). DISCUSSION AND CONCLUSIONS PD FOF avoiders had more involved symptoms and scored lower on balance and physical performance measures. In addition, they reported greater psychological stress. Several potentially mitigable characteristics of those with FOF avoidance behavior were identified.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A153).
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Palotai M, Mike A, Cavallari M, Strammer E, Orsi G, Healy BC, Schregel K, Illes Z, Guttmann CR. Changes to the septo-fornical area might play a role in the pathogenesis of anxiety in multiple sclerosis. Mult Scler 2017; 24:1105-1114. [PMID: 28548605 DOI: 10.1177/1352458517711273] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Reports on the relationships between white matter lesion load (WMLL) and fatigue and anxiety in multiple sclerosis (MS) are inconsistent. OBJECTIVE To investigate the association of total and tract-specific WMLL with fatigue and anxiety. METHODS Total and regional T2 WMLL was assessed for 19 tracts in 48 MS patients (30 females). ICBM-DTI-81 Atlas-based parcellation was combined with WMLL segmentation of T2-weighted magnetic resonance imaging (MRI). Fatigue, anxiety, and depression were assessed using Fatigue Impact Scale, State Trait Anxiety Inventory, and Beck Depression Inventory, respectively. RESULTS Fatigue, anxiety, and depression showed significant inter-correlation. We found no association between fatigue and total or regional WMLLs, whereas anxiety was associated with total and regional WMLLs in nine tracts. After adjusting for total WMLL, age, and depression, only the column and body of the fornix (CBF) remained significantly associated with anxiety. Post hoc analyses showed no CBF lesions on T1-weighted MRI and suggested, but could not confirm, that the septum pellucidum might play a role in the pathogenesis of anxiety. CONCLUSION Our results suggest that anxiety in MS patients may have a neuropathological substrate in the septo-fornical area, which requires further validation using larger sample size and ultra-high-field MRI in targeted prospective studies.
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Affiliation(s)
- Miklos Palotai
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrea Mike
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA/Division of Clinical and Experimental Neuroimmunology, Department of Neurology, University of Pecs, Pecs, Hungary
| | - Michele Cavallari
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Erzsebet Strammer
- Division of Clinical and Experimental Neuroimmunology, Department of Neurology, University of Pecs, Pecs, Hungary
| | - Gergely Orsi
- MTA-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary/Department of Neurosurgery, Clinical Centre, University of Pecs, Pecs, Hungary
| | - Brian C Healy
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA/Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Katharina Schregel
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA/Institute of Neuroradiology, University of Gottingen, Gottingen, Germany
| | - Zsolt Illes
- Division of Clinical and Experimental Neuroimmunology, Department of Neurology, University of Pecs, Pecs, Hungary/MTA-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary/Department of Neurology, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Charles Rg Guttmann
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Impact of Combined Subthalamic Nucleus and Substantia Nigra Stimulation on Neuropsychiatric Symptoms in Parkinson's Disease Patients. PARKINSONS DISEASE 2017; 2017:7306192. [PMID: 28246572 PMCID: PMC5299199 DOI: 10.1155/2017/7306192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 11/17/2022]
Abstract
The goal of the study was to compare the tolerability and the effects of conventional subthalamic nucleus (STN) and combined subthalamic nucleus and substantia nigra (STN+SNr) high-frequency stimulation in regard to neuropsychiatric symptoms in Parkinson's disease patients. In this single center, randomized, double-blind, cross-over clinical trial, twelve patients with advanced Parkinson's disease (1 female; age: 61.3 ± 7.3 years; disease duration: 12.3 ± 5.4 years; Hoehn and Yahr stage: 2.2 ± 0.39) were included. Apathy, fatigue, depression, and impulse control disorder were assessed using a comprehensive set of standardized rating scales and questionnaires such as the Lille Apathy Rating Scale (LARS), Modified Fatigue Impact Scale (MFIS), Becks Depression Inventory (BDI-I), Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease Rating Scale (QUIP-RS), and Parkinson's Disease Questionnaire (PDQ-39). Three patients that were initially assigned to the STN+SNr stimulation mode withdrew from the study within the first week due to discomfort. Statistical comparison of data retrieved from patients who completed the study revealed no significant differences between both stimulation conditions in terms of mean scores of scales measuring apathy, fatigue, depression, impulse control disorder, and quality of life. Individual cases showed an improvement of apathy under combined STN+SNr stimulation. In general, combined STN+SNr stimulation seems to be safe in terms of neuropsychiatric side effects, although careful patient selection and monitoring in the short-term period after changing stimulation settings are recommended.
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Lee SK, Yoon DW, Lee S, Kim J, Choi KM, Shin C. The association between irritable bowel syndrome and the coexistence of depression and insomnia. J Psychosom Res 2017; 93:1-5. [PMID: 28107884 DOI: 10.1016/j.jpsychores.2016.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The individual occurrence of depression or insomnia is a risk factor for irritable bowel syndrome (IBS), but few researchers have evaluated the association between comorbid depression and insomnia and IBS. The aim of the present study is to explore the relationship between IBS and the coexistence of depression and insomnia in a Korean population-based cohort study. METHODS A total of 3429 individuals who were enrolled in the Korean Genome and Epidemiology Study were analysed. Of the participants, 10.9% (n=374) were diagnosed with IBS based on the Rome II criteria. Regarding depressive symptoms, subjects were sub-divided into three groups based on the Beck Depression Inventory (BDI) score. Insomnia was defined as a positive response to at least one of three questions on sleep states. RESULTS The odds ratio (OR) of IBS increased proportionally as depressive symptoms worsened (OR: 1.64; 95% CI: 1.21-2.23 in middle tertile and OR: 2.61; 95% CI: 1.92-3.55 in highest tertile). Subjects with insomnia showed a higher OR of IBS than those without insomnia (OR: 1.81; 95% CI: 1.44-2.27). In the joint analysis of BDI and insomnia, the odds for IBS were significantly higher in all BDI tertiles with insomnia than in the corresponding BDI tertiles without insomnia. There was no significant interaction effect of BDI tertile and insomnia on IBS. CONCLUSION The presence of both depression and insomnia is significantly associated with IBS compared to each individual occurrence. Further prospective investigations are needed to explore possible causality between comorbid depression and insomnia and IBS.
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Affiliation(s)
- Seung Ku Lee
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Dae Wui Yoon
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Sunghee Lee
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Jinkwan Kim
- Department of Biomedical Laboratory Science, College of Health Science, Jungwon University, Chung-Buk, Republic of Korea
| | - Kyung-Mee Choi
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea; Korea Health Promotion Foundation, 24th FL Namsam Square Bldg, Seoul 04554, Korea
| | - Chol Shin
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea; Department of Pulmonary, Sleep and Critical Care Medicine, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.
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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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Petschow C, Scheef L, Paus S, Zimmermann N, Schild HH, Klockgether T, Boecker H. Central Pain Processing in Early-Stage Parkinson's Disease: A Laser Pain fMRI Study. PLoS One 2016; 11:e0164607. [PMID: 27776130 PMCID: PMC5077078 DOI: 10.1371/journal.pone.0164607] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 09/28/2016] [Indexed: 01/08/2023] Open
Abstract
Background & Objective Pain is a common non-motor symptom in Parkinson’s disease. As dopaminergic dysfunction is suggested to affect intrinsic nociceptive processing, this study was designed to characterize laser-induced pain processing in early-stage Parkinson’s disease patients in the dopaminergic OFF state, using a multimodal experimental approach at behavioral, autonomic, imaging levels. Methods 13 right-handed early-stage Parkinson’s disease patients without cognitive or sensory impairment were investigated OFF medication, along with 13 age-matched healthy control subjects. Measurements included warmth perception thresholds, heat pain thresholds, and central pain processing with event-related functional magnetic resonance imaging (erfMRI) during laser-induced pain stimulation at lower (E = 440 mJ) and higher (E = 640 mJ) target energies. Additionally, electrodermal activity was characterized during delivery of 60 randomized pain stimuli ranging from 440 mJ to 640 mJ, along with evaluation of subjective pain ratings on a visual analogue scale. Results No significant differences in warmth perception thresholds, heat pain thresholds, electrodermal activity and subjective pain ratings were found between Parkinson’s disease patients and controls, and erfMRI revealed a generally comparable activation pattern induced by laser-pain stimuli in brain areas belonging to the central pain matrix. However, relatively reduced deactivation was found in Parkinson’s disease patients in posterior regions of the default mode network, notably the precuneus and the posterior cingulate cortex. Conclusion Our data during pain processing extend previous findings suggesting default mode network dysfunction in Parkinson’s disease. On the other hand, they argue against a genuine pain-specific processing abnormality in early-stage Parkinson’s disease. Future studies are now required using similar multimodal experimental designs to examine pain processing in more advanced stages of Parkinson’s disease.
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Affiliation(s)
- Christine Petschow
- Functional Neuroimaging Group, Department of Radiology, University of Bonn, Bonn, Germany
| | - Lukas Scheef
- Functional Neuroimaging Group, Department of Radiology, University of Bonn, Bonn, Germany
| | - Sebastian Paus
- Department of Neurology, University of Bonn, Bonn, Germany
| | | | - Hans H. Schild
- Department of Radiology, University of Bonn, Bonn, Germany
| | | | - Henning Boecker
- Functional Neuroimaging Group, Department of Radiology, University of Bonn, Bonn, Germany
- * E-mail:
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Bega D, Kim S, Zhang Y, Elm J, Schneider J, Hauser R, Fraser A, Simuni T. Predictors of Functional Decline in Early Parkinson's Disease: NET-PD LS1 Cohort. JOURNAL OF PARKINSONS DISEASE 2016; 5:773-82. [PMID: 26639661 DOI: 10.3233/jpd-150668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Data on predictors of decline in PD are largely based on de-novo populations and limited to the use of motor outcomes that fail to capture the full scope of disease. OBJECTIVE Determine the clinical predictors of decline in early treated PD using a novel multi-domain measure. METHODS Data from NINDS Exploratory Trials in PD Long-Term Study 1 (NET-PD LS1), a multicenter Phase 3 study of creatine in early treated PD, were analyzed. Functional decline was defined by a global outcome metric (GO) that consisted of: Schwab and England ADL scale, PD 39-item Questionnaire, Unified PD Rating Scale, Ambulatory Capacity Score, Symbol Digit Modalities Test, and Modified Rankin Scale. Univariate and multivariate models were used to test the association of predictors of interest with a standardized rank-sum of the GO. RESULTS 765 of 1741 participants completed five-year assessments and were included. Older age at disease onset (p < 0.0001), higher baseline levodopa equivalent dose (p = 0.01), and worse Scales for Outcomes of Parkinson's Disease Cognition score (p = 0.001) at baseline were the strongest predictors of functional decline in multivariate analysis. PD symptom subtype was not a significant predictor of outcome (p = 0.42). The full model was only a modest predictor of change in GO (R2 = 0.186). CONCLUSIONS This is the largest study to systematically assess predictors of functional decline in early treated PD over several years, and the first to use a multi-domain outcome measure of decline. Older age at disease onset and worse cognition, and not PD subtype, were predictors of decline.
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Affiliation(s)
- Danny Bega
- Northwestern University, Chicago, IL, USA
| | - Soeun Kim
- University of Texas Health Science Center, Houston, TX, USA
| | - Yunxi Zhang
- University of Texas Health Science Center, Houston, TX, USA
| | - Jordan Elm
- Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Andy Fraser
- Oregon Health Sciences University, Portland, OR, USA
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Speech prosody impairment predicts cognitive decline in Parkinson’s disease. Parkinsonism Relat Disord 2016; 29:90-5. [DOI: 10.1016/j.parkreldis.2016.05.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/02/2016] [Accepted: 05/18/2016] [Indexed: 11/22/2022]
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Goodarzi Z, Mrklas KJ, Roberts DJ, Jette N, Pringsheim T, Holroyd-Leduc J. Detecting depression in Parkinson disease: A systematic review and meta-analysis. Neurology 2016; 87:426-37. [PMID: 27358339 DOI: 10.1212/wnl.0000000000002898] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/18/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Failure to detect depression in patients with Parkinson disease (PD) can lead to worsened outcomes for patients and caregivers. Accurate identification of depression would enable practitioners to provide comprehensive care for their patients with PD. METHODS Our objective was to examine the diagnostic accuracy of tools for detecting depression in adult outpatients with PD. We searched MEDLINE, PsycINFO, and EMBASE (inception to December 1, 2015), gray literature, and bibliographies of included studies. The pooled prevalence of depression across studies and diagnostic accuracy estimates were calculated using random-effects models. Diagnostic accuracy estimates were calculated across the best-reported cutoffs from each study and across specific cutoffs, when feasible. RESULTS Out of 8,184 citations, 21 studies were included, evaluating 24 tools, with 4 amenable to meta-analysis. The pooled prevalence of major depression was 22.9% (95% confidence interval [CI] 18.1-27.7). The 15-item Geriatric Depression Scale (GDS-15) had a pooled sensitivity of 0.81 (95% CI 0.64-0.91) and specificity of 0.91 (95% CI 0.87-0.94). The most sensitive cutoff for the GDS-15 was 5 at 0.91 (95% CI 0.83-1.00). The Beck Depression Inventory I/Ia had a pooled sensitivity of 0.79 (95% CI 0.61-0.90) and specificity of 0.85 (95% CI 0.79-0.90). The Montgomery-Åsberg Depression Rating Scale yielded a pooled sensitivity of 0.77 (95% CI 0.69-0.83) and specificity of 0.92 (95% CI 0.79-0.97). The Unified Parkinson's Disease Rating Scale had a pooled sensitivity of 0.72 (95% CI 0.64-0.79) and specificity of 0.80 (95% CI 0.70-0.87). All estimates had heterogeneity. CONCLUSIONS There are several valid tools for detecting depression in patients with PD. Practitioners should choose one that fits their clinical practice.
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Affiliation(s)
- Zahra Goodarzi
- From the Departments of Community Health Sciences (Z.G., K.J.M., D.J.R., N.J., T.P., J.H.-L.) and Clinical Neurosciences (N.J., T.P.), University of Calgary; Research Priorities and Implementation (K.J.M.), Alberta Health Services, Edmonton; Departments of Critical Care Medicine (D.J.R.) and Surgery (D.J.R.), Hotchkiss Brain Institute and O'Brien Institute for Public Health (N.J., T.P., J.H.-L.), and Departments of Psychiatry and Pediatrics (T.P.) and Medicine (Z.G., J.H.-L.), University of Calgary and Alberta Health Services, Canada.
| | - Kelly J Mrklas
- From the Departments of Community Health Sciences (Z.G., K.J.M., D.J.R., N.J., T.P., J.H.-L.) and Clinical Neurosciences (N.J., T.P.), University of Calgary; Research Priorities and Implementation (K.J.M.), Alberta Health Services, Edmonton; Departments of Critical Care Medicine (D.J.R.) and Surgery (D.J.R.), Hotchkiss Brain Institute and O'Brien Institute for Public Health (N.J., T.P., J.H.-L.), and Departments of Psychiatry and Pediatrics (T.P.) and Medicine (Z.G., J.H.-L.), University of Calgary and Alberta Health Services, Canada
| | - Derek J Roberts
- From the Departments of Community Health Sciences (Z.G., K.J.M., D.J.R., N.J., T.P., J.H.-L.) and Clinical Neurosciences (N.J., T.P.), University of Calgary; Research Priorities and Implementation (K.J.M.), Alberta Health Services, Edmonton; Departments of Critical Care Medicine (D.J.R.) and Surgery (D.J.R.), Hotchkiss Brain Institute and O'Brien Institute for Public Health (N.J., T.P., J.H.-L.), and Departments of Psychiatry and Pediatrics (T.P.) and Medicine (Z.G., J.H.-L.), University of Calgary and Alberta Health Services, Canada
| | - Nathalie Jette
- From the Departments of Community Health Sciences (Z.G., K.J.M., D.J.R., N.J., T.P., J.H.-L.) and Clinical Neurosciences (N.J., T.P.), University of Calgary; Research Priorities and Implementation (K.J.M.), Alberta Health Services, Edmonton; Departments of Critical Care Medicine (D.J.R.) and Surgery (D.J.R.), Hotchkiss Brain Institute and O'Brien Institute for Public Health (N.J., T.P., J.H.-L.), and Departments of Psychiatry and Pediatrics (T.P.) and Medicine (Z.G., J.H.-L.), University of Calgary and Alberta Health Services, Canada
| | - Tamara Pringsheim
- From the Departments of Community Health Sciences (Z.G., K.J.M., D.J.R., N.J., T.P., J.H.-L.) and Clinical Neurosciences (N.J., T.P.), University of Calgary; Research Priorities and Implementation (K.J.M.), Alberta Health Services, Edmonton; Departments of Critical Care Medicine (D.J.R.) and Surgery (D.J.R.), Hotchkiss Brain Institute and O'Brien Institute for Public Health (N.J., T.P., J.H.-L.), and Departments of Psychiatry and Pediatrics (T.P.) and Medicine (Z.G., J.H.-L.), University of Calgary and Alberta Health Services, Canada
| | - Jayna Holroyd-Leduc
- From the Departments of Community Health Sciences (Z.G., K.J.M., D.J.R., N.J., T.P., J.H.-L.) and Clinical Neurosciences (N.J., T.P.), University of Calgary; Research Priorities and Implementation (K.J.M.), Alberta Health Services, Edmonton; Departments of Critical Care Medicine (D.J.R.) and Surgery (D.J.R.), Hotchkiss Brain Institute and O'Brien Institute for Public Health (N.J., T.P., J.H.-L.), and Departments of Psychiatry and Pediatrics (T.P.) and Medicine (Z.G., J.H.-L.), University of Calgary and Alberta Health Services, Canada
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Almeida L, Ahmed B, Walz R, De Jesus S, Patterson A, Martinez-Ramirez D, Vaillancourt D, Bowers D, Ward H, Okun MS, McFarland NR. Depressive Symptoms are Frequent in Atypical Parkinsonian Disorders. Mov Disord Clin Pract 2016; 4:191-197. [PMID: 28944256 DOI: 10.1002/mdc3.12382] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To compare the incidence and prevalence of depressive symptoms in atypical parkinsonian (APD) syndromes versus Parkinson disease (PD). METHODS In a large retrospective patient cohort we analyzed the incidence and prevalence of depressive symptoms using the Beck Depression Inventory (BDI) and evaluated subjects longitudinally on subsequent visits. For individuals who followed in subsequent visits we calculated incidence rates in person-years as a measure of incidence. RESULTS We identified 361 patients with APD including Progressive Supranuclear Palsy (PSP), Corticobasal Degeneration (CBD), Multiple System Atrophy (MSA) and Dementia with Lewy Bodies (DLB), and 2352 PD controls. The mean BDI values were significantly higher in APD (F=14.19, p < 0.001). A significantly higher proportion of APD subjects screened positive for depressive symptoms both at initial and subsequent patient visits (p < 0.001), which appeared to be more severe in the APD subgroups. UPDRS part III and disease duration weakly correlated with depressive symptoms. CONCLUSIONS Our results suggest that the incidence and prevalence of depressive symptoms are higher in APD and appear also to be more severe than in PD. Depressive symptoms in APD are common and affect patients regardless of disease duration or motor severity.
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Affiliation(s)
- Leonardo Almeida
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States
| | - Bilal Ahmed
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States
| | - Roger Walz
- Department of Neurology, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Sol De Jesus
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States
| | - Addie Patterson
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States
| | - Daniel Martinez-Ramirez
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States
| | - David Vaillancourt
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States.,Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, United States
| | - Dawn Bowers
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States.,Department of Clinical & Health Psychology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States
| | - Herbert Ward
- Department of Psychiatry, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States
| | - Michael S Okun
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States
| | - Nikolaus R McFarland
- Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States
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Mindfulness for Motor and Nonmotor Dysfunctions in Parkinson's Disease. PARKINSONS DISEASE 2016; 2016:7109052. [PMID: 27144052 PMCID: PMC4842053 DOI: 10.1155/2016/7109052] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/05/2016] [Accepted: 03/28/2016] [Indexed: 11/17/2022]
Abstract
Background. Motor and nonmotor symptoms negatively influence Parkinson's disease (PD) patients' quality of life. Mindfulness interventions have been a recent focus in PD. The present study explores effectiveness of a manualized group mindfulness intervention tailored for PD in improving both motor and neuropsychiatric deficits in PD. Methods. Fourteen PD patients completed an 8-week mindfulness intervention that included 6 sessions. The Five Facet Mindfulness Questionnaire (FFMQ), Geriatric Anxiety Inventory, Hamilton Depression Rating Scale, PD Cognitive Rating Scale, Unified PD Rating Scale, PD Quality of Life Questionnaire, and Outcome Questionnaire (OQ-45) were administered before and after the intervention. Participants also completed the FFMQ-15 at each session. Gains at postassessment and at 6-month follow-up were compared to baseline using paired t-tests and Wilcoxon nonparametric tests. Results. A significant increase in FFMQ-Observe subscale, a reduction in anxiety, depression, and OQ-45 symptom distress, an increase in PDCRS-Subcortical scores, and an improvement in postural instability, gait, and rigidity motor symptoms were observed at postassessment. Gains for the PDCRS were sustained at follow-up. Conclusion. The mindfulness intervention tailored for PD is associated with reduced anxiety and depression and improved cognitive and motor functioning. A randomised controlled trial using a large sample of PD patients is warranted.
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68
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Lee HG, Choi JW, Lee YJ, Jeong DU. Depressed REM Sleep Behavior Disorder Patients Are Less Likely to Recall Enacted Dreams than Non-Depressed Ones. Psychiatry Investig 2016; 13:227-31. [PMID: 27081385 PMCID: PMC4823200 DOI: 10.4306/pi.2016.13.2.227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/31/2015] [Accepted: 09/09/2015] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE REM sleep behavior disorder (RBD) is associated with psychiatric symptoms, such as anxiety and alexithymia. However, only a few studies on the relationship between depression and RBD have been published. In this study, we investigated the occurrence of depression and associated factors in patients with RBD. METHODS In total 94 patients (mean age: 61.9±12.7 years, male: 70.2%) diagnosed as RBD were examined using detailed clinical histories, the Beck Depression Inventory (BDI), the Epworth Sleepiness Scale (ESS), and nocturnal polysomnography (PSG). RESULTS The mean BDI score of all patients was 12.4±10.3 and 44.7% of RBD patients showed depressed mood (BDI >11 points). Depressed RBD patients were less able to recall enacted dreams than were non-depressed patients (61.9% vs. 86.5%, p=0.008). Logistic regression analysis showed that failure to recall enacted dreams was significantly associated with depression, after controlling for confounding variables including the respiratory disturbance index and a history of psychiatric disorders (odds ratio=0.323, p=0.041). CONCLUSION In this study, 44.7% of RBD patients were found to suffer from depressed mood. And, depression was found to be associated with reduced ability to recall enacted dreams. We suggest that routine evaluation of depression be performed in RBD patients, particularly when failure to recall enacted dreams is evident. We speculate that such failure may be associated with emotional dysregulation or neurodegeneration.
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Affiliation(s)
- Hyeong Gon Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Won Choi
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yu Jin Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do-Un Jeong
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University Hospital, Seoul, Republic of Korea
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69
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Tremblay C, Monetta L, Langlois M, Schneider C. Intermittent Theta-Burst Stimulation of the Right Dorsolateral Prefrontal Cortex to Promote Metaphor Comprehension in Parkinson Disease: A Case Study. Arch Phys Med Rehabil 2016; 97:74-83. [DOI: 10.1016/j.apmr.2015.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 09/06/2015] [Accepted: 09/10/2015] [Indexed: 10/23/2022]
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Unrevealed Depression Involves Dysfunctional Coping Strategies in Crohn's Disease Patients in Clinical Remission. Gastroenterol Res Pract 2015; 2016:7803262. [PMID: 26823663 PMCID: PMC4707369 DOI: 10.1155/2016/7803262] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 02/06/2023] Open
Abstract
Background and Aims. This study investigated the proportion of CD patients in clinical remission with clinical depression, and coping strategies in those with severe depressive disorders. Materials and Methods. One hundred consecutive CD patients in clinical remission were screened for anxiety and depression by using Hospital Anxiety and Depression Scale and patients with depressive symptoms were further investigated by means of Cognitive Behavioural Assessment 2.0 and Beck Depression Inventory (BDI). Afterwards the coping strategies were assessed through the Brief-COPE questionnaire. Results. Twenty-one patients had anxious symptoms and 16 had depressive symptoms with or without anxiety. Seven of these patients (43.8%) showed significant depressive symptoms. Compared to patients without psychiatric disorders, these patients showed significant lower score in “positive reframing” (p: 0.017) and in “planning” (p: 0.046) and higher score in “use of instrumental social support” (p < 0.001), in “denial” scale (p: 0.001), and in “use of emotional social support” (p: 0.003). Conclusions. Depressed CD patients in clinical remission may have dysfunctional coping strategies, meaning that they may not be able to implement functional strategies to manage at best stress related with their disease.
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71
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Martinez-Martin P, Leentjens AFG, de Pedro-Cuesta J, Chaudhuri KR, Schrag AE, Weintraub D. Accuracy of screening instruments for detection of neuropsychiatric syndromes in Parkinson's disease. Mov Disord 2015; 31:270-9. [PMID: 26695691 DOI: 10.1002/mds.26522] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 12/27/2022] Open
Abstract
Parkinson's disease includes neuropsychiatric manifestations, such as depression, anxiety, apathy, psychosis, and impulse control disorders, which often are unreported by patients and caregivers or undetected by doctors. Given their substantial impact on patients and caregivers as well as the existence of effective therapies for some of these disorders, screening for neuropsychiatric symptoms is important. Instruments for screening have a particular methodology for validation, and their performance is expressed in terms of accuracy compared with formal diagnostic criteria. The present study reviews the attributes of the screening instruments applied for detection of the aforementioned major neuropsychiatric symptoms in Parkinson's disease. A quasi-systematic review (including predefined selection criteria, but not evaluating the quality of the reviewed studies) was carried out on the basis of previous systematic reviews (commissioned by the American Academy of Neurology and the Movement Disorder Society) and made current by conducting a literature search (2005-2014). For depression, 11 scales and questionnaires were shown to be valid for Parkinson's disease screening. The recently developed Parkinson Anxiety Scale and the Geriatric Anxiety Inventory demonstrate satisfactory properties as screening instruments for anxiety, and the Lille Apathy Rating Scale for detection of apathy. No scale adequately screens for psychosis, so a specific psychosis instrument should be developed. The Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (Questionnaire and Rating Scale) are valid for comprehensive screening of impulse control disorders, and the Parkinson's Disease-Sexual Addiction Screening Test for hypersexuality specifically.
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Affiliation(s)
- Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Albert F G Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jesus de Pedro-Cuesta
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Kallol Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence, King's College London, London, United Kingdom.,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre and Dementia Unit at South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom
| | - Anette E Schrag
- UCL Institute of Neurology, University College London, London, Royal Free Campus, London, United Kingdom
| | - Daniel Weintraub
- Department of Psychiatry and Departments of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Renfroe JB, Bradley MM, Okun MS, Bowers D. Motivational engagement in Parkinson's disease: Preparation for motivated action. Int J Psychophysiol 2015; 99:24-32. [PMID: 26659013 DOI: 10.1016/j.ijpsycho.2015.11.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 11/20/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
The current study investigated whether motivational dysfunction in Parkinson's patients is related to a deficit in preparing for motivated behavior. Based on previous studies, it was hypothesized that PD patients would show reduced preparation for action specifically when faced with threat (of loss) and that reduced action preparation would relate to self-report of apathy symptoms. The study measured an electrocortical correlate of preparation for action (CNV amplitude) in PD patients and healthy controls, as well as defensive and appetitive activation during emotional perception (LPP amplitude). The sample included 18 non-demented PD patients (tested on dopaminergic medications) and 15 healthy controls who responded as quickly as possible to cues signaling threat of loss or reward, in which the speed of the response determined the outcome. Results indicated that, whereas PD patients showed similar enhanced action preparation with the addition of incentives to controls, PD patients showed generally reduced action preparation, evidenced by reduced CNV amplitude overall. Results suggest that PD patients may have behavioral issues due to globally impaired action preparation but that this deficit is not emotion-specific, and movement preparation may be aided by incentive in PD patients.
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Affiliation(s)
- J B Renfroe
- Department of Clinical and Health Psychology, University of Florida, PO Box 100165, Gainesville, FL 32610, United States; NIMH Center for the Study of Emotion and Attention, University of Florida, Gainesville, FL 32611, United States.
| | - M M Bradley
- NIMH Center for the Study of Emotion and Attention, University of Florida, Gainesville, FL 32611, United States
| | - M S Okun
- Center for Movement Disorders and Neurorestoration, University of Florida, United States
| | - D Bowers
- Department of Clinical and Health Psychology, University of Florida, PO Box 100165, Gainesville, FL 32610, United States
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Identifying Individuals With Generalised Anxiety Disorder: A Receiver Operator Characteristic Analysis of Theoretically Relevant Measures. BEHAVIOUR CHANGE 2015. [DOI: 10.1017/bec.2015.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This article appraises the ability of several measures, assessing symptomatology theoretically relevant to generalised anxiety disorder (GAD), to accomplish successful classification of individuals with DSM-IV GAD and individuals with mood or other anxiety disorders. Participants were 197 individuals (average age = 36.43; 67.5% female) receiving treatment at a clinic, who completed pretreatment self-report measures. Receiver operator characteristic analyses and logistic regression analyses were employed to determine the classificatory abilities, including sensitivity and specificity, of several GAD relevant measures. The Penn State Worry Questionnaire (PSWQ) accomplished significant classification in both comparison group dyads: GAD-Anxiety and GAD-Mood. Whereas the general distress of depression subscale of the Mood and Anxiety Symptoms Questionnaire (MASQ) accomplished significant classification in the GAD-Anxiety group dyad, both the general distress of anxiety and anxious arousal subscales of the MASQ did so in the GAD-Mood group dyad. Only the PSWQ significantly predicted the presence of GAD, while controlling for other symptom variables. Though evidence supports the uniqueness of some symptoms of GAD, including worry, often considered pathognomonic to GAD, the modest areas under the curve, sensitivity, and specificity of the measures afford tenuous support for the utility of these measures. The lack of highly sensitive and specific symptomatology comport with critiques of GAD as a diagnostically delimited category.
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Depression rating scales in Parkinson's disease: A critical review updating recent literature. J Affect Disord 2015; 184:216-24. [PMID: 26114228 DOI: 10.1016/j.jad.2015.05.059] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 01/22/2023]
Abstract
Depression is a prominent non-motor symptom in Parkinson's disease (PD). Assessing depression in PD remains a challenge due to the overlap of somatic symptoms between depression and PD. Other neuropsychiatric manifestations associated with PD, such as cognitive decline, also complicate assessment of depression. Therefore it is critical to investigate the validity of depression rating scales for use in PD. This will allow evaluation of observer- and self-report instruments to be administered in neurologically ill geriatric populations such as PD, and identification of appropriate scales to use in cognitively challenged PD patients. The present review includes all studies examining the validity of depression rating scales in PD. It discusses the usefulness of 13 depression rating scales in PD. The clinician-rated and widely used HAMD-17 and the self-report GDS scales are recommended for screening and measuring severity of depression in PD. The GDS-15 may be a preferred choice due to its brevity and ease of use design for older adults. Other valid and reliable instruments to use in PD include self-rated scales, such as the HADS-D, HDI, and the BDI, and the observer-report, MADRS. The CSDD displayed satisfactory validity and reliability for identification of PD patients with and without dementia. The PHQ-2, PHQ-10, SDS, CES-D, UPDRS-Depression item, IDS-SR, and IDS-C each showed some evidence of validity or reliability, however further research on the psychometric properties of these scales when used in a PD population are required.
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Data-driven atypical profiles of depressive symptoms: Identification and validation in a large cohort. J Affect Disord 2015; 180:36-43. [PMID: 25881279 DOI: 10.1016/j.jad.2015.03.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 03/23/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Atypical response behavior on depression questionnaires may invalidate depression severity measurements. This study aimed to identify and investigate atypical profiles of depressive symptoms using a data-driven approach based on the item response theory (IRT). METHODS A large cohort of participants completed the Inventory of Depressive Symptomatology self-report (IDS-SR) at baseline (n=2329) and two-year follow-up (n=1971). Person-fit statistics were used to quantify how strongly each patient׳s observed symptom profile deviated from the expected profile given the group-based IRT model. Identified atypical profiles were investigated in terms of reported symptoms, external correlates and temporal consistency. RESULTS Compared to others, atypical responders (6.8%) showed different symptom profiles, with higher 'mood reactivity' and 'suicidal ideation' and lower levels of mild symptoms like 'sad mood'. Atypical responding was associated with more medication use (especially tricyclic antidepressants: OR=1.5), less somatization (OR=0.8), anxiety severity (OR=0.8) and anxiety diagnoses (OR=0.8-0.9), and was shown relatively stable (29.0%) over time. LIMITATIONS This is a methodological proof-of-principal based on the IDS-SR in outpatients. Implementation studies are needed. CONCLUSION Person-fit statistics can be used to identify patients who report atypical patterns of depressive symptoms. In research and clinical practice, the extra diagnostic information provided by person-fit statistics could help determine if respondents׳ depression severity scores are interpretable or should be augmented with additional information.
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Bega D, Luo S, Fernandez H, Chou K, Aminoff M, Parashos S, Walker H, Russell DS, Christine CW, Dhall R, Singer C, Bodis-Wollner I, Hamill R, Truong D, Mari Z, Glazmann S, Huang M, Houston E, Simuni T. Impact of Depression on Progression of Impairment and Disability in Early Parkinson's Disease. Mov Disord Clin Pract 2015; 2:371-378. [PMID: 28393083 DOI: 10.1002/mdc3.12205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Danny Bega
- Northwestern University, Chicago, Illinois, USA
| | - Sheng Luo
- University of Texas Health Science Center, Houston, Texas, USA
| | | | - Kelvin Chou
- University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Aminoff
- University of California San Francisco, San Francisco, California, USA
| | | | - Harrison Walker
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David S Russell
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | | | - Rohit Dhall
- Muhammad Ali Parkinson Center, Phoenix, Arizona, USA
| | | | | | | | - Daniel Truong
- Parkinson and Movement Disorders Institute, Fountain Valley, California, USA
| | - Zoltan Mari
- Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Meilin Huang
- University of Texas Health Science Center, Houston, Texas, USA
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Enrici I, Adenzato M, Ardito RB, Mitkova A, Cavallo M, Zibetti M, Lopiano L, Castelli L. Emotion processing in Parkinson's disease: a three-level study on recognition, representation, and regulation. PLoS One 2015; 10:e0131470. [PMID: 26110271 PMCID: PMC4482447 DOI: 10.1371/journal.pone.0131470] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 06/02/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is characterised by well-known motor symptoms, whereas the presence of cognitive non-motor symptoms, such as emotional disturbances, is still underestimated. One of the major problems in studying emotion deficits in PD is an atomising approach that does not take into account different levels of emotion elaboration. Our study addressed the question of whether people with PD exhibit difficulties in one or more specific dimensions of emotion processing, investigating three different levels of analyses, that is, recognition, representation, and regulation. METHODOLOGY Thirty-two consecutive medicated patients with PD and 25 healthy controls were enrolled in the study. Participants performed a three-level analysis assessment of emotional processing using quantitative standardised emotional tasks: the Ekman 60-Faces for emotion recognition, the full 36-item version of the Reading the Mind in the Eyes (RME) for emotion representation, and the 20-item Toronto Alexithymia Scale (TAS-20) for emotion regulation. PRINCIPAL FINDINGS Regarding emotion recognition, patients obtained significantly worse scores than controls in the total score of Ekman 60-Faces but not in any other basic emotions. For emotion representation, patients obtained significantly worse scores than controls in the RME experimental score but no in the RME gender control task. Finally, on emotion regulation, PD and controls did not perform differently at TAS-20 and no specific differences were found on TAS-20 subscales. The PD impairments on emotion recognition and representation do not correlate with dopamine therapy, disease severity, or with the duration of illness. These results are independent from other cognitive processes, such as global cognitive status and executive function, or from psychiatric status, such as depression, anxiety or apathy. CONCLUSIONS These results may contribute to better understanding of the emotional problems that are often seen in patients with PD and the measures used to test these problems, in particular on the use of different versions of the RME task.
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Affiliation(s)
- Ivan Enrici
- Department of Philosophy and Educational Sciences, University of Turin, Turin, Italy
- Center for Cognitive Science, University of Turin, Turin, Italy
- Neuroscience Institute of Turin, Turin, Italy
| | - Mauro Adenzato
- Center for Cognitive Science, University of Turin, Turin, Italy
- Neuroscience Institute of Turin, Turin, Italy
- Department of Psychology, University of Turin, Turin, Italy
- * E-mail:
| | - Rita B. Ardito
- Center for Cognitive Science, University of Turin, Turin, Italy
- Department of Psychology, University of Turin, Turin, Italy
| | | | - Marco Cavallo
- eCampus University, Novedrate, Como, Italy
- Azienda Sanitaria Locale Torino 3, Turin, Italy
| | | | - Leonardo Lopiano
- Neuroscience Institute of Turin, Turin, Italy
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin, Turin, Italy
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Kadastik-Eerme L, Rosenthal M, Paju T, Muldmaa M, Taba P. Health-related quality of life in Parkinson's disease: a cross-sectional study focusing on non-motor symptoms. Health Qual Life Outcomes 2015; 13:83. [PMID: 26088201 PMCID: PMC4474578 DOI: 10.1186/s12955-015-0281-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 06/06/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The objective of this study was to investigate factors affecting health-related quality of life (HRQoL) among Estonian persons with Parkinson's disease (PD). METHODS 268 persons with PD were evaluated using: the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS); the Hoehn and Yahr scale (HY); the Schwab and England Activities of Daily Living scale (SE-ADL); the Beck Depression Inventory (BDI); the Mini Mental State Examination (MMSE); the Parkinson's Disease Questionnaire (PDQ-39). Additional questions on clinical and socio-demographic variables were asked during a semi-structured interview. Predictors of HRQoL were tested using multiple regression analysis. RESULTS The main predictors of low HRQoL were depression and motor and non-motor aspects of daily living. 59.9 % of the variation in the PDQ-39 summary index (SI) score was explained by the predictive variables identified in this study. None of the socio-demographic variables (age, gender, urban/rural living, marital status, living alone/with others, education level) were significant predictors of HRQoL. Prevalence of non-motor Parkinson's symptoms were high (99.6 %); cognitive impairment, sleep and urinary problems were the most common. All non-motor symptoms correlated significantly with low HRQoL, except the features of impulse control disorders (ICDs). CONCLUSIONS Depression and motor and non-motor daily living experiences were found to be significant and independent factors of low HRQoL in persons with PD. Depression was the strongest determinant of low HRQoL. Our results highlight the importance of recognition and management of non-motor symptoms, as these features had more impact on patients' HRQoL than clinically assessed motor symptoms.
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Affiliation(s)
- Liis Kadastik-Eerme
- Department of Neurosurgery and Neurology, Tartu University Hospital, L. Puusepa 8, Tartu, 51014, Estonia.
| | - Marika Rosenthal
- Department of Neurosurgery and Neurology, Tartu University Hospital, L. Puusepa 8, Tartu, 51014, Estonia.
| | - Tiiu Paju
- Department of Neurosurgery and Neurology, Tartu University Hospital, L. Puusepa 8, Tartu, 51014, Estonia.
| | - Mari Muldmaa
- Department of Neurosurgery and Neurology, Tartu University Hospital, L. Puusepa 8, Tartu, 51014, Estonia.
| | - Pille Taba
- Department of Neurosurgery and Neurology, Tartu University Hospital, L. Puusepa 8, Tartu, 51014, Estonia.
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Wardenaar KJ, Wanders RBK, Roest AM, Meijer RR, De Jonge P. What does the beck depression inventory measure in myocardial infarction patients? a psychometric approach using item response theory and person-fit. Int J Methods Psychiatr Res 2015; 24:130-42. [PMID: 25994207 PMCID: PMC6878327 DOI: 10.1002/mpr.1467] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/04/2015] [Accepted: 03/17/2015] [Indexed: 11/05/2022] Open
Abstract
Observed associations between depression following myocardial infarction (MI) and adverse cardiac outcomes could be overestimated due to patients' tendency to over report somatic depressive symptoms. This study was aimed to investigate this issue with modern psychometrics, using item response theory (IRT) and person-fit statistics to investigate if the Beck Depression Inventory (BDI) measures depression or something else among MI-patients. An IRT-model was fit to BDI-data of 1135 MI patients. Patients' adherence to this IRT-model was investigated with person-fit statistics. Subgroups of "atypical" (low person-fit) and "prototypical" (high person-fit) responders were identified and compared in terms of item-response patterns, psychiatric diagnoses, socio-demographics and somatic factors. In the IRT model, somatic items had lower thresholds compared to depressive mood/cognition items. Empirically identified "atypical" responders (n = 113) had more depressive mood/cognitions, scored lower on somatic items and more often had a Comprehensive International Diagnostic Interview (CIDI) depressive diagnosis than "prototypical" responders (n = 147). Additionally, "atypical" responders were younger and more likely to smoke. In conclusion, the BDI measures somatic symptoms in most MI patients, but measures depression in a subgroup of patients with atypical response patterns. The presented approach to account for interpersonal differences in item responding could help improve the validity of depression assessments in somatic patients.
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Affiliation(s)
- Klaas J Wardenaar
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
| | - Rob B K Wanders
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
| | - Annelieke M Roest
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
| | - Rob R Meijer
- Department of Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands
| | - Peter De Jonge
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
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Shine JM, Mills JM, Qiu J, O'Callaghan C, Terpening Z, Halliday GM, Naismith SL, Lewis SJ. Validation of the Psychosis and Hallucinations Questionnaire in Non-demented Patients with Parkinson's Disease. Mov Disord Clin Pract 2015; 2:175-181. [PMID: 30363832 PMCID: PMC6183006 DOI: 10.1002/mdc3.12139] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/09/2014] [Accepted: 12/10/2014] [Indexed: 01/29/2023] Open
Abstract
People diagnosed with Parkinson's disease (PD) frequently experience visual and non-visual hallucinations often with comorbid psychosis, however, there is currently no gold standard tool for accurately assessing these symptoms. To address this problem, we designed a novel questionnaire to evaluate the presence of hallucinatory and psychotic symptoms in PD, as well as related symptoms, such as attentional dysfunction and sleep disturbance. We administered the 20-item Psychosis and Hallucinations Questionnaire (PsycH-Q) and three common questionnaire measures in a large cohort of 197 patients with idiopathic PD via a postal survey. We established concurrent validity, convergent validity, and internal consistency of the questionnaire and then assessed test-retest reliability in a subcohort of 44 patients. PsycH-Q was found to be a valid instrument when analogous items were compared across three other existing tools (Spearman's rho range: 0.34-0.64; P < 0.01). PsycH-Q demonstrated a strong relationship between self-reported hallucinations and psychosis and symptoms of the broader hallucinatory phenotype (Kendall's tau = 0.41; P < 0.01; positive predictive value = 0.97). PsycH-Q also displayed a high level of internal consistency (Cronbach's alpha = 0.900; range, 0.696-0.923) and reproducibility (intraclass correlation coefficient = 0.928). PsycH-Q is a simple, valid, self-completed instrument that reliably identifies hallucinations and psychosis in PD and has the ability to characterize related patterns of attentional and sleep impairments. As such, PsycH-Q is a highly valuable tool for use in both clinical and research settings.
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Affiliation(s)
- James M. Shine
- Brain and Mind Research InstituteUniversity of SydneySydneyNew South WalesAustralia
| | - Joanna M.Z. Mills
- Brain and Mind Research InstituteUniversity of SydneySydneyNew South WalesAustralia
| | - Jessica Qiu
- Brain and Mind Research InstituteUniversity of SydneySydneyNew South WalesAustralia
| | - Claire O'Callaghan
- Neuroscience Research Australia and University of New South WalesSydneyNew South WalesAustralia
| | - Zoe Terpening
- Brain and Mind Research InstituteUniversity of SydneySydneyNew South WalesAustralia
| | - Glenda M. Halliday
- Neuroscience Research Australia and University of New South WalesSydneyNew South WalesAustralia
| | - Sharon L. Naismith
- Brain and Mind Research InstituteUniversity of SydneySydneyNew South WalesAustralia
| | - Simon J.G. Lewis
- Brain and Mind Research InstituteUniversity of SydneySydneyNew South WalesAustralia
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Rai NK, Goyal V, Kumar N, Shukla G, Srivastava AK, Singh S, Behari M. Neuropsychiatric co-morbidities in non-demented Parkinson's disease. Ann Indian Acad Neurol 2015; 18:33-8. [PMID: 25745308 PMCID: PMC4350211 DOI: 10.4103/0972-2327.144287] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 06/15/2014] [Accepted: 08/29/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate neuropsychiatric co-morbidities (depression, psychosis and anxiety) in non-demented patients with Parkinson's disease (PD). BACKGROUND Non-motor symptoms like neuropsychiatric co-morbidities are common in Parkinson's disease and may predate motor symptoms. Currently there is scarcity of data regarding neuropsychiatry manifestations in Indian patients with PD. METHODS In this cross-sectional study consecutive 126 non-demented patients with PD (MMSE ≥25) were enrolled. They were assessed using Unified Parkinson's disease rating scale (UPDRS), Hoehn & Yahr (H&Y) stage, Schwab and England (S&E) scale of activity of daily life. Mini-international neuropsychiatric interview (MINI) was used for diagnosis of depression, psychosis and anxiety. Beck's depression inventory (BDI), Brief psychiatric rating scale (BSRS) and Hamilton rating scale for anxiety (HAM-A) scales were used for assessment of severity of depression, psychosis and anxiety respectively. RESULTS Mean age and duration of disease was 57.9 ± 10.9 years and 7.3 ± 3.6 years respectively. At least one of the neuropsychiatric co-morbidity was present in 64% patients. Depression, suicidal risk, psychosis and anxiety were present in 43.7%, 31%, 23.8% and 35.7% respectively. Visual hallucinations (20.6%) were most frequent, followed by tactile (13.5%), auditory (7.2%) and olfactory hallucinations (1.6%). Patients with depression had higher motor disability (UPDRS-motor score 33.1 ± 14.0 vs 27.3 ± 13.3; and UPDRS-total 50.7 ± 21.8 vs 41.0 ± 20.3, all p values <0.05). Patients with psychosis were older (63.6 ± 8.0 years vs 56.1 ± 11.1 years, p < 0.05) and had longer duration of illness (8.6 ± 3.4 years vs 6.9 ± 3.5, p < 0.05). CONCLUSIONS About two third patients with Parkinson's disease have associated neuropsychiatric co-morbidities. Depression was more frequent in patients with higher disability and psychosis with longer duration of disease and older age. These co-morbidities need to be addressed during management of patients with PD.
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Affiliation(s)
- Nirendra Kumar Rai
- Department of Neurology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Vinay Goyal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Shukla
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sumit Singh
- Department of Neurology, Medanta, Gurgaon, Haryana, India
| | - Madhuri Behari
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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van Mierlo TJ, Chung C, Foncke EM, Berendse HW, van den Heuvel OA. Depressive symptoms in Parkinson's disease are related to decreased hippocampus and amygdala volume. Mov Disord 2015; 30:245-52. [DOI: 10.1002/mds.26112] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 10/28/2014] [Accepted: 11/03/2014] [Indexed: 12/16/2022] Open
Affiliation(s)
- Tom J. van Mierlo
- Department of Neurology; VU University Medical Center (VUmc); Amsterdam The Netherlands
| | - Chin Chung
- Department of Neurology; VU University Medical Center (VUmc); Amsterdam The Netherlands
| | - Elisabeth M. Foncke
- Department of Neurology; VU University Medical Center (VUmc); Amsterdam The Netherlands
| | - Henk W. Berendse
- Department of Neurology; VU University Medical Center (VUmc); Amsterdam The Netherlands
- Neuroscience Campus Amsterdam; Amsterdam The Netherlands
| | - Odile A. van den Heuvel
- Neuroscience Campus Amsterdam; Amsterdam The Netherlands
- Department of Psychiatry; VUmc; Amsterdam The Netherlands
- Department of Anatomy & Neurosciences; VUmc; Amsterdam The Netherlands
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83
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Grover S, Somaiya M, Kumar S, Avasthi A. Psychiatric aspects of Parkinson's disease. J Neurosci Rural Pract 2015; 6:65-76. [PMID: 25552854 PMCID: PMC4244792 DOI: 10.4103/0976-3147.143197] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Parkinson's disease (PD) is essentially characterized by the motor symptoms in the form of resting tremor, rigidity and bradykinesia. However, over the years it has been recognized that motor symptoms are just the "tip of the iceberg" of clinical manifestations of PD. Besides motor symptoms, PD characterized by many non-motor symptoms, which include cognitive decline, psychiatric disturbances (depression, psychosis and impulse control), sleep difficulties, autonomic failures (gastrointestinal, cardiovascular, urinary, thermoregulation) and pain syndrome. This review evaluates the various aspects of psychiatric disorders including cognitive decline and sleep disturbances in patients with PD. The prevalence rate of various psychiatric disorders is high in patients with PD. In terms of risk factors, various demographic, clinical and treatment-related variables have been shown to be associated with higher risk of development of psychiatric morbidity. Evidence also suggests that the presence of psychiatric morbidity is associated with poorer outcome. Randomized controlled trials, evaluating the various pharmacological and non-pharmacological treatments for management of psychiatric morbidity in patients with PD are meager. Available evidence suggests that tricyclic antidepressants like desipramine and nortriptyline are efficacious for management of depression. Among the antipsychotics, clozapine is considered to be the best choice for management of psychosis in patients with PD. Among the various cognitive enhancers, evidence suggest efficacy of rivastigmine in management of dementia in patients with PD. To conclude, this review suggests that psychiatric morbidity is highly prevalent in patients with PD. Hence, a multidisciplinary approach must be followed to improve the overall outcome of PD. Further studies are required to evaluate the efficacy of various other measures for management of psychiatric morbidity in patients with PD.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mansi Somaiya
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Santhosh Kumar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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84
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Jones JD, Butterfield LC, Song W, Lafo J, Mangal P, Okun MS, Bowers D. Anxiety and Depression Are Better Correlates of Parkinson's Disease Quality of Life Than Apathy. J Neuropsychiatry Clin Neurosci 2015; 27:213-8. [PMID: 25162776 PMCID: PMC4344415 DOI: 10.1176/appi.neuropsych.13120380] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Due to controversy regarding the influence of apathy on quality of life (QoL), the authors examined the independent influence of apathy, depression, and trait anxiety in a nondemented sample of patients with Parkinson disease (PD). Participants (N=107) completed standard self-report measures of QoL and mood/motivation. Analyses investigated the contribution of these measures and empirically derived factor scores on QoL. QoL was predicted by trait anxiety, dysphoria, and decreased interest, with no independent contribution of apathy. Different patterns emerged with respect to domain-specific QoL, with trait anxiety being the strongest predictor across most domains. Anxiety was most widely related to QoL in PD, with minimal contribution of apathy. Future studies should examine different roles of PD mood/motivation symptoms on caregiver QoL.
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85
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Jones JD, Marsiske M, Okun MS, Bowers D. Latent growth-curve analysis reveals that worsening Parkinson's disease quality of life is driven by depression. Neuropsychology 2014; 29:603-9. [PMID: 25365564 DOI: 10.1037/neu0000158] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Parkinson's disease (PD) is a neurodegenerative disorder resulting in a wide variety of symptoms. The current study examined the influence of apathy, depression and motor symptoms on quality of life (QoL) in PD patients. Information was drawn from an 18-month period. METHOD Participants (N = 397) were assessed for apathy (Apathy Scale; Starkstein et al., 1992), depression (Beck Depression Inventory-II; Beck, Steer, Ball & Ranieri, 1996), motor severity (Unified Parkinson's Disease Rating Scale, Part III; UPDRS; Fahn, Elton & Committee, 1987), and QoL (Parkinson's Disease Questionnaire-39; Jenkinson, Fitzpatrick, Peto, Greenhall, & Hyman,1997) at 3 time points: an initial clinical evaluation (baseline), a 6-month follow-up, and an 18-month follow-up. Latent growth-curve models were used to determine the influence of apathy, depression, and motor symptoms on QoL trajectories. RESULTS Greater difficulties with QoL at baseline showed the strongest relationship to more severe depression symptoms, followed by more severe motor symptoms, younger age, and less education (all p values < .001). Worsening of QoL over the 18-month period was only predicted by a worsening of depression (p = .003). The relationship between QoL and depression symptoms remained significant in a subsample of nondepressed PD patients. CONCLUSION Overall, findings from the current study suggest that self-reported QoL among PD patients is primarily related to depression. Future efforts to improving clinical care of PD patients may benefit by focusing on improving psychosocial adjustment or treatments targeting depression.
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Affiliation(s)
- Jacob D Jones
- Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida
| | - Michael S Okun
- Department of Neurology, McKnight Brain Institute, University of Florida
| | - Dawn Bowers
- Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida
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86
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Jones JD, Hass C, Mangal P, Lafo J, Okun MS, Bowers D. The cognition and emotional well-being indices of the Parkinson's disease questionnaire-39: what do they really measure? Parkinsonism Relat Disord 2014; 20:1236-41. [PMID: 25260967 DOI: 10.1016/j.parkreldis.2014.09.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/04/2014] [Accepted: 09/08/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The Parkinson's disease questionnaire-39 (PDQ-39) is a common measure of health related quality of life (HRQoL) that is widely used with Parkinson disease (PD) patients. Previous evidence suggests that the PDQ-39 reflects at least 8 dimensions (i.e., Emotion, Cognitions, Mobility, etc). To date, little research has examined the external/convergent validity of the Cognitions and Emotional Well-being domains of the PDQ-39. METHODS A convenience sample of 303 PD patients underwent a comprehensive multi-domain neuropsychological evaluation, including tests of execution function, episodic verbal memory, processing speed, language and working memory, as well as completing measures of depression, apathy, state and trait anxiety and HRQoL (PDQ-39). Hierarchical regressions were conducted in order to examine the relationship between scores on neuropsychological tests and the Cognitions index, as well as mood measures and the Emotional Well-being index of the PDQ-39. RESULTS Neuropsychological test performance did not account for a significant amount of variance in the PDQ-39 Cognitions index scores. Instead, it was depression that significantly contributed to the Cognitions index, above and beyond neuropsychological performance. The PDQ-39 Emotional Well-being index was also related to mood measures, primarily depression and trait anxiety. CONCLUSIONS The PDQ-39 Cognition index may be more related to mood functioning, as opposed to cognitive functioning, and should not be considered a "proxy" for cognitive functioning. Future studies are needed to better explain the construct of this index.
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Affiliation(s)
- Jacob D Jones
- Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Chris Hass
- Department of Applied Physiology and Kinesiology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Paul Mangal
- Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Jacob Lafo
- Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, University of Florida, Gainesville, FL, USA.
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Huebl J, Spitzer B, Brücke C, Schönecker T, Kupsch A, Alesch F, Schneider GH, Kühn AA. Oscillatory subthalamic nucleus activity is modulated by dopamine during emotional processing in Parkinson's disease. Cortex 2014; 60:69-81. [PMID: 24713195 DOI: 10.1016/j.cortex.2014.02.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 01/09/2014] [Accepted: 02/12/2014] [Indexed: 11/19/2022]
Abstract
Dopaminergic denervation in Parkinson's disease (PD) leads to motor deficits but also depression, lack of motivation and apathy. These symptoms can be reversed by dopaminergic treatment, which may even lead to an increased hedonic tone in some patients with PD. Here, we tested the effects of dopamine on emotional processing as indexed by changes in local field potential (LFP) activity of the subthalamic nucleus (STN) in 28 PD patients undergoing deep brain stimulation. LFP activity from the STN was recorded after the administration of levodopa (ON group) or after overnight withdrawal of medication (OFF group) during presentation of an emotional picture-viewing task. Neutral and emotionally arousing pleasant and unpleasant stimuli were chosen from the International Affective Picture System. We found a double dissociation of the alpha band response depending on dopamine state and stimulus valence: dopamine enhanced the processing of pleasant stimuli, while activation during unpleasant stimuli was reduced, as indexed by the degree of desynchronization in the alpha frequency band. This pattern was reversed in the OFF state and more pronounced in the subgroup of non-depressed PD patients. Further, we found an early gamma band increase with unpleasant stimuli that occurred when ON but not OFF medication and was correlated with stimulus arousal. The late STN alpha band decrease is thought to represent active processing of sensory information. Our findings support the idea that dopamine enhances approach-related processes during late stimulus evaluation in PD. The early gamma band response may represent local encoding of increased attention, which varies as a function of stimulus arousal.
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Affiliation(s)
- Julius Huebl
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Bernhard Spitzer
- Dahlem Institute for Neuroimaging of Emotion, Free University Berlin, Berlin, Germany
| | - Christof Brücke
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Thomas Schönecker
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Andreas Kupsch
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - François Alesch
- Neurosurgical Department of the Vienna General Hospital, Vienna, Austria
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany; Berlin School of Mind and Brain, Charité - University Medicine Berlin, Berlin, Germany; NeuroCure, Charité - University Medicine Berlin, Berlin, Germany.
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Wurster I, Abaza A, Brockmann K, Liepelt-Scarfone I, Berg D. Parkinson's disease with and without preceding essential tremor-similar phenotypes: a pilot study. J Neurol 2014; 261:884-8. [PMID: 24590404 DOI: 10.1007/s00415-014-7285-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/27/2014] [Accepted: 02/12/2014] [Indexed: 01/12/2023]
Abstract
The aim of this pilot study was to compare clinical aspects of tremor-dominant Parkinson's disease (PD) patients with and without preceding essential tremor to identify characteristics of these two subgroups. Nineteen patients with diagnoses of both essential tremor (ET) and Parkinson's disease in comparison to 18 patients with tremor-dominant Parkinson's disease without preceding tremor were investigated. The profile of several motor and non-motor symptoms, including cognitive dysfunction, depression, sleep alterations, olfaction changes and some autonomic symptoms, as well as imaging aspects obtained by transcranial sonography were compared between groups. Parkinson's patients with essential tremor scored higher in kinetic and postural tremor items (p < 0.05) and displayed an enlarged third ventricle on transcranial sonography (p = 0.010), which was not found in tremor-dominant Parkinson's disease patients. All other motor and non-motor symptoms could not distinguish between either study group. Neither group showed a distinct clinical profile related to non-motor symptoms or symptoms other than tremor-specific motor aspects. The fact that non-motor symptoms were similar in ET-PD gives rise to the hypothesis that also the prodromal phase of PD is similar in ET patients later developing classical PD compared to individuals developing PD without preceding ET. This hypothesis needs to be followed in prospective studies to verify whether the establishment of an ET subgroup with prodromal markers for PD is feasible.
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Affiliation(s)
- Isabel Wurster
- Department of Neurodegeneration and Hertie Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany,
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89
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Evans AH, Kettlewell J, McGregor S, Kotschet K, Griffiths RI, Horne M. A conditioned response as a measure of impulsive-compulsive behaviours in Parkinson's disease. PLoS One 2014; 9:e89319. [PMID: 24586685 PMCID: PMC3933354 DOI: 10.1371/journal.pone.0089319] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 01/17/2014] [Indexed: 01/01/2023] Open
Abstract
Objectives Parkinson's Disease patients wore a device on the wrist that gave reminders to take levodopa and also measured bradykinesia and dyskinesia. Consumption of medications was acknowledged by placing the thumb on the device. Some patients performed this acknowledgement repeatedly and unconsciously. This study examines whether this behaviour reflected increased impulsivity. Methods and Results Twenty five participants were selected because they had i) excess acknowledgements described above or ii) Impulsive-Compulsive Behaviours or iii) neither of these. A blinded assessor applied clinical scales to measure Impulsive-Compulsive Behaviours, cognition, depression, anxiety and apathy. A Response Ratio, representing the number of acknowledgements/number of doses (expressed as a percentage) was tightly correlated with ratings of Impulsive-Compulsive Behaviours (r2 = 0.79) in 19/25 subjects. Some of these patients had dyskinesia, which was higher with extraneous responses than with response indicating medication consumption. Six of the 25 subjects had high Impulsive-Compulsive Behaviour Scores, higher apathy scores, low levels of dyskinesia and normal Response Ratios. Patients without ICB (low RR) also had low dyskinesia levels regardless of the relevance of the response. Conclusion An elevated Response Ratio is a specific measure of a type of ICB where increased incentive salience is attributed to cues by the presence of high striatal dopamine levels, manifested by high levels of dyskinesia. This study also points to a second form of ICBs which occur in the absence of dyskinesia, has normal Response Ratios and higher apathy scores, and may represent prefrontal pathology.
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Affiliation(s)
| | - Jade Kettlewell
- Florey Neuroscience Institute, University of Melbourne, Parkville Victoria, Australia
| | | | - Katya Kotschet
- Florey Neuroscience Institute, University of Melbourne, Parkville Victoria, Australia
- St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Robert I. Griffiths
- Florey Neuroscience Institute, University of Melbourne, Parkville Victoria, Australia
| | - Malcolm Horne
- Florey Neuroscience Institute, University of Melbourne, Parkville Victoria, Australia
- St Vincent's Hospital, Fitzroy, Victoria, Australia
- Department of Medicine, St Vincent's Hospital, Fitzroy, Victoria, Australia
- * E-mail:
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90
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Lagopoulos J, Malhi GS, Ivanovski B, Cahill CM, Morris JGL. A matter of motion or an emotional matter? Management of depression in Parkinson’s disease. Expert Rev Neurother 2014; 5:803-10. [PMID: 16274337 DOI: 10.1586/14737175.5.6.803] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Jim Lagopoulos
- School of Psychiatry, The University of New South Wales, Australia
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91
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Moustafa AA, Poletti M. Neural and behavioral substrates of subtypes of Parkinson's disease. Front Syst Neurosci 2013; 7:117. [PMID: 24399940 PMCID: PMC3872046 DOI: 10.3389/fnsys.2013.00117] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/05/2013] [Indexed: 01/18/2023] Open
Abstract
Parkinson’s disease (PD) is a neurological disorder, associated with rigidity, bradykinesia, and resting tremor, among other motor symptoms. In addition, patients with PD also show cognitive and psychiatric dysfunction, including dementia, mild cognitive impairment (MCI), depression, hallucinations, among others. Interestingly, the occurrence of these symptoms—motor, cognitive, and psychiatric—vary among individuals, such that a subgroup of PD patients might show some of the symptoms, but another subgroup does not. This has prompted neurologists and scientists to subtype PD patients depending on the severity of symptoms they show. Neural studies have also mapped different motor, cognitive, and psychiatric symptoms in PD to different brain networks. In this review, we discuss the neural and behavioral substrates of most common subtypes of PD patients, that are related to the occurrence of: (a) resting tremor (vs. nontremor-dominant); (b) MCI; (c) dementia; (d) impulse control disorders (ICD); (e) depression; and/or (f) hallucinations. We end by discussing the relationship among subtypes of PD subgroups, and the relationship among motor, cognitive, psychiatric factors in PD.
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Affiliation(s)
- Ahmed A Moustafa
- Department of Veterans Affairs, New Jersey Health Care System East Orange, NJ, USA ; School of Social Sciences and Psychology and Marcs Institute for Brain and Behaviour, University of Western Sydney Sydney, NSW, Australia
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, AUSL of Reggio Emilia Reggio Emilia, Italy
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92
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Simuni T, Luo ST, Chou KL, Fernandez H, He B, Parashos S. Rankin scale as a potential measure of global disability in early Parkinson's disease. J Clin Neurosci 2013; 20:1200-3. [PMID: 23810387 DOI: 10.1016/j.jocn.2012.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 10/14/2012] [Indexed: 10/26/2022]
Abstract
We conducted an exploratory analysis of the utility of the modified Rankin Scale (mRS) as a global measure of disability in early Parkinson's diesase (PD) using the baseline data from a large cohort of PD patients enrolled in a longitudinal study of creatine. The mRS is scored 0-6 with lower scores reflecting less disability. For the analysis the mRS score was dichotomized at <2 versus ≥2. We explored the association of the mRS with multiple measures of PD-related impairments, including the Unified Parkinson Disease Rating Scale (UPDRS); cognitive function characterized by the Symbol Digit Modalities--verbal, and Scales for Outcomes in Parkinson's disease--cognition (SCOPA-COG); quality of life (Parkinson's disease questionnaire [PDQ-39]) and EuroQOL; Beck Depression Inventory II (BDI); and Total Functional Capacity (TFC). We also investigated the interaction between variables. One thousand seven hundred forty-one patients were included in the analysis of which 374 had a mRS score of 2 or above. In the univariate model, all interested measures except SCOPA-COG (p=0.23) had significant association with mRS (p<0.001) after controlling for confounders. In the multivariate model, UPDRS Part II and III (activities of daily living and motor), BDI, TFC and PDQ-39 were significant (p<0.05). The mRS has a significant association with the wide spectrum of measures of impairment and quality of life in early PD and shows good potential to be a global measure of disability in early PD. The sensitivity of the mRS to change and performance of the scale in more advanced PD will have to be established longitudinally.
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Affiliation(s)
- Tanya Simuni
- Northwestern University Feinberg School of Medicine, Abbott Hall 11th Floor, 710 North Lake Shore Drive, Chicago, IL 60611, USA.
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93
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Tedeschini E, Pingani L, Simoni E, Ferrari D, Giubbarelli C, Giuggioli D, Lumetti F, Rigatelli M, Ferri C, Ferrari S. Correlation of articular involvement, skin disfigurement and unemployment with depressive symptoms in patients with systemic sclerosis: a hospital sample. Int J Rheum Dis 2013; 17:186-94. [DOI: 10.1111/1756-185x.12100] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Luca Pingani
- Department of Human Resources; Azienda USL Reggio Emilia; Reggio Emilia Italy
- International PhD School in Clinical and Experimental Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Elena Simoni
- Psychiatry Unit; Department of Clinical-Diagnostic Medicine and Public Health; University of Modena and Reggio Emilia; Modena Italy
| | - Daniela Ferrari
- Rheumatology Unit; Department of Internal Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Cinzia Giubbarelli
- Psychiatry Unit; Department of Clinical-Diagnostic Medicine and Public Health; University of Modena and Reggio Emilia; Modena Italy
| | - Dilia Giuggioli
- Rheumatology Unit; Department of Internal Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Federica Lumetti
- Rheumatology Unit; Department of Internal Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Marco Rigatelli
- Psychiatry Unit; Department of Clinical-Diagnostic Medicine and Public Health; University of Modena and Reggio Emilia; Modena Italy
| | - Clodoveo Ferri
- Rheumatology Unit; Department of Internal Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Silvia Ferrari
- Psychiatry Unit; Department of Clinical-Diagnostic Medicine and Public Health; University of Modena and Reggio Emilia; Modena Italy
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94
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Weissbach A, Kasten M, Grünewald A, Brüggemann N, Trillenberg P, Klein C, Hagenah J. Prominent psychiatric comorbidity in the dominantly inherited movement disorder myoclonus-dystonia. Parkinsonism Relat Disord 2013; 19:422-5. [PMID: 23332219 DOI: 10.1016/j.parkreldis.2012.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 12/06/2012] [Accepted: 12/19/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Neurological and psychiatric disorders show clinical overlap suggesting a shared pathophysiological background. We evaluated myoclonus-dystonia, a monogenic movement disorder as a disease model for inherited psychopathology. METHOD We investigated 12 SGCE mutation carriers using standardized neurological and psychiatric examinations to assign DSM-IV diagnoses. Furthermore, we analyzed all studies in the Medline database which included psychiatric information on SGCE mutation-positive patients. RESULTS Of our twelve SGCE mutation carriers, 10 were older than 16 years. Two of them (20%) reported psychiatric diagnoses before our examination, which resulted in at least one psychiatric diagnosis in seven (70%) patients, most frequently anxiety (60%), depression (30%) or both. Substance abuse was observed in 20%, whereas obsessive-compulsive disorders were absent. One mutation carrier showed Axis 2 features. In the literature analysis, the ten studies using standardized tools covering DSM-IV criteria reported prevalences similar to those in our sample. This was three times the frequency of psychiatric disorders detected in 13 studies using clinical history or patient report only. CONCLUSION About two thirds of SGCE mutation carriers develop psychiatric comorbidity and >80% are previously undiagnosed.
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Affiliation(s)
- Anne Weissbach
- Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck, Germany
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Kasten M, Hagenah J, Graf J, Lorwin A, Vollstedt EJ, Peters E, Katalinic A, Raspe H, Klein C. Cohort Profile: a population-based cohort to study non-motor symptoms in parkinsonism (EPIPARK). Int J Epidemiol 2012; 42:128-128k. [PMID: 23257687 DOI: 10.1093/ije/dys202] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Parkinson's disease is increasingly viewed as a complex disorder including a range of typical non-motor symptoms in addition to the cardinal motor signs. This cohort was set up in 2010 to investigate the specificity of non-motor symptoms for Parkinson's disease. For this, we included several control groups with decreasing contrast from Parkinson's disease patients. Group definitions ranged from healthy control subjects to those with suspected early motor signs of parkinsonism. Using a mailed questionnaire, we screened 5838 inhabitants of Lübeck, Germany, out of a target population of 10 000 citizens, enquiring about motor impairment, pain, quality of life, comorbidities, somatization and demographics. Based on this information, participants were assigned to screening groups, and selected participants were invited for in-person examination (n = 623). The examination included cognitive examinations, transcranial ultrasound, a brief psychiatric interview and a standardized motor examination that was used to assign examination groups. In addition, all participants answered questionnaires addressing depression, anxiety, sleep and quality of life. The first-year follow-up examination was performed either in person using the same protocol or via mailed questionnaires. This study is ongoing and publications are in preparation, but you may contact the first author (meike.kasten@neuro.uni-luebeck.de) with suggestions for collaboration or data requests.
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Affiliation(s)
- Meike Kasten
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany.
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96
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Suija K, Rajala U, Jokelainen J, Liukkonen T, Härkönen P, Keinänen-Kiukaanniemi S, Timonen M. Validation of the Whooley questions and the Beck Depression Inventory in older adults. Scand J Prim Health Care 2012; 30:259-64. [PMID: 23113732 PMCID: PMC3520422 DOI: 10.3109/02813432.2012.732473] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyse the psychometric properties of the Whooley questions and the 21-item Beck Depression Inventory (BDI-21) in older adults with depression and chronic health problems. DESIGN A population-based study. SETTING Community. SUBJECTS 474 adults, aged 72-73 years, living in the city of Oulu, Finland. MAIN OUTCOME MEASURES The screening parameters of the Whooley questions and the BDI-21 for detecting major depression. RESULTS The prevalence of major depression according to the DSM-IV was 5.3% (single or recurrent episode) obtained by the Mini Neuropsychiatric Interview (MINI). The BDI-21 was best able to identify a current episode of major depression with a cut-off point of 11. The sensitivity and specificity of this cut-off point were 88.0% (95% confidence interval (95% CI) 68.8-97.5) and 81.7% (95% CI 77.8-85.2), respectively. The area under the receiver operating characteristics (ROC) curve was 0.89 (95% CI 0.83-0.96). The two Whooley screening questions had a sensitivity of 62.5% (95% CI 40.6-81.2) and either screening question plus the help question had a sensitivity of 66.7% (44.7-84.4). CONCLUSIONS The Beck Depression Inventory is a valid instrument for the diagnosis of depression in older adults. As a screening measure, the optimal cut-off score should be 11 or higher. Our results indicate that the sensitivity of the Whooley questions is not high enough to be used as a screening scale among the elderly.
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Affiliation(s)
- Kadri Suija
- Department of Family Medicine, University of Tartu, Tartu, Estonia.
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Erro R, Pappatà S, Amboni M, Vicidomini C, Longo K, Santangelo G, Picillo M, Vitale C, Moccia M, Giordano F, Brunetti A, Pellecchia MT, Salvatore M, Barone P. Anxiety is associated with striatal dopamine transporter availability in newly diagnosed untreated Parkinson's disease patients. Parkinsonism Relat Disord 2012; 18:1034-8. [DOI: 10.1016/j.parkreldis.2012.05.022] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 05/21/2012] [Accepted: 05/24/2012] [Indexed: 11/27/2022]
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98
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Baggio H, Segura B, Ibarretxe-Bilbao N, Valldeoriola F, Marti M, Compta Y, Tolosa E, Junqué C. Structural correlates of facial emotion recognition deficits in Parkinson's disease patients. Neuropsychologia 2012; 50:2121-8. [DOI: 10.1016/j.neuropsychologia.2012.05.020] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 05/16/2012] [Accepted: 05/20/2012] [Indexed: 10/28/2022]
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Case identification of depression in patients with chronic physical health problems: a diagnostic accuracy meta-analysis of 113 studies. Br J Gen Pract 2012; 61:e808-20. [PMID: 22137418 DOI: 10.3399/bjgp11x613151] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Depression is more likely in patients with chronic physical illness, and is associated with increased rates of disability and mortality. Effective treatment of depression may reduce morbidity and mortality. The use of two stem questions for case finding in diabetes and coronary heart disease is advocated in the Quality and Outcomes Framework, and has become normalised into primary care. AIM To define the most effective tool for use in consultations to detect depression in people with chronic physical illness. DESIGN Meta-analysis. METHOD The following data sources were searched: CENTRAL, CINAHL, Embase, HMIC, MEDLINE, PsycINFO, Web of Knowledge, from inception to July 2009. Three authors selected studies that examined identification tools and used an interview-based ICD (International Classification of Diseases) or DSM (Diagnostic and statistical Manual of Mental Disorders) diagnosis of depression as reference standard. At least two authors independently extracted study characteristics and outcome data and assessed methodological quality. RESULTS A total of 113 studies met the eligibility criteria, providing data on 20,826 participants. It was found that two stem questions, PHQ-9 (Patient Health Questionnaire), the Zung, and GHQ-28 (General Health Questionnaire) were the optimal measures for case identification, but no method was sufficiently accurate to recommend as a definitive case-finding tool. Limitations were the moderate-to-high heterogeneity for most scales and the facts that few studies used ICD diagnoses as the reference standard, and that a variety of methods were used to determine DSM diagnoses. CONCLUSION Assessing both validity and ease of use, the two stem questions are the preferred method. However, clinicians should not rely on the two-questions approach alone, but should be confident to engage in a more detailed clinical assessment of patients who score positively.
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The prevalence of fatigue following deep brain stimulation surgery in Parkinson's disease and association with quality of life. PARKINSONS DISEASE 2012; 2012:769506. [PMID: 22666631 PMCID: PMC3359731 DOI: 10.1155/2012/769506] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 03/06/2012] [Accepted: 03/06/2012] [Indexed: 11/20/2022]
Abstract
Fatigue is a common and disabling nonmotor symptom seen in Parkinson's disease (PD). While deep brain stimulation surgery (DBS) improves motor symptoms, it has also been associated with non-motor side effects. To date no study has utilized standardized instruments to evaluate fatigue following DBS surgery. Our objective was to determine the prevalence of fatigue following DBS surgery in PD its impact on quality of life and explore predictive factors. We recruited 44 PD subjects. At least one year following DBS placement, we administered the Fatigue Severity Scale (FSS), the Parkinson's Disease Questionnaire (PDQ-39), the Beck Depression Inventory, the Beck Anxiety Inventory, the UPDRS, and a neuropsychological battery. Fifty-eight percent of subjects had moderate to severe fatigue. Fatigue was significantly associated with quality of life, depression, and anxiety. Depression preoperatively was the only predictive factor of fatigue. Fatigue is common following DBS surgery and significantly impacts quality of life.
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