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

Discrimination and structural validity evaluation of Zung self-rating depression scale for pregnant women in China

PURPOSE

The applicability of the Zung self-rating depression scale (SDS) in pregnancy is unknown. We aimed to identify redundant items and evaluate the Zung SDS's structural validity.

METHOD

Two samples of pregnant women were invited from two districts in Shanghai (Yangpu sample, n = 6468 and Huangpu sample, n = 402). The Yangpu sample was randomly split into YGroup1/2/3. Item's properties were evaluated via the item response theory in YGroup1. Exploratory and confirmatory factor analyses were correspondingly executed in YGroup2 and YGroup3. Those items with discrimination parameter (α) lower than 0.65 or factor loading smaller than 0.4 were deleted from the scale. The final structure was validated in the Huangpu sample.

RESULTS

Items 4 (sleep), 7 (weight loss), 8 (constipation) and 9 (tachyarrhythmia) exhibited low discrimination power. Items 2 (diurnal variation), 5 (appetite), 10 (fatigue) and 19 (suicide idea) made a low contribution to all factors. A three-factor model was eventually constructed as cognitive (Items 14, 16, 17, 18 and 20), psychomotor (Items 6, 11 and 12) and affective (Items 1, 3, 13 and 15).

CONCLUSION

The Zung SDS needs modification before applied to pregnant women in China. The items describing the overlap symptoms of the physical change in pregnancy and mood disorder should be deleted.

Efficacy and safety of phytoestrogens in the treatment of perimenopausal and postmenopausal depressive disorders: A systematic review and meta-analysis

BACKGROUND

Depression is one of the most common and specific symptoms among menopausal women, leading to significant personal, family, and economic burdens. Some studies have shown that phytoestrogens can help relieve symptoms of depression.

OBJECTIVES

This systematic review and meta-analysis aim to assess the efficacy and safety of phytoestrogens in treating depression among menopausal women.

METHODS

A comprehensive search for relevant studies published until November 25, 2020, was conducted in PubMed, the Cochrane Library, Chinese Biomedical Literature Database, Web of Science, and EMBASE. Statistical analyses were performed with R 4.0.3.and Review Manager 5.4.

RESULTS

2183 studies were identified and 10 studies with 15 independent reports were included, involving 1248 participants. The quality of the four studies was assessed as high risk, six studies were assessed as unclear. The analyses conducted according random effects model indicated the significant positive effect on depressive symptoms for postmenopausal women compared with the placebo (SMD = -0.62; 95% CI = -1.13 to -0.12; Q = 45.62, df = 14, P < .01; I²  = 79%). The low dose phytoestrogens (25 mg/d ≤ dose ≤ 100 mg/d) have better effectiveness (SMD = -0.52; 95% CI = -0.85 to -0.20; I²  = 79%, P< .01) than high dose (dose > 100 mg/d) and ultralow dose (0 < dose < 25 mg/d), but showed no statistical significance (Q = 0.81 df = 2, P = .67). Isoflavones had better effectiveness (SMD = -0.48; 95% CI = -0.75 to 0.21; I²  = 75%, P < .01) than lignans of phytoestrogens (SMD = -0.22; 95% CI = -0.37 to 0.08; I²  = 0%, P = .96). The duration of intervention affects the efficacy of phytoestrogens (β = -0.03; 95% CI: [-0.05, 0.00]; P = .045). The effectiveness varies in regions. The adverse reactions frequently reported were gastrointestinal symptoms and cold or upper respiratory tract infection.

CONCLUSIONS

Phytoestrogen can relieve depression symptoms among menopausal, especially for postmenopausal women who take low doses(25 mg/d ≤ dose ≤ 100 mg/d) of phytoestrogens for a long-term duration. Although mild adverse reactions have been reported, phytoestrogen could be considered as a complementary treatment for postmenopausal depression.

Depression and anxiety among patients with Parkinson’s disease: frequency, risk factors, and impact on quality of life

Background

Depression and anxiety are non-motor symptoms of Parkinson’s disease (PD) that are often overlooked and underrated. This study aimed to highlight the frequency and risk factors of depression and anxiety among subjects with PD.

Methods

Sixty-four patients with PD who were diagnosed according to United Kingdom Parkinson’s Disease Society (UKPDS) Brain Bank Criteria and 50 sex- and age-matched healthy control subjects are evaluated for depression and anxiety. PD severity and staging were assessed using Unified Parkinson’s Disease Rating Scale (UPDRS) and Hoehn and Yahr scale. Depression and anxiety were diagnosed using DSM-IV TR criteria and scored using Hamilton Depression and Hamilton Anxiety Rating Scales (HAM-D and HAM-A). The World Health Organization Quality of Life (WHOQOL)-BREF was used to assess impact of depression and anxiety on quality of life.

Results

31.25% of patients with PD had depression while 40.6% of patients had anxiety disorder. Depression was higher in females and patients with history of depression and low socioeconomic status (SES). Anxiety was common in young patients and those who had history of anxiety. Overlap between depression and anxiety was recorded in 23.4%. Total UPDRS and Hoehn and Yahr scale accounted for 33.4% of variance for depression. Total UPDRS and earlier age of onset accounted for 39% of variance for anxiety. Advanced disease stage and severity were independent predictors for depression while disease severity and younger age of onset were the main predictors for anxiety. Depression and anxiety have a negative impact on the overall quality of life of PD patients especially on physical and psychosocial domains.

Conclusion

Depression and anxiety are relatively common in PD. Female gender, low SES, and history of depression were the main risk factors for developing depression. Young age and history of anxiety were risk factors for anxiety. Both had negative impact on quality of life.

Suicide in Parkinson's disease

Persons with Parkinson's disease (PwP) have many known risk factors for suicide and suicidal ideation (SI). Despite this, there is limited understanding of suicidality in this population. We conducted a systematic review to synthesise the available literature on suicidality in PwP and highlight areas for potential intervention and further research. We identified 116 articles discussing SI, suicidal behaviours, suicide attempts and/or fatal suicide in PwP. These articles describe prevalence, suicide methods, risk factors for suicide and SI and treatment of suicidality. In this review, we summarise the current literature and provide suggestions for how clinicians can identify and treat PwP who are at risk for suicide, for example, through aggressive treatment of depression and improved screening for access to lethal means.

Abdominal Massage for the Relief of Constipation in People with Parkinson's: A Qualitative Study

Objectives. To explore the experiences of people with Parkinson's (PwP) who suffer from constipation, the impact this has on their lives, and the effect of using lifestyle changes and abdominal massage as a form of constipation management. Method. Fourteen semistructured interviews were completed (8 males and 6 females; mean age 72.2 years) at the end of a care programme, which consisted of either lifestyle advice and abdominal massage (intervention group; n = 7) or lifestyle advice only (control group; n = 7). Data were analysed using constant-comparison techniques and Framework methods. Themes and key quotes were identified to depict major findings. Findings. Four key themes were identified: (i) the adverse impact of bowel problems on quality of life; (ii) positive experience of behaviour adjustments: experimentation; (iii) abdominal massage as a dynamic and relaxing tool: experiential learning (intervention group only); (iv) abdominal massage as a contingency plan: hesitation (control group only). Constipation was reported as having a significant impact on quality of life. Participants in both groups perceived lifestyle advice to relieve symptoms. Specific improvements were described in those who also received the abdominal massage. Conclusions. Both lifestyle advice and abdominal massage were perceived to be beneficial in relieving symptoms of constipation for PwP.

Fatigue is associated with the onset of hallucinations in patients with Parkinson's disease: A 3-year prospective study

Hallucinations remain problematic in Parkinson's disease (PD). Various factors have been studied, and many previous studies identified risk factors for hallucinations, such as sleep disorders. At the same time, fatigue is a common symptom in Parkinson's disease, and any factors associated with fatigue in PD have been reported. Factors associated with fatigue in PD are likely to be similar to risk factors for hallucinations. However, fatigue has been not been reported to be a risk factor for hallucinations in previous studies. We prospectively studied non-hallucinators with PD during 3 years to identify factors associated with the onset of hallucinations, including fatigue. We initially screened 100 consecutive patients and registered 78 patients with PD. During 3 years of follow-up, 31 patients newly presented with visual hallucinations. A total of 18 variables were evaluated by logistic regression analysis. Brief Fatigue Inventory (BFI) (OR = 1.027, p = 0.045, 95% CI = 1.001-1.053) was related to first-onset hallucinations on multivariate logistic regression analysis. The present study is the first to demonstrate an association of fatigue with the onset of hallucinations. Fatigue, especially mental fatigue, can be a risk factor for future hallucinations.

Human behavioral assessments in current research of Parkinson's disease

Parkinson's disease (PD) is traditionally classified as a movement disorder because patients mainly complain about motor symptoms. Recently, non-motor symptoms of PD have been recognized by clinicians and scientists as early signs of PD, and they are detrimental factors in the quality of life in advanced PD patients. It is crucial to comprehensively understand the essence of behavioral assessments, from the simplest measurement of certain symptoms to complex neuropsychological tasks. We have recently reviewed behavioral assessments in PD research with animal models (Asakawa et al., 2016). As a companion volume, this article will systematically review the behavioral assessments of motor and non-motor PD symptoms of human patients in current research. The major aims of this article are: (1) promoting a comparative understanding of various behavioral assessments in terms of the principle and measuring indexes; (2) addressing the major strengths and weaknesses of these behavioral assessments for a better selection of tasks/tests in order to avoid biased conclusions due to inappropriate assessments; and (3) presenting new concepts regarding the development of wearable devices and mobile internet in future assessments. In conclusion we emphasize the importance of improving the assessments for non-motor symptoms because of their complex and unique mechanisms in human PD brains.

Depression rating scales in Parkinson's disease: A critical review updating recent literature

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.

Translation and adaptation of the Zung Self- Rating Depression Scale for application in the bilingual Azerbaijani population

BACKGROUND

A self-reported Zung Self-Rating Depression Scale (ZSDS) is recognized as a reliable and valid measure for assessment of depressive symptoms, applicable cross-culturally. The aim of the study was to adapt ZSDS for application in the bilingual Azerbaijani population.

METHODS

ZSDS was translated into Azerbaijani and Russian. Two pilot studies on small samples (n=30 and n=45) were conducted to improve the scale's acceptability. A readability study was conducted on a bigger sample of depressed subjects (n=55) and healthy controls (n=120). Chronbach's alpha for the total scale, item-test correlations, alpha if item deleted, and sensitivity and specificity at various cut-off levels were calculated.

RESULTS

The drop-out rate was 83.3% at the first pilot study due to problems of comprehension of item 5 and culturally unacceptable wording of item 6. After rewording of the items drop-out reduced to 20%. On the reliability study Chronbach's alpha for the total scale was 0.8727, and item-test correlations for the most individual items were satisfactory. An optimal cut-off point was 45 points with sensitivity=90.91%, specificity=80.83%.

CONCLUSIONS

Adaptation of the Zung Self-Reported Depression Scale improved cultural acceptability of the scale in the context of the Azerbaijani study population.

Is depression in Parkinson's disease (PD) a specific entity?

BACKGROUND

Clinical lore and research have suggested for a long time that depression and PD are closely related. We examined the validity of depression associated with PD (dPD) as a specific subtype of depression according to face validity, descriptive validity, construct validity and predictive validity.

METHODS

The English literature was reviewed after searching the MEDLINE database up to June 2010.

RESULTS

There appears to be three possible subtypes of comorbid depression: 1) patients who would have been depressed even if they had no PD (nonspecific-casual comorbid dPD), 2) patients who would have been depressed if they had had another disabling medical illness (nonspecific-reactive comorbid dPD) 3) those for which depression is directly related to the underlying pathophysiology of PD (specific comorbid dPD). These latter patients may more often present with particular clinical characteristics (descriptive validity): absence of history of depression or only within 5 years prior to onset of PD, absence of guilty thoughts and self-blame, absence of suicidal behavior, right-sided onset. However, dPD is only partly responsive to dopamine replacement and cannot be solely explained by dopamine deficiency. Other neurotransmitter systems are affected in PD and are involved in the pathophysiology of dPD. Their relative involvement however may differ from that in idiopathic depression (i.e.: lesser involvement of serotonergic systems).

LIMITATIONS

Therapeutic data are limited to few controlled trials.

CONCLUSIONS

Further research may allow differential diagnosis between dPD subtypes (i.e.: those who do and do not result from the underlying pathophysiological process of PD) and help inform treatment choice.

Pramipexole reduces the prevalence of fatigue in patients with Parkinson's disease

OBJECTIVE

The aim of this multicenter cross-sectional study was to assess the relation between fatigue in a large number of Japanese patients with Parkinson's disease (PD) and drugs taken to treat PD.

METHOD

We used the 16-item Parkinson Fatigue Scale (PFS-16), which was designed to assess fatigue exclusively associated with PD. Multiple logistic regression analyses were used to assess the relation between antiparkinson drugs and fatigue in PD.

RESULTS

A total of 350 non-demented PD patients were enrolled. Fatigue (PFS score of ≥4) was revealed in 319 patients (91%). Pramipexole was administered to 24% of PD patients. Multiple logistic regression analysis revealed that the administration of Pramipexole was significantly related to low rates of fatigue in PD patients with Hoehn and Yahr stage <3 (p=0.011, odds ratio=5.23, 95% confidence interval; 1.47-18.63).

CONCLUSION

The reduced fatigue in PD patients was observed in taking Pramipexole.

Apathy and depression in Parkinson disease

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

Fatigue in Japanese patients with Parkinson's disease: a study using Parkinson fatigue scale

The objective of this multicenter cross-sectional study was to determine the prevalence of fatigue and factors contributing to it in a large sample of Japanese patients with Parkinson's disease (PD). We used the 16-item Parkinson Fatigue Scale (PFS-16), which was designed to assess fatigue exclusively associated with PD. We carried out this study using PFS-16, the Unified Parkinson's Disease Rating Scale, Zung's Self-Rating Depression Scale, Parkinson's Disease Sleep Scale (PDSS), and the PD quality of life (QOL) scale (PDQ-39) by interview using questionnaires and physical examination by neurologists in 361 nondemented PD patients. Fatigue (an average PFS score of 3.3 or greater) was revealed in 151 patients (41.8%). Multiple logistic regression analysis indicated that the significant independent variables related to the presence of fatigue were the scores of PDSS and PDQ-39. Depression score was not a significant contributing factor. Our study revealed that the prevalence of fatigue in Japanese PD patients is as high as that in Western countries, and that fatigue is a relatively independent symptom, although sleep disturbance may be associated with fatigue. Since fatigue is significantly related to QOL reduction, therapeutic interventions including treatment of sleep disturbance are important.