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Heimrich KG, Schönenberg A, Mendorf S, Moussaoui J, Prell T. An examination of anxiety and its influence on health-related quality of life in Parkinson's disease using the geriatric anxiety scale: a cross-sectional study. BMC Geriatr 2024; 24:298. [PMID: 38549058 PMCID: PMC10979635 DOI: 10.1186/s12877-024-04911-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/21/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Anxiety is one of the most common but often overlooked mood-related nonmotor symptoms in people with Parkinson's disease (PD). To improve the well-being of people with PD, it is important to understand the impact of anxiety in PD, especially its association with depressive and motor symptoms and its impact on health-related quality of life (HRQoL). METHODS 91 people with PD were assessed between June 2017 and June 2018. Anxiety was measured using the Geriatric Anxiety Scale (GAS) and its cognitive, somatic, and affective subscales. HRQoL was assessed using the Parkinson's Disease Questionnaire 39 (PDQ-39). Moreover, sociodemographic information, depressive symptoms, cognition, motor and nonmotor symptoms were assessed. Descriptive statistics, regression analyses, and path analyses were performed to understand predictors of anxiety and its influence on HRQoL. RESULTS Of the 91 people with PD, 35 (38.5%) experienced anxiety. Anxiety symptoms in these individuals primarily manifest as somatic sensations. Anxiety, motor, and depressive symptoms are interlinked but contribute individually to HRQoL. Beyond motor symptoms, cognitive and affective aspects of anxiety impact HRQoL. While anxiety and depression overlap, the somatic and cognitive aspects of anxiety play a significant role in determining HRQoL in addition to depressive symptoms. CONCLUSION Our study used the GAS and its three subscales to shed light on the connections between anxiety, depression, and motor impairment in people with PD. Although anxiety is linked to depression and motor symptoms, it independently affects the HRQoL of people with PD. Thus, it is crucial to adopt a comprehensive diagnostic approach that detects and considers the impact of anxiety on HRQoL in PD.
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Affiliation(s)
- Konstantin G Heimrich
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Aline Schönenberg
- Department of Geriatrics, Halle University Hospital, Ernst-Grube-Straße 40, 06120, Halle, Germany
| | - Sarah Mendorf
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Juliane Moussaoui
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Tino Prell
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Department of Geriatrics, Halle University Hospital, Ernst-Grube-Straße 40, 06120, Halle, Germany
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Hinkle JT, Mills KA, Morrow CB, Pontone GM. Anxiety Change After Dopamine Therapy in Parkinson Disease is Independent of Motor Improvement. Am J Geriatr Psychiatry 2024; 32:220-229. [PMID: 37867011 PMCID: PMC10846408 DOI: 10.1016/j.jagp.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Several anxiety syndromes have been associated with Parkinson disease (PD), but their interactions with dopamine replacement therapy (DRT) and motor function dynamics are not completely understood. We sought to delineate how DRT impacts anxiety phenomenology in PD and whether these changes are dissociable from improved motoric function. METHODS We compared anxiety responses to DRT in two cohorts: 1) a study of 200 PD participants who completed neuropsychiatric assessments before and after taking their dopaminergic medications ("On-Off"); 2) participants in the Parkinson's Progression Markers Initiative (PPMI) de novo PD cohort who completed the State-Trait Anxiety Inventory (STAI) at the time of DRT initiation and a subsequent study visit (n = 113, mean 8-month interval). RESULTS Among On-Off participants transitioning acutely to the On-state, scores on the Hamilton anxiety rating scale decreased by 37% (t = 14.8, df = 199, p <0.0001). Among PPMI participants, STAI-state scores decreased by 10.4% following DRT initiation (t = 4.5, df = 112, p <0.0001). Item-level anxiety changes exhibited weak and nonsignificant correlations (Spearman ρ: -0.24 to 0.33) with objective MDS-UPDRS motor improvements in both immediate and sustained dopamine replacement contexts. CONCLUSION Dopamine repletion effected immediate relief of anxiety in an On-Off state comparison. A similar benefit was observed in the longitudinal PPMI cohort by comparing anxiety before and after DRT initiation, suggesting DRT confers sustained anxiolytic effects in early PD. The weak correlations between improvements to anxiety and motor function on both timescales support the view that these changes are not mediated by improved motor function.
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Affiliation(s)
- Jared T Hinkle
- Medical Scientist Training Program (JTH), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Behavioral Sciences (JTH, CBM), Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Kelly A Mills
- Department of Neurology (KAM, GMP), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher B Morrow
- Department of Psychiatry and Behavioral Sciences (JTH, CBM), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences (JTH, CBM), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (KAM, GMP), Johns Hopkins University School of Medicine, Baltimore, MD
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Yassine S, Almarouk S, Gschwandtner U, Auffret M, Fuhr P, Verin M, Hassan M. Electrophysiological signatures of anxiety in Parkinson's disease. Transl Psychiatry 2024; 14:66. [PMID: 38280864 PMCID: PMC10821912 DOI: 10.1038/s41398-024-02745-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 12/19/2023] [Accepted: 01/08/2024] [Indexed: 01/29/2024] Open
Abstract
Anxiety is a common non-motor symptom in Parkinson's disease (PD) occurring in up to 31% of the patients and affecting their quality of life. Despite the high prevalence, anxiety symptoms in PD are often underdiagnosed and, therefore, undertreated. To date, functional and structural neuroimaging studies have contributed to our understanding of the motor and cognitive symptomatology of PD. Yet, the underlying pathophysiology of anxiety symptoms in PD remains largely unknown and studies on their neural correlates are missing. Here, we used resting-state electroencephalography (RS-EEG) of 68 non-demented PD patients with or without clinically-defined anxiety and 25 healthy controls (HC) to assess spectral and functional connectivity fingerprints characterizing the PD-related anxiety. When comparing the brain activity of the PD anxious group (PD-A, N = 18) to both PD non-anxious (PD-NA, N = 50) and HC groups (N = 25) at baseline, our results showed increased fronto-parietal delta power and decreased frontal beta power depicting the PD-A group. Results also revealed hyper-connectivity networks predominating in delta, theta and gamma bands against prominent hypo-connectivity networks in alpha and beta bands as network signatures of anxiety in PD where the frontal, temporal, limbic and insular lobes exhibited the majority of significant connections. Moreover, the revealed EEG-based electrophysiological signatures were strongly associated with the clinical scores of anxiety and followed their progression trend over the course of the disease. We believe that the identification of the electrophysiological correlates of anxiety in PD using EEG is conducive toward more accurate prognosis and can ultimately support personalized psychiatric follow-up and the development of new therapeutic strategies.
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Affiliation(s)
- Sahar Yassine
- MRC Brain Dynamic Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
- University of Rennes, LTSI - U1099, F-35000, Rennes, France.
- Behavior & Basal Ganglia, CIC1414, CIC-IT, CHU Rennes, Rennes, France.
| | - Sourour Almarouk
- University of Rennes, LTSI - U1099, F-35000, Rennes, France
- Behavior & Basal Ganglia, CIC1414, CIC-IT, CHU Rennes, Rennes, France
- Neuroscience Research Centre, Lebanese University, Faculty of Medicine, Beirut, Lebanon
| | - Ute Gschwandtner
- Dept. of Neurology, Hospitals of the University of Basel, Basel, Switzerland
| | - Manon Auffret
- University of Rennes, LTSI - U1099, F-35000, Rennes, France
- Behavior & Basal Ganglia, CIC1414, CIC-IT, CHU Rennes, Rennes, France
- Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France
- France Développement Electronique, Monswiller, France
| | - Peter Fuhr
- Dept. of Neurology, Hospitals of the University of Basel, Basel, Switzerland
| | - Marc Verin
- University of Rennes, LTSI - U1099, F-35000, Rennes, France
- Behavior & Basal Ganglia, CIC1414, CIC-IT, CHU Rennes, Rennes, France
- Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France
- Movement Disorders Unit, Neurology Department, Pontchaillou University Hospital, Rennes, France
| | - Mahmoud Hassan
- Behavior & Basal Ganglia, CIC1414, CIC-IT, CHU Rennes, Rennes, France
- School of Science and Engineering, Reykjavik University, Reykjavik, Iceland
- MINDIG, F-35000, Rennes, France
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Hussein A, Guevara CA, Valle PD, Gupta S, Benson DL, Huntley GW. Non-Motor Symptoms of Parkinson's Disease: The Neurobiology of Early Psychiatric and Cognitive Dysfunction. Neuroscientist 2023; 29:97-116. [PMID: 33966533 PMCID: PMC9338765 DOI: 10.1177/10738584211011979] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder that has been recognized for over 200 years by its clinically dominant motor system impairment. There are prominent non-motor symptoms as well, and among these, psychiatric symptoms of depression and anxiety and cognitive impairment are common and can appear earlier than motor symptoms. Although the neurobiology underlying these particular PD-associated non-motor symptoms is not completely understood, the identification of PARK genes that contribute to hereditary and sporadic PD has enabled genetic models in animals that, in turn, have fostered ever deepening analyses of cells, synapses, circuits, and behaviors relevant to non-motor psychiatric and cognitive symptoms of human PD. Moreover, while it has long been recognized that inflammation is a prominent component of PD, recent studies demonstrate that brain-immune signaling crosstalk has significant modulatory effects on brain cell and synaptic function in the context of psychiatric symptoms. This review provides a focused update on such progress in understanding the neurobiology of PD-related non-motor psychiatric and cognitive symptoms.
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Affiliation(s)
- Ayan Hussein
- Nash Family Department of Neuroscience and Friedman Brain Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Graduate School of Biomedical Sciences, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher A. Guevara
- Nash Family Department of Neuroscience and Friedman Brain Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Graduate School of Biomedical Sciences, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pamela Del Valle
- Nash Family Department of Neuroscience and Friedman Brain Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Graduate School of Biomedical Sciences, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Swati Gupta
- Nash Family Department of Neuroscience and Friedman Brain Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deanna L. Benson
- Nash Family Department of Neuroscience and Friedman Brain Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Graduate School of Biomedical Sciences, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George W. Huntley
- Nash Family Department of Neuroscience and Friedman Brain Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Graduate School of Biomedical Sciences, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Gibson JS, Flanigan JL, Patrie JT, Dalrymple WA, Harrison MB. Predictors of anxiety in Parkinson's disease: results from a 3-year longitudinal cohort study. Neurol Sci 2023; 44:547-556. [PMID: 36216970 PMCID: PMC9842547 DOI: 10.1007/s10072-022-06427-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/22/2022] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Anxiety symptoms are the most common neuropsychiatric manifestation of Parkinson's disease (PD), contributing to decreased quality of life. Few longitudinal studies in PD samples have examined correlates of anxiety symptoms over time. Understanding predictor variables may help to identify novel targets for reducing anxiety in PD. The aim of this study was to identify predictors of anxiety symptoms over 3 years in a clinic-based PD cohort. METHODS Our cohort included patients with PD at an academic medical center in the Southeastern United States (n = 105). Visits included assessment of motor, psychiatric, and cognitive features, including neuropsychological testing. For our multivariate model, we selected 11 predictor variables with the most existing evidence or theoretical support for an association with anxiety symptoms in PD. Multivariate linear mixed model regression was performed to determine which variables were significantly associated with anxiety symptoms over time. RESULTS Over half of participants (57%) met the screening threshold for an anxiety disorder at some point during the study. Independent predictors of anxiety symptoms over time included symptoms of REM sleep behavior disorder (RBD) and dysautonomia. DISCUSSION In this PD sample, RBD and dysautonomia symptoms were significantly associated with anxiety symptoms over time. Each of these relationships has been reported in one of two prior longitudinal studies. Unlike prior studies, cognitive impairment was not a significant predictor of anxiety symptoms in our sample. Future research should confirm the direction and mechanisms underlying these relationships, including the potential for anxiety symptom reduction through treatment for RBD and dysautonomia.
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Affiliation(s)
- Jessie S Gibson
- School of Nursing, University of Virginia, Charlottesville, VA, USA.
- Department of Neurology, University of Virginia, Charlottesville, VA, USA.
| | - Joseph L Flanigan
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - James T Patrie
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - W Alex Dalrymple
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
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Pontone GM, Perepezko KM, Hinkle JT, Gallo JJ, Grill S, Leoutsakos JM, Mills KA, Weiss HD, Mari Z. 'Anxious fluctuators' a subgroup of Parkinson's disease with high anxiety and problematic on-off fluctuations. Parkinsonism Relat Disord 2022; 105:62-68. [PMID: 36371868 PMCID: PMC9722648 DOI: 10.1016/j.parkreldis.2022.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
Anxiety that occurs in association with on-off dopamine medication fluctuations is a major cause of distress, dysfunction, and lower quality of life in people with Parkinson's disease (PD). However, the association between anxiety and on-off fluctuations is poorly understood and it is difficult to predict which patients will suffer from this atypical form of anxiety. To understand whether fluctuating anxiety in PD exists as part of an endophenotype that is associated with other signs or symptoms, we prospectively assessed the change in anxiety and a battery of clinical variables when transitioning from the off-dopamine medication state to the on state in 200 people with PD. We performed latent profile analysis with observed variables as latent profile indicators measuring the on-off-state difference in anxiety, depression, motor function, daily functioning, and the wearing off questionnaire 19 item scale (WOQ-19) in order to model unobserved (i.e., latent) profiles. A two-class model produced the best fit. The majority of participants, 69%, were categorized as having a 'typical on-off response' compared to a second profile constituting 31% of the sample who experienced a worsening in anxiety in the off state that was three times that of other participants. This profile referred to as "anxious fluctuators" had a Hamilton Anxiety Rating Scale change between the off and on medication state of 10.22(32.85) compared to 3.27 (7.62), higher depression scores, greater disability and was less likely to improve on select WOQ-19 items when in the on-state. Anxious fluctuators were more likely to be male and have a family history of anxiety disorder. Given the adverse impact of this profile we believe it may be important to distinguish patients with a typical on-off response from those with this more problematic course of fluctuations.
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Affiliation(s)
- Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Kate M Perepezko
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jared T Hinkle
- Medical Scientist Training Program, Johns Hopkins School of Medicine, Baltimore, MD, USA; Solomon H. Snyder Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Joseph J Gallo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephen Grill
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Parkinson's and Movement Disorder Center of Maryland, Baltimore, MD, USA
| | | | - Kelly A Mills
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Howard D Weiss
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Zoltan Mari
- Lou Ruvo Center for Brain Health, Cleveland Clinic Nevada, Las Vegas, NV, USA
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Dissanayaka NN, Forbes EJ, Perepezko K, Leentjens AFG, Dobkin RD, Dujardin K, Pontone GM. Phenomenology of Atypical Anxiety Disorders in Parkinson's Disease: A Systematic Review. Am J Geriatr Psychiatry 2022; 30:1026-1050. [PMID: 35305884 DOI: 10.1016/j.jagp.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Anxiety is a prominent concern in Parkinson's disease (PD) that negatively impacts quality of life, increases functional disability, and complicates clinical management. Atypical presentations of anxiety are under-recognized and inadequately treated in patients with PD, compromising global PD care. METHODS This systematic review focuses on the prevalence, symptomology and clinical correlates of atypical presentations of PD-related anxiety following PRISMA guidelines. RESULTS Of the 60 studies meeting inclusion criteria, 14 focused on 'Anxiety Not Otherwise Specified (NOS)' or equivalent, 31 reported on fluctuating anxiety symptoms, and 22 reported on 'Fear of Falling (FOF)'. Anxiety NOS accounted for a weighted mean prevalence of 14.9%, fluctuating anxiety for 34.19%, and FOF for 51.5%. These latter two exceeded the average reported overall prevalence rate of 31% for anxiety disorders in PD. We identified a diverse array of anxiety symptoms related to motor and non-motor symptoms of PD, to complications of PD medication (such as "on" and "off" fluctuations, or both), and, to a lesser extent, to cognitive symptoms. CONCLUSION Atypical anxiety is common, clinically relevant, and heterogeneous in nature. A better understanding of the phenomenology, clinical course, and pathophysiology of varied forms of atypical anxiety in PD is needed to improve recognition, advance therapeutic development and ultimately optimize quality of life in PD.
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Affiliation(s)
- Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine (NND, EJF), The University of Queensland, Brisbane, Australia; School of Psychology (NND, EJF), University of Queensland, Brisbane, Australia; Department of Neurology (NND), Royal Brisbane & Women's Hospital, Brisbane, Australia.
| | - Elana J Forbes
- UQ Centre for Clinical Research, Faculty of Medicine (NND, EJF), The University of Queensland, Brisbane, Australia; School of Psychology (NND, EJF), University of Queensland, Brisbane, Australia
| | - Kate Perepezko
- Department of Mental Health (KP), Johns Hopkins University Blomberg School of Public Health, Baltimore, USA
| | - Albert F G Leentjens
- Department of Psychiatry (AFGL), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Roseanne D Dobkin
- Department of Psychiatry (RDD), Rutgers University, Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Kathy Dujardin
- Department of Neurology and Movement Disorders (KD), University Lille, Lille, France
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences (GMP), Johns Hopkins University School of Medicine, Baltimore, USA; Department of Neurology (GMP), Johns Hopkins University School of Medicine, Baltimore, USA
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The impact of multiple gender dimensions on health-related quality of life in persons with Parkinson's disease: an exploratory study. J Neurol 2022; 269:5963-5972. [PMID: 35833983 PMCID: PMC9281291 DOI: 10.1007/s00415-022-11228-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022]
Abstract
Background There is a growing recognition that sex characteristics and gender-related aspects can have a substantial impact on the health-related quality of life (HRQoL) of persons with Parkinson’s disease (PD). Gender is a multidimensional construct, including dynamic social norms and relations that influence health and impact quality of life. Even when gender is investigated in the field of PD, it is frequently conceptualized as gender identity while other dimensions, such as roles or relations, are generally ignored. The aim of this study was to explore the impact of several gender dimensions on HRQoL among people with PD. Methods We performed a survey-based, cross-sectional study in the Netherlands to explore the impact of several gender dimensions, namely; gender identity, gender roles and gender relations on HRQoL (PDQ-39) of people with PD. Results In our study population (N = 307), including 127 (41%) women, we did not observe an association between gender identity and overall HRQoL. In contrast, an androgynous gender role and higher engagement in household tasks were associated with better overall HRQoL among people with PD. Conclusions This study offers the first detailed description of the impact of different gender dimensions on the HRQoL of people with PD and highlights the need for more precise gender-measures to inform actionable gender-sensitive health interventions for people with PD. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11228-2.
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Chaudhuri KR, Odin P, Ferreira JJ, Antonini A, Rascol O, Kurtis MM, Storch A, Bannister K, Soares-da-Silva P, Costa R, Magalhães D, Rocha JF. Opicapone versus placebo in the treatment of Parkinson’s disease patients with end-of-dose motor fluctuation-associated pain: rationale and design of the randomised, double-blind OCEAN (OpiCapone Effect on motor fluctuations and pAiN) trial. BMC Neurol 2022; 22:88. [PMID: 35279112 PMCID: PMC8917369 DOI: 10.1186/s12883-022-02602-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Optimisation of dopaminergic therapy may alleviate fluctuation-related pain in Parkinson’s disease (PD). Opicapone (OPC) is a third-generation, once-daily catechol-O-methyltransferase inhibitor shown to be generally well tolerated and efficacious in reducing OFF-time in two pivotal trials in patients with PD and end-of-dose motor fluctuations. The OpiCapone Effect on motor fluctuations and pAiN (OCEAN) trial aims to investigate the efficacy of OPC 50 mg in PD patients with end-of-dose motor fluctuations and associated pain, when administered as adjunctive therapy to existing treatment with levodopa/dopa decarboxylase inhibitor (DDCi).
Methods
OCEAN is a Phase IV, international, multicentre, randomised, double-blind, placebo-controlled, parallel-group, interventional trial in PD patients with end-of-dose motor fluctuations and associated pain. It consists of a 1-week screening period, 24-week double-blind treatment period and 2-week follow-up period. Eligible patients will be randomised 1:1 to OPC 50 mg or placebo once daily while continuing current treatment with levodopa/DDCi and other chronic, stable anti-PD and/or analgesic treatments. The primary efficacy endpoint is change from baseline in Domain 3 (fluctuation-related pain) of the King’s Parkinson’s disease Pain Scale (KPPS). The key secondary efficacy endpoint is change from baseline in Domain B (anxiety) of the Movement Disorder Society-sponsored Non-Motor rating Scale (MDS-NMS). Additional secondary efficacy assessments include other domains and total scores of the KPPS and MDS-NMS, the Parkinson’s Disease Questionnaire (PDQ-8), the MDS-sponsored Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Parts III and IV, Clinical and Patient’s Global Impressions of Change, and change in functional status via Hauser’s diary. Safety assessments include the incidence of treatment-emergent adverse events. The study will be conducted in approximately 140 patients from 50 clinical sites in Germany, Italy, Portugal, Spain and the United Kingdom. Recruitment started in February 2021 and the last patient is expected to complete the study by late 2022.
Discussion
The OCEAN trial will help determine whether the use of adjunctive OPC 50 mg treatment can improve fluctuation-associated pain in PD patients with end-of-dose motor fluctuations. The robust design of OCEAN will address the current lack of reliable evidence for dopaminergic-based therapy in the treatment of PD-associated pain.
Trial registration
EudraCT number 2020–001175-32; registered on 2020-08-07.
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Meng D, Jin Z, Gao L, Wang Y, Wang R, Fang J, Qi L, Su Y, Liu A, Fang B. The quality of life in patients with Parkinson's disease: Focus on gender difference. Brain Behav 2022; 12:e2517. [PMID: 35138047 PMCID: PMC8933778 DOI: 10.1002/brb3.2517] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/14/2021] [Accepted: 01/22/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND To improve understanding of gender differences on quality of life (QoL) in patients with Parkinson's disease (PWP) of a different race, the differences of clinical features and health-related quality of life (HRQoL) between male and female PWP were studied in a small cohort early to middle stage of Chinese PWP. METHODS A cross-sectional study was carried out. PWP were consecutively included from April 2020 to July 2021 in Beijing Rehabilitation Hospital. HRQoL, motor symptoms, and nonmotor symptoms in each patient were evaluated. The differences of demographic, motor symptoms assessments, nonmotor symptoms assessments, and QoL between two gender groups were tested using t-test statistics, Mann-Whitney-Wilcoxon test, or χ2 depending on the data type. To eliminate the possible factors contributing to the QoL, linear regression models were constructed to sort out the effect of gender. RESULTS One hundred and sixty-two Parkinson's disease (PD) patients were included. Demographic, clinical characteristics, and symptom scale assessments had no statistical differences except for levodopa equivalent daily dose, Hamilton Anxiety Rating Score, REM sleep behavior disorder sleep questionnaire, and Hyposmia Rating Scale score. After baseline imbalance corrections, a significantly higher score of PD Questionnaire-39 (PDQ-39) in female than in male patients(p<.05) was found. In the questionnaire, summary Index and bodily discomfort, stigma, and emotional well-being subscores were the main contribution differences. CONCLUSIONS Gender differences are associated with the QoL in the early to middle stage PWP in China. Female patients have poorer QoL than male patients, especially bodily discomfort, stigma, and emotional well-being.
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Affiliation(s)
- Detao Meng
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Zhaohui Jin
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Lei Gao
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yixuan Wang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Ruidan Wang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jinping Fang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Lin Qi
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yuan Su
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Aixian Liu
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Boyan Fang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
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Thangavelu K, Hayward JA, Pachana NA, Byrne GJ, Mitchell LK, Wallis GM, Au TR, Dissanayaka NN. Designing Virtual Reality Assisted Psychotherapy for Anxiety in Older Adults Living with Parkinson's Disease: Integrating Literature for Scoping. Clin Gerontol 2022; 45:235-251. [PMID: 31903862 DOI: 10.1080/07317115.2019.1709597] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: This review integrates literature to discuss the potential use of virtual reality (VR) in treatment of anxiety in Parkinson's disease (PD) and inform next steps.Methods: A systematic search was performed to identify studies of VR use in PD, using four databases. Data were reported in accordance to the Preferred Reporting Items for Systematic reviews and Meta-Analyzes extension for Scoping Reviews (PRISMA-ScR).Results: Thirty-two studies met the inclusion criteria with four VR studies from the same study group directly assessing the effects of anxiety on motor symptoms in PD. Primary studies implementing a VR protocol in PD identified focus areas of understanding and alleviating freezing of gait (FOG), balance training, and cognitive and motor rehabilitation, and informed design considerations.Conclusion: VR in PD studies suggested established feasibility. With appropriate design considerations, a VR based protocol could improve anxiety outcomes in PD.Clinical implications: VR in PD provides control of a patient's field of view, which can be exploited to induce specific responses, provide visual feedback, analysis of patient actions, and introduce safe challenges in the context of training. VR assisted Cognitive Behavioral Therapy (CBT) tailored to suit subtypes of anxiety disorders in PD have the potential to improve the efficacy and effectiveness of psychotherapy in PD.
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Affiliation(s)
- Karthick Thangavelu
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Joshua A Hayward
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Mental Health Service, Royal Brisbane & Woman's Hospital, Brisbane, Australia
| | | | - Guy M Wallis
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Tiffany R Au
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,School of Psychology, The University of Queensland, Brisbane, Australia.,Department of Neurology, Royal Brisbane & Woman's Hospital, Brisbane, Australia
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12
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Radulovic J, Ivkovic S, Adzic M. From chronic stress and anxiety to neurodegeneration: Focus on neuromodulation of the axon initial segment. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:481-495. [PMID: 35034756 DOI: 10.1016/b978-0-12-819410-2.00025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To adapt to the sustained demands of chronic stress, discrete brain circuits undergo structural and functional changes often resulting in anxiety disorders. In some individuals, anxiety disorders precede the development of motor symptoms of Parkinson's disease (PD) caused by degeneration of neurons in the substantia nigra (SN). Here, we present a circuit framework for probing a causal link between chronic stress, anxiety, and PD, which postulates a central role of abnormal neuromodulation of the SN's axon initial segment by brainstem inputs. It is grounded in findings demonstrating that the earliest PD pathologies occur in the stress-responsive, emotion regulation network of the brainstem, which provides the SN with dense aminergic and cholinergic innervation. SN's axon initial segment (AIS) has unique features that support the sustained and bidirectional propagation of activity in response to synaptic inputs. It is therefore, especially sensitive to circuit-mediated stress-induced imbalance of neuromodulation, and thus a plausible initiating site of neurodegeneration. This could explain why, although secondary to pathophysiologies in other brainstem nuclei, SN degeneration is the most extensive. Consequently, the cardinal symptom of PD, severe motor deficits, arise from degeneration of the nigrostriatal pathway rather than other brainstem nuclei. Understanding when and how circuit dysfunctions underlying anxiety can progress to neurodegeneration, raises the prospect of timed interventions for reversing, or at least impeding, the early pathophysiologies that lead to PD and possibly other neurodegenerative disorders.
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Affiliation(s)
- Jelena Radulovic
- Department of Neuroscience, Albert Einstein Medical College, Bronx, NY, United States; Department of Psychiatry and Behavioral Sciences, Albert Einstein Medical College, Bronx, NY, United States.
| | - Sanja Ivkovic
- Department of Molecular Biology and Endocrinology, Vinca Institute of Nuclear Sciences, National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Miroslav Adzic
- Department of Molecular Biology and Endocrinology, Vinca Institute of Nuclear Sciences, National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
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13
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Sveinsdóttir HS, Decker A, Christensen C, Lucena PB, Þorsteinsson H, Richert E, Maier VH, Cornell R, Karlsson KÆ. Motility phenotype in a zebrafish vmat2 mutant. PLoS One 2022; 17:e0259753. [PMID: 34986152 PMCID: PMC8730441 DOI: 10.1371/journal.pone.0259753] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/20/2021] [Indexed: 01/22/2023] Open
Abstract
In the present study, we characterize a novel zebrafish mutant of solute carrier 18A2 (slc18a2), also known as vesicular monoamine transporter 2 (vmat2), that exhibits a behavioural phenotype partially consistent with human Parkinson´s disease. At six days-post-fertilization, behaviour was analysed and demonstrated that vmat2 homozygous mutant larvae, relative to wild types, show changes in motility in a photomotor assay, altered sleep parameters, and reduced dopamine cell number. Following an abrupt lights-off stimulus mutant larvae initiate larger movements but subsequently inhibit them to a lesser extent in comparison to wild-type larvae. Conversely, during a lights-on period, the mutant larvae are hypomotile. Thigmotaxis, a preference to avoid the centre of a behavioural arena, was increased in homozygotes over heterozygotes and wild types, as was daytime sleep ratio. Furthermore, incubating mutant larvae in pramipexole or L-Dopa partially rescued the motor phenotypes, as did injecting glial cell-derived neurotrophic factor (GDNF) into their brains. This novel vmat2 model represents a tool for high throughput pharmaceutical screens for novel therapeutics, in particular those that increase monoamine transport, and for studies of the function of monoamine transporters.
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Affiliation(s)
| | - Amanda Decker
- Department of Anatomy and Cell Biology, University of Iowa, Iowa City, Iowa, United States of America
| | | | | | | | - Elena Richert
- School of Science and Engineering, Reykjavik University, Reykjavik, Iceland
- Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | | | - Robert Cornell
- Department of Anatomy and Cell Biology, University of Iowa, Iowa City, Iowa, United States of America
| | - Karl Ægir Karlsson
- 3Z, Reykjavik, Iceland
- School of Science and Engineering, Reykjavik University, Reykjavik, Iceland
- Biomedical Center, University of Iceland, Reykjavik, Iceland
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14
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Weintraub D, Aarsland D, Chaudhuri KR, Dobkin RD, Leentjens AF, Rodriguez-Violante M, Schrag A. The neuropsychiatry of Parkinson's disease: advances and challenges. Lancet Neurol 2022; 21:89-102. [PMID: 34942142 PMCID: PMC8800169 DOI: 10.1016/s1474-4422(21)00330-6] [Citation(s) in RCA: 117] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 08/21/2021] [Accepted: 09/20/2021] [Indexed: 01/03/2023]
Abstract
In people with Parkinson's disease, neuropsychiatric signs and symptoms are common throughout the disease course. These symptoms can be disabling and as clinically relevant as motor symptoms, and their presentation can be similar to, or distinct from, their counterparts in the general population. Correlates and risk factors for developing neuropsychiatric signs and symptoms include demographic, clinical, and psychosocial characteristics. The underlying neurobiology of these presentations is complex and not well understood, with the strongest evidence for neuropathological changes associated with Parkinson's disease, mechanisms linked to dopaminergic therapy, and effects not specific to Parkinson's disease. Assessment instruments and formal diagnostic criteria exist, but there is little routine screening of these signs and symptoms in clinical practice. Mounting evidence supports a range of pharmacological and non-pharmacological interventions, but relatively few efficacious treatment options exist. Optimising the management of neuropsychiatric presentations in people with Parkinson's disease will require additional research, raised awareness, specialised training, and development of innovative models of care.
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Affiliation(s)
- Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Parkinson's Disease Research, Education and Clinical Center, Corporal Michael J Crescenz Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
| | - Dag Aarsland
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Age-Related Disease, Stavanger University Hospital, Stavanger, Norway
| | - Kallol Ray Chaudhuri
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Parkinson's Foundation Centre of Excellence, King's College Hospital, King's College London, London, UK
| | - Roseanne D Dobkin
- Department of Psychiatry, Rutgers University, Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Albert Fg Leentjens
- Department of Psychiatry, and School for Mental Health and Neuroscience, Maastricht University Hospital, Maastricht, Netherlands
| | - Mayela Rodriguez-Violante
- Clinical Neurodegenerative Diseases Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, UCL, London, UK
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15
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Veenit V, Zhang X, Ambrosini A, Sousa V, Svenningsson P. The Effect of Early Life Stress on Emotional Behaviors in GPR37KO Mice. Int J Mol Sci 2021; 23:410. [PMID: 35008836 PMCID: PMC8745300 DOI: 10.3390/ijms23010410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 12/14/2022] Open
Abstract
GPR37 is an orphan G-protein-coupled receptor, a substrate of parkin which is linked to Parkinson's disease (PD) and affective disorders. In this study, we sought to address the effects of early life stress (ELS) by employing the paradigm of limited nesting material on emotional behaviors in adult GPR37 knockout (KO) mice. Our results showed that, while there was an adverse effect of ELS on various domains of emotional behaviors in wild type (WT) mice in a sex specific manner (anxiety in females, depression and context-dependent fear memory in males), GPR37KO mice subjected to ELS exhibited less deteriorated emotional behaviors. GPR37KO female mice under ELS conditions displayed reduced anxiety compared to WT mice. This was paralleled by lower plasma corticosterone in GPR37KO females and a lower increase in P-T286-CaMKII by ELS in the amygdala. GPR37KO male mice, under ELS conditions, showed better retention of hippocampal-dependent emotional processing in the passive avoidance behavioral task. GPR37KO male mice showed increased immobility in the forced swim task and increased P-T286-CaMKII in the ventral hippocampus under baseline conditions. Taken together, our data showed overall long-term effects of ELS-deleterious or beneficial depending on the genotype, sex of the mice and the emotional context.
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Affiliation(s)
- Vandana Veenit
- Neuro Svenningsson, Department of Clinical Neuroscience, Karolinska Institutet, 171 76 Stockholm, Sweden; (X.Z.); (A.A.); (V.S.)
| | | | | | | | - Per Svenningsson
- Neuro Svenningsson, Department of Clinical Neuroscience, Karolinska Institutet, 171 76 Stockholm, Sweden; (X.Z.); (A.A.); (V.S.)
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16
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Perepezko K, Naaz F, Wagandt C, Dissanayaka NN, Mari Z, Nanavati J, Bakker A, Pontone GM. Anxiety in Parkinson's Disease: A Systematic Review of Neuroimaging Studies. J Neuropsychiatry Clin Neurosci 2021; 33:280-294. [PMID: 34280319 DOI: 10.1176/appi.neuropsych.20110272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The mechanisms and neuronal networks associated with anxiety in Parkinson's disease (PD) are incompletely understood. One of the best tools for investigating both component function and neuronal networks associated with psychiatric symptoms is functional MRI (fMRI). Unlike structural scans, functional scans, whether task-based or resting-state, are more likely to be clinically relevant and sensitive to changes related to treatment. The investigators provide a comprehensive review of and present results for imaging studies of anxiety in PD. METHODS A systematic review of the literature on fMRI and anxiety in PD was conducted, and the quality of all included studies was simultaneously assessed. Eighteen studies were included: 15 studies assessed anxiety directly, and three evaluated emotional processing. Imaging methodology and behavioral assessments varied across studies, preventing direct comparison of results in most cases. RESULTS There was a convergence in findings across methods, implicating involvement of the amygdala, caudate, and putamen in association with anxiety in PD. For both task-based activation and resting-state connectivity, dopamine medication status was associated with differences in activation and behavioral function. CONCLUSIONS Although there is little consensus in the current fMRI literature studying anxiety in PD, these results suggest an overlap between structures classically involved in the brain's fear circuit (particularly the amygdala) and the alterations in the nigro-striatal system (e.g., the caudate and putamen and on-off dopamine findings) related to PD and its dopaminergic treatments.
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Affiliation(s)
- Kate Perepezko
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Perepezko, Bakker); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine (Naaz, Wagandt, Nanavati, Bakker, Pontone); University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia (Dissanayaka); School of Psychology, University of Queensland (Dissanayaka); Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia (Dissanayaka); Department of Neurology, Johns Hopkins University School of Medicine (Mari, Bakker, Pontone); and Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Mari)
| | - Farah Naaz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Perepezko, Bakker); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine (Naaz, Wagandt, Nanavati, Bakker, Pontone); University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia (Dissanayaka); School of Psychology, University of Queensland (Dissanayaka); Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia (Dissanayaka); Department of Neurology, Johns Hopkins University School of Medicine (Mari, Bakker, Pontone); and Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Mari)
| | - Carrie Wagandt
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Perepezko, Bakker); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine (Naaz, Wagandt, Nanavati, Bakker, Pontone); University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia (Dissanayaka); School of Psychology, University of Queensland (Dissanayaka); Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia (Dissanayaka); Department of Neurology, Johns Hopkins University School of Medicine (Mari, Bakker, Pontone); and Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Mari)
| | - Nadeeka N Dissanayaka
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Perepezko, Bakker); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine (Naaz, Wagandt, Nanavati, Bakker, Pontone); University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia (Dissanayaka); School of Psychology, University of Queensland (Dissanayaka); Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia (Dissanayaka); Department of Neurology, Johns Hopkins University School of Medicine (Mari, Bakker, Pontone); and Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Mari)
| | - Zoltan Mari
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Perepezko, Bakker); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine (Naaz, Wagandt, Nanavati, Bakker, Pontone); University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia (Dissanayaka); School of Psychology, University of Queensland (Dissanayaka); Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia (Dissanayaka); Department of Neurology, Johns Hopkins University School of Medicine (Mari, Bakker, Pontone); and Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Mari)
| | - Julie Nanavati
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Perepezko, Bakker); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine (Naaz, Wagandt, Nanavati, Bakker, Pontone); University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia (Dissanayaka); School of Psychology, University of Queensland (Dissanayaka); Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia (Dissanayaka); Department of Neurology, Johns Hopkins University School of Medicine (Mari, Bakker, Pontone); and Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Mari)
| | - Arnold Bakker
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Perepezko, Bakker); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine (Naaz, Wagandt, Nanavati, Bakker, Pontone); University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia (Dissanayaka); School of Psychology, University of Queensland (Dissanayaka); Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia (Dissanayaka); Department of Neurology, Johns Hopkins University School of Medicine (Mari, Bakker, Pontone); and Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Mari)
| | - Gregory M Pontone
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Perepezko, Bakker); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine (Naaz, Wagandt, Nanavati, Bakker, Pontone); University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia (Dissanayaka); School of Psychology, University of Queensland (Dissanayaka); Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia (Dissanayaka); Department of Neurology, Johns Hopkins University School of Medicine (Mari, Bakker, Pontone); and Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas (Mari)
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17
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Paniak I, Lewis SJG, Ehgoetz Martens KA. Measuring anxiety in Lewy Body Disease - Which scale to choose? Clin Park Relat Disord 2021; 5:100110. [PMID: 34647014 PMCID: PMC8501759 DOI: 10.1016/j.prdoa.2021.100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022] Open
Abstract
Parkinson Anxiety Scale is best suited to assess anxiety in synucleinopathies. Anxiety section of the HADS shows strong convergent validity in PD and iRBD. The UPDRS anxiety item did not correlate with any of the other anxiety scales.
Background Anxiety is among the most prevalent mood disorders in Lewy Body Disease (LBD) (i.e., Parkinson’s disease (PD), Dementia with Lewy bodies DLB), and those at-risk for developing LBD (e.g. isolated REM Sleep Behaviour Disorder (iRBD)). Yet, there is little consensus on which clinical scale best evaluates anxiety across synuclein-based diseases. Objective This study compared the convergent validity of commonly used anxiety scales across PD, DLB and iRBD patients. Methods Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS-A), State-Trait Anxiety Inventory (STAI), MDS-UPDRS Anxiety item, and the Parkinson Anxiety Scale (PAS) in 57 participants (17 PD, 16 DLB, and 23 iRBD). Results Across all groups, PAS total score was significantly associated with trait anxiety (STAI-Y2), whilst HADS-A was associated with PAS total score in the PD and iRBD group. In DLB patients, HADS-A was weakly associated with PAS total score, and significantly correlated with PAS episodic anxiety. Notably, the anxiety item from the MDS-UPDRS did not correlate with any of the other anxiety outcome measures in any group. Conclusions PAS and STAI-Y2 are the most suitable scales to assess anxiety in synuclein-based diseases. HADS-A showed strong convergent validity in PD and iRBD, it had weaker convergent validity in DLB. The UPDRS anxiety item did not correlate with any of the other anxiety measures, and thus may not be sensitive at detecting anxiety symptoms. Future work should validate anxiety scales in all Lewy Body Disease groups if they are to be implemented in prospective longitudinal cohorts.
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Affiliation(s)
- Isabel Paniak
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Kaylena A Ehgoetz Martens
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, New South Wales, Australia.,Department of Kinesiology and Health Sciences, University of Waterloo, Ontario, Canada
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18
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The Importance of Cross-Disciplinary Research: A Commentary on "Brainstem Pathologies Correlate With Depression and Psychosis in Parkinson's Disease". Am J Geriatr Psychiatry 2021; 29:969-971. [PMID: 33526370 DOI: 10.1016/j.jagp.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/20/2022]
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Pontone GM, Mills KA. Optimal Treatment of Depression and Anxiety in Parkinson's Disease. Am J Geriatr Psychiatry 2021; 29:530-540. [PMID: 33648830 DOI: 10.1016/j.jagp.2021.02.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 12/21/2022]
Abstract
Depression and anxiety are highly prevalent and have major adverse effects on function and quality of life in Parkinson's disease (PD). Optimal management requires that motor symptoms and psychiatric symptoms be simultaneously addressed. While there is fairly robust evidence for the treatment of motor symptoms, there are no completed randomized controlled trials to guide pharmacological treatment of anxiety in PD and no nonpharmacologic interventions have proven efficacious. Several high-quality trials for depression in PD suggest a number of antidepressants and cognitive behavioral therapy may help, but there is no data on rates of recurrence, comparative efficacy, or augmentation strategies. In order to address the gaps in knowledge, the authors provide a summary of the current evidence for treating depression and anxiety in PD and offer an algorithm that extends beyond the current literature based on clinical experience working in a multidisciplinary specialty center.
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Affiliation(s)
- Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences (GMP), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (GMP, KAM), Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Kelly A Mills
- Department of Neurology (GMP, KAM), Johns Hopkins University School of Medicine, Baltimore, MD
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20
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Elefante C, Brancati GE, Bacciardi S, Mazzucchi S, Del Prete E, Palermo G, Frosini D, Bonuccelli U, Ceravolo R, Lattanzi L, Maremmani I, Perugi G. Prevalence and Clinical Correlates of Comorbid Anxiety and Panic Disorders in Patients with Parkinson's Disease. J Clin Med 2021; 10:2302. [PMID: 34070549 PMCID: PMC8198165 DOI: 10.3390/jcm10112302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/13/2021] [Accepted: 05/21/2021] [Indexed: 12/18/2022] Open
Abstract
Mood and anxiety disorders are the most common neuropsychiatric syndromes associated with Parkinson's disease (PD). The aim of our study was to estimate the prevalence of lifetime and current anxiety disorders in patients with Parkinson's Disease (PD), to explore possible distinctive neurological and psychiatric features associated with such comorbidity. One hundred patients were consecutively recruited at the Movement Disorders Section of the Neurological Outpatient Clinic of the University of Pisa. According to the MINI-Plus 5.0.0, 41 subjects were diagnosed with lifetime anxiety disorder (22 with panic disorder) and 26 were diagnosed with current anxiety disorders. Patients with anxiety disorders were more frequently characterized by psychiatric symptoms preceding PD, lifetime major depression and antidepressant treatments. They showed more anxious temperamental traits and scored higher at Parkinson Anxiety Scale (PAS) and persistent anxiety subscale. Current anxiety disorders were associated with more severe psychopathology, depressive symptomatology, and avoidant behavior. Among anxiety subtypes, patients with lifetime panic disorder showed higher rates of psychiatric symptoms before PD, lifetime unipolar depression, current psychiatric treatment, and a more severe psychopathology. Given the overall high impact of anxiety on patients' quality of life, clinicians should not underestimate the extent of different anxiety dimensions in PD.
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Affiliation(s)
- Camilla Elefante
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy; (C.E.); (G.E.B.); (S.B.); (L.L.); (G.P.)
| | - Giulio Emilio Brancati
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy; (C.E.); (G.E.B.); (S.B.); (L.L.); (G.P.)
| | - Silvia Bacciardi
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy; (C.E.); (G.E.B.); (S.B.); (L.L.); (G.P.)
| | - Sonia Mazzucchi
- Neurological Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy; (S.M.); (E.D.P.); (G.P.); (D.F.); (U.B.); (R.C.)
| | - Eleonora Del Prete
- Neurological Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy; (S.M.); (E.D.P.); (G.P.); (D.F.); (U.B.); (R.C.)
| | - Giovanni Palermo
- Neurological Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy; (S.M.); (E.D.P.); (G.P.); (D.F.); (U.B.); (R.C.)
| | - Daniela Frosini
- Neurological Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy; (S.M.); (E.D.P.); (G.P.); (D.F.); (U.B.); (R.C.)
| | - Ubaldo Bonuccelli
- Neurological Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy; (S.M.); (E.D.P.); (G.P.); (D.F.); (U.B.); (R.C.)
| | - Roberto Ceravolo
- Neurological Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy; (S.M.); (E.D.P.); (G.P.); (D.F.); (U.B.); (R.C.)
| | - Lorenzo Lattanzi
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy; (C.E.); (G.E.B.); (S.B.); (L.L.); (G.P.)
| | - Icro Maremmani
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy; (C.E.); (G.E.B.); (S.B.); (L.L.); (G.P.)
| | - Giulio Perugi
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy; (C.E.); (G.E.B.); (S.B.); (L.L.); (G.P.)
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21
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Forbes EJ, Byrne GJ, O'Sullivan JD, Yang J, Marsh R, Dissanayaka NN. Defining Atypical Anxiety in Parkinson's Disease. Mov Disord Clin Pract 2021; 8:571-581. [PMID: 33981790 PMCID: PMC8088112 DOI: 10.1002/mdc3.13193] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/14/2021] [Accepted: 02/28/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Anxiety is a major complication in Parkinson's disease (PD). Many PD patients experience clinically significant anxiety not meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) anxiety disorder criteria. This atypical anxiety (anxiety disorder not otherwise specified [NOS]) is often under-recognized and its diagnosis is underdeveloped. OBJECTIVES This study aimed to identify the demographic, psychiatric, and clinical characteristics of anxiety disorder NOS in PD. METHODS A cross-sectional design studied a convenience sample of 184 PD patients without dementia recruited from neurology outpatient clinics. A semi-structured interview using DSM-IV criteria categorized PD patients into current anxiety disorder NOS (n = 28), DSM-IV anxiety disorders (n = 42) or no anxiety (n = 86) groups. Logistic regression modeling identified characteristics associated with the anxiety disorder NOS group compared to DSM-IV anxiety and no anxiety groups. RESULTS The anxiety disorder NOS group was associated with motor complications of PD therapy, episodic, persistent and social anxiety symptoms, depression, non-motor experiences of daily living, poor quality of life, and female sex compared to the no anxiety group. Compared to DSM-IV anxiety, those with anxiety disorder NOS demonstrated greater global cognitive impairment, more severe motor complications of PD therapy, a greater severity and functional impact of dyskinesias, and greater complexity of motor fluctuations. Persistent, episodic, and social anxiety symptoms did not significantly differ between anxiety disorder NOS and DSM-IV anxiety groups. CONCLUSIONS These findings suggest that PD-specific symptoms characterize anxiety in a subgroup of PD patients who do not fulfill DSM-IV criteria for anxiety disorders.
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Affiliation(s)
- Elana J. Forbes
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
- UQ Centre for Clinical Research, Faculty of Medicine, University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Gerard J. Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Mental Health ServiceRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - John D. O'Sullivan
- UQ Centre for Clinical Research, Faculty of Medicine, University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Department of NeurologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Jihyun Yang
- UQ Centre for Clinical Research, Faculty of Medicine, University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Rodney Marsh
- UQ Centre for Clinical Research, Faculty of Medicine, University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Asia‐Pacific Centre for NeuromodulationUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Nadeeka N. Dissanayaka
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
- UQ Centre for Clinical Research, Faculty of Medicine, University of QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Department of NeurologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
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22
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How COVID-19 will boost remote exercise-based treatment in Parkinson's disease: a narrative review. NPJ Parkinsons Dis 2021; 7:25. [PMID: 33686074 PMCID: PMC7940641 DOI: 10.1038/s41531-021-00160-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/14/2021] [Indexed: 02/02/2023] Open
Abstract
The lack of physical exercise during the COVID-19 pandemic-related quarantine measures is challenging, especially for patients with Parkinson's disease (PD). Without regular exercise not only patients, but also nursing staff and physicians soon noticed a deterioration of motor and non-motor symptoms. Reduced functional mobility, increased falls, increased frailty, and decreased quality of life were identified as consequences of increased sedentary behavior. This work overviews the current literature on problems of supplying conventional physiotherapy and the potential of telerehabilitation, allied health services, and patient-initiated exercise for PD patients during the COVID-19 period. We discuss recent studies on approaches that can improve remote provision of exercise to patients, including telerehabilitation, motivational tools, apps, exergaming, and virtual reality (VR) exercise. Additionally, we provide a case report about a 69-year-old PD patient who took part in a 12-week guided climbing course for PD patients prior to the pandemic and found a solution to continue her climbing training independently with an outdoor rope ladder. This case can serve as a best practice example for non-instructed, creative, and patient-initiated exercise in the domestic environment in difficult times, as are the current. Overall, many recent studies on telemedicine, telerehabilitation, and patient-initiated exercises have been published, giving rise to optimism that facilitating remote exercise can help PD patients maintain physical mobility and emotional well-being, even in phases such as the COVID-19 pandemic. The pandemic itself may even boost the need to establish comprehensive and easy-to-do telerehabilitation programs.
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23
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The Relationship Between Anxiety Disorders and Parkinson's Disease: Clinical and Therapeutic Issues. Curr Psychiatry Rep 2021; 23:20. [PMID: 33660146 DOI: 10.1007/s11920-021-01229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW This paper seeks to describe anxiety's different symptomatologic presentations in Parkinson's disease (PD), its longitudinal course and predictors, as well as its motor and non-motor correlates. It also reviews the available screening tools and different treatment modalities. RECENT FINDINGS In PD, longitudinal predictors of anxiety are mostly non-motor non-dopaminergic symptoms. The longitudinal course of anxiety is mainly a stable one. The Parkinson Anxiety Scale and the Geriatric Anxiety Scale are the 2 recommended screening tools. A third of PD patients suffer from an anxiety disorder at any time point. It can precede or follow PD motor symptoms. Anxiety is associated with demographic, disease-related motor and non-motor features. There is a lack of studies evaluating psychotropic treatment of anxiety in PD. Adjustment of dopaminergic treatment is indicated when anxiety is associated with motor fluctuations. DBS can be useful as well as CBT and body-mind interventions.
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Moonen AJH, Mulders AEP, Defebvre L, Duits A, Flinois B, Köhler S, Kuijf ML, Leterme AC, Servant D, de Vugt M, Dujardin K, Leentjens AFG. Cognitive Behavioral Therapy for Anxiety in Parkinson's Disease: A Randomized Controlled Trial. Mov Disord 2021; 36:2539-2548. [PMID: 33617699 PMCID: PMC9290129 DOI: 10.1002/mds.28533] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/13/2021] [Accepted: 01/22/2021] [Indexed: 12/14/2022] Open
Abstract
Background Anxiety disorders are among the most prevalent and disabling neuropsychiatric syndromes in patients with Parkinsonʼs disease (PD), but no randomized controlled treatment trials of anxiety have been published to date. Objective The aim of this study was to assess the effectiveness of cognitive behavioral therapy (CBT) in the treatment of anxiety in patients with PD. Methods Forty‐eight patients with PD with anxiety were randomized 1:1 between CBT and clinical monitoring only (CMO). The CBT program was developed to specifically address anxiety symptoms in PD and consisted of 10 weekly sessions. Assessments were conducted by blinded assessors at baseline, at the end of the intervention, after 3 months, and after 6 months (CBT group only). Main outcome measures were the Hamilton Anxiety Rating Scale (HARS) and the Parkinson Anxiety Scale (PAS). Results Both the CBT and CMO groups showed clinically relevant improvement. Although there was no between‐group difference in outcome on the Hamilton Anxiety Rating Scale (6.7‐point reduction in the CBT group versus 3.9‐point reduction in the CMO group; P = 0.15), there was both a statistically significant and a clinically relevant between‐group difference on the total PAS in favor of CBT (9.9‐point reduction in the CBT group versus 5.2‐point reduction in the CMO group; P = 0.012), which was due to improvement on the PAS subscales for episodic (situational) anxiety and avoidance behavior. This greater improvement was maintained at 3‐ and 6‐month follow‐ups. Conclusion CBT is an effective treatment for anxiety in patients with PD and reduces situational and social anxiety, as well as avoidance behavior. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Anja J H Moonen
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Research School of Mental Health and Neuroscience (Mhens), Maastricht University, Maastricht, the Netherlands
| | - Anne E P Mulders
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Research School of Mental Health and Neuroscience (Mhens), Maastricht University, Maastricht, the Netherlands
| | - Luc Defebvre
- Neurology and Movement Disorders Department, Centre Hospitalier Universitaire, Lille, France
| | - Annelien Duits
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Research School of Mental Health and Neuroscience (Mhens), Maastricht University, Maastricht, the Netherlands
| | - Bérengère Flinois
- Neurology and Movement Disorders Department, Centre Hospitalier Universitaire, Lille, France
| | - Sebastian Köhler
- Research School of Mental Health and Neuroscience (Mhens), Maastricht University, Maastricht, the Netherlands
| | - Mark L Kuijf
- Research School of Mental Health and Neuroscience (Mhens), Maastricht University, Maastricht, the Netherlands.,Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Anne-Claire Leterme
- Neurology and Movement Disorders Department, Centre Hospitalier Universitaire, Lille, France
| | - Dominique Servant
- Neurology and Movement Disorders Department, Centre Hospitalier Universitaire, Lille, France
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Research School of Mental Health and Neuroscience (Mhens), Maastricht University, Maastricht, the Netherlands
| | - Kathy Dujardin
- Neurology and Movement Disorders Department, Centre Hospitalier Universitaire, Lille, France.,Degenerative & Vascular Cognitive Disorders, University of Lille, Lille, France
| | - Albert F G Leentjens
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Research School of Mental Health and Neuroscience (Mhens), Maastricht University, Maastricht, the Netherlands
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Rukavina K, Batzu L, Boogers A, Abundes-Corona A, Bruno V, Chaudhuri KR. Non-motor complications in late stage Parkinson's disease: recognition, management and unmet needs. Expert Rev Neurother 2021; 21:335-352. [PMID: 33522312 DOI: 10.1080/14737175.2021.1883428] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: The burden of non-motor symptoms (NMS) is a major determinant of health-related quality of life in Parkinson's disease (PD), particularly at its late stage.Areas covered: The late stage is usually defined as the period from unstable advanced to the palliative stage, characterized by a combination of emerging treatment-resistant axial motor symptoms (freezing of gait, postural instability, falls and dysphagia), as well as both non-dopaminergic and dopaminergic NMS: cognitive decline, neuropsychiatric symptoms, aspects of dysautonomia, pain and sleep disturbances (insomnia and excessive day-time sleepiness). Here, the authors summarize the current knowledge on NMS dominating the late stage of PD and propose a pragmatic and clinically focused approach for their recognition and treatment.Expert opinion: The NMS progression pattern is complex and remains under-researched. While dopamine-dependent NMS may improve with dopamine replacement therapy, non-dopamine dependent NMS worsen progressively and culminate at the late stages of PD. Furthermore, some PD specific features could interact negatively with other comorbidities, multiple medication use and frailty - the evaluation of these aspects is important in the creation of personalized management plans in the late stage of PD.
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Affiliation(s)
- Katarina Rukavina
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience at King's College and King's College Hospital NHS Foundation Trust, London, UK.,Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Lucia Batzu
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience at King's College and King's College Hospital NHS Foundation Trust, London, UK.,Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Alexandra Boogers
- Department of Neurology, University Hospital Leuven, Leuven, U.Z, Belgium
| | - Arturo Abundes-Corona
- Department of Neurology, Clinical Laboratory of Neurodegenerative Diseases, National Institute of Neurology and Neurosurgery, Mexico City, México.,Neurology Department, American British Cowdray Medical Center IAP, Mexico City, Mexico
| | - Veronica Bruno
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience at King's College and King's College Hospital NHS Foundation Trust, London, UK.,Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
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26
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Mood and emotional disorders associated with parkinsonism, Huntington disease, and other movement disorders. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:175-196. [PMID: 34389117 DOI: 10.1016/b978-0-12-822290-4.00015-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This chapter provides a review of mood, emotional disorders, and emotion processing deficits associated with diseases that cause movement disorders, including Parkinson's disease, Lewy body dementia, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, frontotemporal dementia with parkinsonism, Huntington's disease, essential tremor, dystonia, and tardive dyskinesia. For each disorder, a clinical description of the common signs and symptoms, disease progression, and epidemiology is provided. Then the mood and emotional disorders associated with each of these diseases are described and discussed in terms of clinical presentation, incidence, prevalence, and alterations in quality of life. Alterations of emotion communication, such as affective speech prosody and facial emotional expression, associated with these disorders are also discussed. In addition, if applicable, deficits in gestural and lexical/verbal emotion are reviewed. Throughout the chapter, the relationships among mood and emotional disorders, alterations of emotional experiences, social communication, and quality of life, as well as treatment, are emphasized.
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Invited Perspective on the "Annual Prevalence of Use of Potentially Inappropriate Medications for Treatment of Affective Disorders in Parkinson's Disease". Am J Geriatr Psychiatry 2021; 29:48-50. [PMID: 32622729 DOI: 10.1016/j.jagp.2020.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022]
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