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Stocchi F, Angelo Antonini, Barone P, Bellelli G, Fagiolini A, Ferini Strambi L, Sorbi S, Padovani A. Exploring depression in Parkinson's disease: an Italian Delphi Consensus on phenomenology, diagnosis, and management. Neurol Sci 2023; 44:3123-3131. [PMID: 37100925 PMCID: PMC10415449 DOI: 10.1007/s10072-023-06740-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/05/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Depression is a prodromic and a frequent non-motor symptom of Parkinson's disease, associated to reduced quality of life and poor outcomes. The diagnosis of depression in parkinsonian patients represents a challenge due to the overlapping of symptoms typical of the two conditions. METHODS A Delphi panel survey was performed to reach a consensus amongst different Italian specialists on four main topics: the neuropathological correlates of depression, main clinical aspects, diagnosis, and management of depression in Parkinson's disease. RESULTS AND CONCLUSION Experts have recognized that depression is an established risk factor of PD and that its anatomic substrate is related to the neuropathological abnormalities typical of the disease. Multimodal and SSRI antidepressant have been confirmed as a valid therapeutic option in the treatment of depression in PD. Tolerability, safety profile, and potential efficacy on broad spectrum of symptoms of depression including cognitive symptoms and anhedonia should be considered when selecting an antidepressant and the choice should be tailored on the patients' characteristics.
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Affiliation(s)
- Fabrizio Stocchi
- University San Raffaele Rome and IRCCS San Raffaele, Rome, Italy.
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Center for Neurodegenerative Diseases (CENSE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Paolo Barone
- Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Salerno, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, 20126, Milan, Italy
- Acute Geriatric Unit, IRCCS San Gerardo, 20900, Monza, Italy
| | - Andrea Fagiolini
- Department of Molecular and Developmental Medicine, University of Siena, School of Medicine, Siena, Italy
| | - Luigi Ferini Strambi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology-Sleep Disorders Centre, Milan, Italy
- Vita-Salute" San Raffaele University, Milan, Italy
| | - Sandro Sorbi
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
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Santos-García D, de Deus Fonticoba T, Cores Bartolomé C, Feal Panceiras MJ, García Díaz I, Íñiguez Alvarado MC, Jesús S, Boungiorno MT, Planellas L, Cosgaya M, García Caldentey J, Caballol N, Legarda I, Hernández Vara J, Cabo I, López Manzanares L, González Aramburu I, Ávila Rivera MA, Gómez Mayordomo V, Nogueira V, Puente V, Dotor García-Soto J, Borrué C, Vila BS, Álvarez Sauco M, Vela L, Escalante S, Cubo E, Carrillo Padilla F, Martínez Castrillo JC, Sánchez Alonso P, Alonso Losada MG, López Ariztegui N, Gastón I, Kulisevsky J, Blázquez Estrada M, Seijo M, Rúiz Martínez J, Valero C, Kurtis M, de Fábregues O, González Ardura J, Alonso Redondo R, Ordás C, López Díaz LM, McAfee D, Martinez-Martin P, Mir P. Suicidal ideation among people with Parkinson's disease and comparison with a control group. Int J Geriatr Psychiatry 2023; 38:e5919. [PMID: 37147900 DOI: 10.1002/gps.5919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/18/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Detection of suicidal ideation (SI) is key for trying to prevent suicide. The aim of this study was to analyze the frequency of SI and related factors in Spanish people with Parkinson's Disease (PwPD) and to compare them with a control group. METHODS PD patients and controls recruited from the Spanish cohort COPPADIS from January 2016 to November 2017 were included. Two visits were conducted: V0 (baseline); V2 (2-year ± 1 month follow-up). SI was defined as a score ≥1 on item nine of the Beck Depression Inventory-II (BDI-II). Regression analyses were conducted to identify factors related to SI. RESULTS At baseline, 693 PwPD (60.2% males; 62.59 ± 8.91 years old) and 207 controls (49.8% males; 60.99 ± 8.32 years old) were included. No differences between PwPD and controls were detected in SI frequency at either V0 (5.1% [35/693] vs. 4.3% [9/207]; p = 0.421) or at V2 (5.1% [26/508] vs. 4.8% [6/125]; p = 0.549). Major depression (MD) and a worse quality of life were associated with SI at both visits in PwPD: V0 (MD, OR = 5.63; p = 0.003; PDQ-39, OR = 1.06; p = 0.021); V2 (MD, OR = 4.75; p = 0.027; EUROHIS-QOL8, OR = 0.22; p = 0.006). A greater increase in the BDI-II total score from V0 to V2 was the only factor predicting SI at V2 (OR = 1.21; p = 0.002) along with an increase in the total number of non-antiparkinsonian drugs (OR = 1.39; p = 0.041). CONCLUSION The frequency of SI (5%) in PwPD was similar to in controls. Depression, a worse quality of life, and a greater comorbidity were related to SI.
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Affiliation(s)
| | | | | | | | - Iago García Díaz
- CHUAC, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - Silvia Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
| | | | | | | | | | - Nuria Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | - Ines Legarda
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Jorge Hernández Vara
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
- Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Iria Cabo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | - Isabel González Aramburu
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Maria A Ávila Rivera
- Consorci Sanitari Integral, Hospital General de L´Hospitalet, L´Hospitalet de Llobregat, Barcelona, Spain
| | - Víctor Gómez Mayordomo
- Neurology Department, Institute of Neuroscience, Vithas Madrid La Milagrosa University Hospital, Vithas Hospital Group, Madrid, Spain
| | | | | | | | | | - Berta Solano Vila
- Institut d'Assistència Sanitària (IAS) - Institut Català de la Salut, Girona, Spain
| | | | - Lydia Vela
- Fundación Hospital de Alcorcón, Madrid, Spain
| | - Sonia Escalante
- Hospital de Tortosa Verge de La Cinta (HTVC), Tortosa, Tarragona, Spain
| | - Esther Cubo
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | | | | | | | - Maria G Alonso Losada
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | | | | | - Jaime Kulisevsky
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
- Hospital de Sant Pau, Barcelona, Spain
| | | | - Manuel Seijo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | | | | | | | | | | | | | | | - Darrian McAfee
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Pablo Martinez-Martin
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
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Epping-Jordan MP, Girard F, Bessis AS, Mutel V, Boléa C, Derouet F, Bessif A, Mingard B, Barbier S, Paradis JS, Rocher JP, Lütjens R, Kalinichev M, Poli S. Effect of the Metabotropic Glutamate Receptor Type 5 Negative Allosteric Modulator Dipraglurant on Motor and Non-Motor Symptoms of Parkinson's Disease. Cells 2023; 12:1004. [PMID: 37048075 PMCID: PMC10093229 DOI: 10.3390/cells12071004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Parkinson's disease (PD) patients suffer not only from the primary motor symptoms of the disease but also from a range of non-motor symptoms (NMS) that cause disability and low quality of life. Excessive glutamate activity in the basal ganglia resulting from degeneration of the nigrostriatal dopamine pathway has been implicated in the motor symptoms, NMS and dyskinesias in PD patients. In this study, we investigated the effects of a selective mGlu5 negative allosteric modulator (NAM), dipraglurant, in a rodent motor symptoms model of PD, but also in models of anxiety, depression and obsessive-compulsive disorder, all of which are among the most prevalent NMS symptoms. Dipraglurant is rapidly absorbed after oral administration, readily crosses the blood-brain barrier, and exhibits a high correlation between plasma concentration and efficacy in behavioral models. In vivo, dipraglurant dose-dependently reduced haloperidol-induced catalepsy, increased punished licks in the Vogel conflict-drinking model, decreased immobility time in the forced swim test, decreased the number of buried marbles in the marble-burying test, but had no effect on rotarod performance or locomotor activity. These findings suggest that dipraglurant may have benefits to address some of the highly problematic comorbid non-motor symptoms of PD, in addition to its antidyskinetic effect demonstrated in PD-LID patients.
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Pagonabarraga J, Álamo C, Castellanos M, Díaz S, Manzano S. Depression in Major Neurodegenerative Diseases and Strokes: A Critical Review of Similarities and Differences among Neurological Disorders. Brain Sci 2023; 13:brainsci13020318. [PMID: 36831861 PMCID: PMC9954482 DOI: 10.3390/brainsci13020318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Depression and anxiety are highly prevalent in most neurological disorders and can have a major impact on the patient's disability and quality of life. However, mostly due to the heterogeneity of symptoms and the complexity of the underlying comorbidities, depression can be difficult to diagnose, resulting in limited recognition and in undertreatment. The early detection and treatment of depression simultaneously with the neurological disorder is key to avoiding deterioration and further disability. Although the neurologist should be able to identify and treat depression initially, a neuropsychiatry team should be available for severe cases and those who are unresponsive to treatment. Neurologists should be also aware that in neurodegenerative diseases, such as Alzheimer's or Parkinson's, different depression symptoms could develop at different stages of the disease. The treatment options for depression in neurological diseases include drugs, cognitive-behavioral therapy, and somatic interventions, among others, but often, the evidence-based efficacy is limited and the results are highly variable. Here, we review recent research on the diagnosis and treatment of depression in the context of Alzheimer's disease, Parkinson's disease, and strokes, with the aim of identifying common approaches and solutions for its initial management by the neurologist.
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Affiliation(s)
- Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Centro de Investigación en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031 Madrid, Spain
- Correspondence:
| | - Cecilio Álamo
- Department of Biomedical Sciences (Pharmacology), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain
| | - Mar Castellanos
- Department of Neurology, A Coruña University Hospital and Biomedical Research Institute, 15006 La Coruña, Spain
| | - Samuel Díaz
- Headaches Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Sagrario Manzano
- Department of Neurology, Infanta Leonor University Hospital, 28031 Madrid, Spain
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5
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Heronemus M, Hostetter TA, Smith AA, Forster JE, Brenner LA. Parkinson's disease and suicide among individuals seeking care within the United States Veterans Health Administration. Parkinsonism Relat Disord 2022; 105:58-61. [PMID: 36370654 DOI: 10.1016/j.parkreldis.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Independently, veterans and individuals with Parkinson's Disease (PD) are at increased risk for suicide. To our knowledge, the risk of suicide among veterans with PD has yet to be evaluated. This study aimed to examine the associations between PD and risk of suicide, as well as suicide means among those using Veteran Health Administration (VHA) services. METHODS Retrospective cohort study of individuals who used VHA services between 1/1/2001-12/31/2019. Cox proportional hazard models were used to estimate the hazard of suicide for those with PD relative to those without. A nested-case control study was carried out among the suicide decedents where logistic regression was used to assess the relationship between PD and suicide by firearms versus suicide by any other means. RESULTS The unadjusted hazard of death by suicide for those with a PD diagnosis, relative to those without, was 1.51 (95% CI: 1.32-1.72, p < 0.0001), and was still significant after controlling for age/gender, and psychiatric/chronic physical health diagnoses (HR: 1.50; 95% CI: 1.32-1.72, p < 0.0001; HR:1.21, 95% CI:1.06-1.38, p = 0.006, respectively). Compared to the non-PD cohort, the PD group also had higher rates of mood, anxiety, and psychotic disorders. There was no significant difference between the method of suicide for those with PD versus those without PD (p = 0.60). Most suicide deaths among both cohorts were firearm-related (PD = 78.9%, No-PD = 80.3%). CONCLUSIONS PD is associated with an elevated risk for suicide. Based on the high rate of deaths by firearm, increased efforts to facilitate lethal means safety among veterans is warranted.
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Affiliation(s)
- Marc Heronemus
- University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, CO, USA
| | - Trisha A Hostetter
- Veterans Health Administration (VHA), Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Aurora, CO, USA
| | - Alexandra A Smith
- Veterans Health Administration (VHA), Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Aurora, CO, USA
| | - Jeri E Forster
- University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, CO, USA; Veterans Health Administration (VHA), Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Aurora, CO, USA
| | - Lisa A Brenner
- University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, CO, USA; University of Colorado, Anschutz Medical Campus, Departments of Psychiatry and Neurology, Aurora, CO, USA.
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Kawakami I, Iga J, Takahashi S, Lin Y, Fujishiro H. Towards an understanding of the pathological basis of senile depression and incident dementia: Implications for treatment. Psychiatry Clin Neurosci 2022; 76:620-632. [PMID: 36183356 PMCID: PMC10092575 DOI: 10.1111/pcn.13485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/15/2022] [Accepted: 09/24/2022] [Indexed: 11/30/2022]
Abstract
Senile depression (SD) is a heterogeneous syndrome. Several clinical profiles are more likely to appear in SD than in early-life depression, but it remains unclear whether the pathophysiology is different. The prevalence of dementia increases with aging, and the underlying pathophysiological processes in the preclinical phase begin even before cognitive deficits or neurological signs appear. SD may be either a risk factor for developing dementia or a prodromal stage of dementia. The inconsistent findings regarding the association between SD and incident dementia may be attributable to the neuropathological heterogeneity underlying SD. Most studies have focused on patients with the clinical diagnosis of Alzheimer disease (AD) as an outcome, but several clinicopathological studies suggest that primary age-related tauopathy and argyrophilic grain disease may account for a proportion of cases clinically misdiagnosed as AD in the elderly population. Furthermore, most AD cases have additional neuropathologic changes such as cerebrovascular disease and Lewy body disease. Here, we review the neuropathological findings linking SD to incident dementia, focusing on common age-related neuropathologies. In particular, the roles of disturbance of neural circuity, imbalance of monoaminergic systems, dysregulation of the hypothalamic-pituitary-adrenal axis, and elevated neuroinflammatory status are discussed. Finally, we review the current treatment of SD in the context of age-related neuropathological changes.
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Affiliation(s)
- Ito Kawakami
- Department of PsychiatryJuntendo University School of MedicineTokyoJapan
- Dementia Research ProjectTokyo Metropolitan Institute of Medical ScienceTokyoJapan
| | - Jun‐ichi Iga
- Department of NeuropsychiatryEhime University Graduate School of MedicineMatsuyamaJapan
| | - Sho Takahashi
- Department of Disaster and Community Psychiatry, Division of Clinical Medicine, Faculty of MedicineUniversity of TsukubaTsukubaJapan
- Department of Community and Disaster Assistance, Ibaraki Prefectural Medical Research Center of PsychiatryUniversity of TsukubaTsukubaJapan
| | - Yi‐Ting Lin
- Department of PsychiatryNational Taiwan University HospitalTaipeiTaiwan
| | - Hiroshige Fujishiro
- Department of PsychiatryNagoya University Graduate School of MedicineAichiJapan
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Chikatimalla R, Dasaradhan T, Koneti J, Cherukuri SP, Kalluru R, Gadde S. Depression in Parkinson's Disease: A Narrative Review. Cureus 2022; 14:e27750. [PMID: 36106206 PMCID: PMC9447473 DOI: 10.7759/cureus.27750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/24/2022] Open
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative age-related disorder that affects the central nervous system (CNS) and is characterized by uncontrollable movements such as shaking, stiffness, and loss of balance and coordination. Depression is a common non-motor manifestation of PD, but unfortunately, depression remains unrecognized and often undertreated. The underlying pathophysiology of depression in PD is complicated, and many studies have been conducted to know the exact cause, but the question remains unanswered. In this article, we discuss various pathophysiologies by which depression occurs in PD. The most widely accepted theories are neuroinflammation and monoamine oxidase theory. This article also explored the pharmacological treatment of depression in PD; this involves standard antidepressant therapy such as tricyclic antidepressants (TCA), serotonin-norepinephrine reuptake inhibitors (SNRI), selective serotonin reuptake inhibitors (SSRI), and monoamine oxidase inhibitors (MAO); non-pharmacological treatments such as electroconvulsive therapy (ECT), cognitive-behavioral therapy (CBT) have also been discussed. However, physicians hesitate to prescribe antidepressants to patients with PD due to concerns about harmful drug-drug interactions between antidepressants and antiparkinsonian drugs. Despite the complicated link between PD and depression, the co-administration of antidepressants and antiparkinsonian drugs is safe and beneficial when appropriately managed. However, early recognition and initiation of treatment of depression in PD reduces the longitudinal course and improves the cross-sectional picture. This review article also explored the clinical and diagnostic findings and impact on the quality of life of depression in PD.
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Austgen G, Marsh L. Cognitive dysfunction and neuropsychiatric aspects of Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:59-90. [PMID: 35248207 DOI: 10.1016/bs.pbr.2022.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Movement abnormalities, by definition, and cognitive changes, to varying extents, affect every patient with Parkinson's disease (PD) and are attributed to the underlying neurodegenerative disease. Various psychiatric disorders occur in most patients at some point over the course of PD, including in the prodromal phase. Even though psychiatric disturbances tend to aggravate motor and cognitive deficits, they are under-recognized and under-treated, and the role of the underlying neurological disease is often minimized. To provide an integrated approach to understanding neuropsychiatric aspects of PD, this chapter reviews how cognitive changes in PD relate to the common psychiatric disturbances in PD along with the prevalence, phenomenology, pathophysiology, and treatment of each.
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Affiliation(s)
- Gabriela Austgen
- Behavioral Neurology & Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Laura Marsh
- Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Professor, Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences and Department of Neurology, Baylor College of Medicine, Houston, TX, United States.
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Mizrahi-Kliger AD, Feldmann LK, Kühn AA, Bergman H. Etiologies of insomnia in Parkinson's disease - Lessons from human studies and animal models. Exp Neurol 2022; 350:113976. [PMID: 35026228 DOI: 10.1016/j.expneurol.2022.113976] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/27/2021] [Accepted: 01/06/2022] [Indexed: 12/28/2022]
Abstract
Sleep disorders are integral to Parkinson's disease (PD). Insomnia, an inability to maintain stable sleep, affects most patients and is widely rated as one of the most debilitating facets of this disease. PD insomnia is often perceived as a multifactorial entity - a consequence of several of the disease symptoms, comorbidities and therapeutic strategies. Yet, this view evolved against a backdrop of a relative scarcity of works trying to directly dissect the underlying neural correlates and mechanisms in animal models. The last years have seen the emergence of a wealth of new evidence regarding the neural underpinnings of insomnia in PD. Here, we review early and recent reports from patients and animal models evaluating the etiology of PD insomnia. We start by outlining the phenomenology of PD insomnia and continue to analyze the evidence supporting insomnia as emanating from four distinct subdivisions of etiologies - the symptoms and comorbidities of the disease, the medical therapy, the degeneration of non-dopaminergic cell groups and subsequent alterations in circadian rhythms, and the degeneration of dopaminergic neurons in the brainstem and its resulting effect on the basal ganglia. Finally, we review emerging neuromodulation-based therapeutic avenues for PD insomnia.
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Affiliation(s)
- Aviv D Mizrahi-Kliger
- Department of Neurobiology, Institute of Medical Research Israel-Canada, Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem 91120, Israel.
| | - Lucia K Feldmann
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany; NeuroCure Cluster of Excellence, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen, Berlin, Germany
| | - Hagai Bergman
- Department of Neurobiology, Institute of Medical Research Israel-Canada, Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem 91120, Israel; The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem 91904, Israel; Department of Neurosurgery, Hadassah University Hospital, Jerusalem 91120, Israel
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10
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Chendo I, Silva C, Duarte GS, Prada L, Vian J, Quintão A, Voon V, Ferreira JJ. Frequency of Depressive Disorders in Parkinson's Disease: A Systematic Review and Meta-Analysis. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1409-1418. [PMID: 35491801 DOI: 10.3233/jpd-223207] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Depressive disorders are recognized as a common neuropsychiatric disorder of Parkinson's disease (PD). Reported frequencies vary widely among studies and depend on the diagnostic criteria, the methods of ascertainment used, and the population sampled. OBJECTIVE We aimed to evaluate the frequency of depressive disorders in PD and to investigate the relationship with PD clinical variables. METHODS A systematic review and meta-analysis of observational studies (community-based, prospective and retrospective cohort, case-control, and cross-sectional studies) reporting the frequency of depressive disorders in PD patients. RESULTS Electronic database search wielded 3,536 articles; an additional 91 were identified through citation chaining. 163 full-text articles were assessed for eligibility. Of these, 49 met the inclusion criteria for our analysis. The pooled frequency of depressive disorders was 30.7% (95% confidence interval [CI] 25.6 to 36.2; I2 = 95%; 49 studies; combined n = 10,039). The pooled frequency of major depressive disorder was 14.0% (95% CI 10.5 to 18.5; I2 = 88%; 23 studies; combined n = 5,218). Subgroup/meta-regression analyses were conducted to investigate the relationship between frequency and study inclusion criteria, methodology used for diagnosis, and study design. We found a statistically significant correlation between study design and depressive disorders frequency (ranging from 8% in the community-based study to 44% in the retrospective studies) and a statistically significant positive correlation between mean baseline PD duration and major depressive disorder frequency. CONCLUSION The current meta-analysis found a global frequency of depressive disorders of 30.7% and major depressive disorder of 14.0%. Study design influenced the frequency of depressive disorders in PD. Mean baseline PD duration and major depressive disorder frequency were positively correlated.
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Affiliation(s)
- Ines Chendo
- Psychiatry Department, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- CNS - Campus Neurológico, Torres Vedras, Portugal
| | - Carlos Silva
- Psychiatry Department, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal
| | - Gonçalo S Duarte
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal
| | - Luisa Prada
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal
| | - João Vian
- Department of Psychiatry, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana Quintão
- Department of Psychiatry, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Joaquim J Ferreira
- CNS - Campus Neurológico, Torres Vedras, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal
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Antidepressant-Like Properties of Intrastriatal Botulinum Neurotoxin-A Injection in a Unilateral 6-OHDA Rat Model of Parkinson's Disease. Toxins (Basel) 2021; 13:toxins13070505. [PMID: 34357977 PMCID: PMC8310221 DOI: 10.3390/toxins13070505] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/09/2021] [Accepted: 07/14/2021] [Indexed: 12/14/2022] Open
Abstract
Parkinson’s patients often suffer from depression and anxiety, for which there are no optimal treatments. Hemiparkinsonian (hemi-PD) rats were used to test whether intrastriatal Botulinum neurotoxin-A (BoNT-A) application could also have antidepressant-like properties in addition to the known improvement of motor performance. To quantify depression- and anxiety-like behavior, the forced swim test, tail suspension test, open field test, and elevated plus maze test were applied to hemi-PD rats injected with BoNT-A or vehicle. Furthermore, we correlated the results in the forced swim test, open field test, and elevated plus maze test with the rotational behavior induced by apomorphine and amphetamine. Hemi-PD rats did not show significant anxiety-like behavior as compared with Sham 6-OHDA- + Sham BoNT-A-injected as well as with non-injected rats. However, hemi-PD rats demonstrated increased depression-like behaviors compared with Sham- or non-injected rats; this was seen by increased struggling frequency and increased immobility frequency. Hemi-PD rats intrastriatally injected with BoNT-A exhibited reduced depression-like behavior compared with the respective vehicle-receiving hemi-PD animals. The significant effects of intrastriatally applied BoNT-A seen in the forced swim test are reminiscent of those found after various antidepressant drug therapies. Our data correspond with the efficacy of BoNT-A treatment of glabellar frown lines in treating patients with major depression and suggest that also intrastriatal injected BoNT-A may have some antidepressant-like effect on hemi-PD.
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Santos-García D, De Deus FT, Cores BC, Valdés AL, Suárez CE, Aneiros Á, Jesús S, Aguilar M, Pastor P, Planellas L, Cosgaya M, García CJ, Caballol N, Legarda I, Hernández VJ, Cabo I, López ML, González AI, Ávila RMA, José CM, Nogueira V, Puente V, García MJM, Borrué C, Solano VB, Álvarez SM, Vela L, Escalante S, Cubo E, Carrillo PF, Martínez CJC, Sánchez AP, Alonso LMG, López AN, Gastón I, Kulisevsky J, Blázquez EM, Seijo M, Rúiz MJ, Valero C, Kurtis M, de Fábregues-Boixar O, González AJ, Prieto JC, López DL, McAfee D, Mir P. Mood in Parkinson's disease: From early- to late-stage disease. Int J Geriatr Psychiatry 2021; 36:627-646. [PMID: 33169885 DOI: 10.1002/gps.5461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/01/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although depression is known to be frequent in Parkinson's disease (PD), it is unclear how mood can change and/or impact on patient's quality of life (QoL) over time. Our aim was to analyze the frequency of depression, mood related factors and the contribution of mood to a patient's QoL perception in regard to disease duration. METHODS PD patients recruited from the COPPADIS cohort from January 2016 to November 2017 were included in this cross-sectional study. Three groups were defined: <5 years (Group A); from 5 to <10 years (Group B); ≥10 years (Group C). Analysis with well-planned linear regression models was conducted to determine how different factors contribute to mood (Beck Depression Inventory-II [BDI-II] as dependent variable), to health-related QoL (39-item Parkinson's Disease Questionnaire [PDQ-39SI] as dependent variable) and to global QoL (European Health Interview Survey - Quality of Life Eight-Item Index [EUROHIS-QOL8] as dependent variable). RESULTS Six hundred and sixty-three PD patients (62.6 ± 8.9 years old, 59.6% males) were included: Group A, 50.1% (n = 332); Group B, 33.3% (n = 221) and Group C, 16.6% (n = 110). There were no differences between the three groups in terms of the frequency of depressive symptoms nor the frequency of depression type (major vs. minor vs. subthreshold) (p = 0.729). However, the unique percent variance of PDQ-39SI and EUROHIS-QOL8 explained by BDI-II total score was 2 (23.7%) and threefold (26.9%), respectively, in Group C compared to the other two groups. EUROHIS-QOL8 total score provided the highest unique contribution to mood (16.8%). CONCLUSIONS Although depression-type frequency does not appear to change over time in PD; the contribution of mood on QoL perception is greater in patients with longer disease duration.
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Affiliation(s)
| | | | - Bartolome C Cores
- Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Aymerich L Valdés
- Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Castro E Suárez
- Complejo Hospitalario Universitario de Ferrol (CHUF), A Coruña, Spain
| | - Ángel Aneiros
- Complejo Hospitalario Universitario de Ferrol (CHUF), A Coruña, Spain
| | - Silvia Jesús
- Hospital Universitario Virgen del Rocío, Sevilla, Spain.,Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Miquel Aguilar
- Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | - Pau Pastor
- Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | | | | | | | - Nuria Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | - Inés Legarda
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Iria Cabo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | - Aramburu I González
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Rivera M A Ávila
- Consorci Sanitari Integral, Hospital General de L´Hospitalet, Barcelona, Spain
| | - Catalán M José
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | | | | | | | - Vila B Solano
- Institut d'Assistència Sanitària (IAS) - Institut Català de la Salut, Girona, Spain
| | | | - Lydia Vela
- Fundación Hospital de Alcorcón, Madrid, Spain
| | - Sonia Escalante
- Hospital de Tortosa Verge de la Cinta (HTVC), Tortosa, Tarragona, Spain
| | - Esther Cubo
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Padilla F Carrillo
- Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
| | | | | | - Losada M G Alonso
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | | | | | - Jaime Kulisevsky
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Hospital de Sant Pau, Barcelona, Spain
| | | | - Manuel Seijo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | | | | | | | | | | | - Díaz L López
- Complejo Hospitalario Universitario de Orense (CHUO), Orense, Spain
| | - Darrian McAfee
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pablo Mir
- Hospital Universitario Virgen del Rocío, Sevilla, Spain.,Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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Perez-Pardo P, Grobben Y, Willemsen-Seegers N, Hartog M, Tutone M, Muller M, Adolfs Y, Pasterkamp RJ, Vu-Pham D, van Doornmalen AM, van Cauter F, de Wit J, Gerard Sterrenburg J, Uitdehaag JCM, de Man J, Buijsman RC, Zaman GJR, Kraneveld AD. Pharmacological validation of TDO as a target for Parkinson's disease. FEBS J 2021; 288:4311-4331. [PMID: 33471408 PMCID: PMC8359396 DOI: 10.1111/febs.15721] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/24/2020] [Accepted: 12/30/2020] [Indexed: 12/21/2022]
Abstract
Parkinson’s disease patients suffer from both motor and nonmotor impairments. There is currently no cure for Parkinson’s disease, and the most commonly used treatment, levodopa, only functions as a temporary relief of motor symptoms. Inhibition of the expression of the L‐tryptophan‐catabolizing enzyme tryptophan 2,3‐dioxygenase (TDO) has been shown to inhibit aging‐related α‐synuclein toxicity in Caenorhabditis elegans. To evaluate TDO inhibition as a potential therapeutic strategy for Parkinson’s disease, a brain‐penetrable, small molecule TDO inhibitor was developed, referred to as NTRC 3531‐0. This compound potently inhibits human and mouse TDO in biochemical and cell‐based assays and is selective over IDO1, an evolutionary unrelated enzyme that catalyzes the same reaction. In mice, NTRC 3531‐0 increased plasma and brain L‐tryptophan levels after oral administration, demonstrating inhibition of TDO activity in vivo. The effect on Parkinson’s disease symptoms was evaluated in a rotenone‐induced Parkinson’s disease mouse model. A structurally dissimilar TDO inhibitor, LM10, was evaluated in parallel. Both inhibitors had beneficial effects on rotenone‐induced motor and cognitive dysfunction as well as rotenone‐induced dopaminergic cell loss and neuroinflammation in the substantia nigra. Moreover, both inhibitors improved intestinal transit and enhanced colon length, which indicates a reduction of the rotenone‐induced intestinal dysfunction. Consistent with this, mice treated with TDO inhibitor showed decreased expression of rotenone‐induced glial fibrillary acidic protein, which is a marker of enteric glial cells, and decreased α‐synuclein accumulation in the enteric plexus. Our data support TDO inhibition as a potential therapeutic strategy to decrease motor, cognitive, and gastrointestinal symptoms in Parkinson’s disease.
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Affiliation(s)
- Paula Perez-Pardo
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Yvonne Grobben
- Netherlands Translational Research Center B.V, Oss, The Netherlands
| | | | - Mitch Hartog
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Michaela Tutone
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Michelle Muller
- Netherlands Translational Research Center B.V, Oss, The Netherlands
| | - Youri Adolfs
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ronald Jeroen Pasterkamp
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Diep Vu-Pham
- Netherlands Translational Research Center B.V, Oss, The Netherlands
| | | | - Freek van Cauter
- Netherlands Translational Research Center B.V, Oss, The Netherlands
| | - Joeri de Wit
- Netherlands Translational Research Center B.V, Oss, The Netherlands
| | | | | | - Jos de Man
- Netherlands Translational Research Center B.V, Oss, The Netherlands
| | | | - Guido J R Zaman
- Netherlands Translational Research Center B.V, Oss, The Netherlands
| | - Aletta D Kraneveld
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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14
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Zhang X, Wang Y, Zhao Z, Chen X, Li W, Li X. Transcriptome sequencing reveals aerobic exercise training-associated lncRNAs for improving Parkinson's disease. 3 Biotech 2020; 10:498. [PMID: 33150124 DOI: 10.1007/s13205-020-02483-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022] Open
Abstract
The present study aimed to evaluate the effect of aerobic exercise training (AET) on the performance of mice with Parkinson's disease (PD) and to explore the molecular mechanism of AET-associated long noncoding RNAs (lncRNAs) in PD treatment. The results showed that the behaviors of PD mice were significantly improved after 4 weeks of AET. The substantia nigra pars compacta of PD mice showed scattered large multipolar cells and surrounding neutrophils after AET. In addition, a total of 62 differentially expressed lncRNAs (DE-lncRNAs) were identified between the AET group and the PD group, including 55 up-regulated and 7 down-regulated DE-lncRNAs in the AET group. Furthermore, the target genes of DE-lncRNAs, including LOC102633466, LOC102637865, and LOC102638670, were mainly involved in ECM-receptor interaction, the Wnt pathway and the PI3K/AKT/mTOR pathway. Quantitative real-time polymerase chain reaction showed that these three DE-lncRNAs were significantly up-regulated in the AET group than in the PD group. The lncRNA-miRNA-mRNA ceRNA network suggested that these 3 DE-lncRNAs may improve PD via the ceRNA mechanism. In conclusion, this study suggests that aerobic exercise improves motor performance of PD mice and provides a foundation for further studies on the molecular mechanism of lncRNAs in treating PD.
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15
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DeKarske D, Alva G, Aldred JL, Coate B, Cantillon M, Jacobi L, Nunez R, Norton JC, Abler V. An Open-Label, 8-Week Study of Safety and Efficacy of Pimavanserin Treatment in Adults with Parkinson's Disease and Depression. JOURNAL OF PARKINSONS DISEASE 2020; 10:1751-1761. [PMID: 32804101 PMCID: PMC7683094 DOI: 10.3233/jpd-202058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Many patients with Parkinson's disease (PD) experience depression. OBJECTIVE Evaluate pimavanserin treatment for depression in patients with PD. METHODS Pimavanserin was administered as monotherapy or adjunctive therapy to a selective serotonin reuptake inhibitor or serotonin/noradrenaline reuptake inhibitor in this 8-week, single-arm, open-label phase 2 study (NCT03482882). The primary endpoint was change from baseline to week 8 in Hamilton Depression Scale-17-item version (HAMD-17) score. Safety, including collection of adverse events and the Mini-Mental State Examination (MMSE) and Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III) scores, was assessed in patients who received ≥1 pimavanserin dose. RESULTS Efficacy was evaluated in 45 patients (21 monotherapy, 24 adjunctive therapy). Mean (SE) baseline HAMD-17 was 19.2 (3.1). Change from baseline to week 8 (least squares [LS] mean [SE]) in the HAMD-17 was -10.8 (0.63) (95% CI, -12.0 to -9.5; p < 0.0001) with significant improvement seen at week 2 (p < 0.0001) and for both monotherapy (week 8, -11.2 [0.99]) and adjunctive therapy (week 8,-10.2 [0.78]). Most patients (60.0%) had ≥50% improvement at week 8, and 44.4% of patients reached remission (HAMD-17 score ≤7). Twenty-one of 47 patients experienced 42 treatment-emergent adverse events; the most common by system organ class were gastrointestinal (n = 7; 14.9%) and psychiatric (n = 7; 14.9%). No negative effects were observed on MMSE or MDS-UPDRS Part III. CONCLUSION In this 8-week, single-arm, open-label study, pimavanserin as monotherapy or adjunctive therapy was well tolerated and associated with early and sustained improvement of depressive symptoms in patients with PD.
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Affiliation(s)
| | - Gustavo Alva
- Department of Neuroscience, University of California, Riverside, Riverside, CA, USA
| | | | - Bruce Coate
- ACADIA Pharmaceuticals Inc., San Diego, CA, USA
| | - Marc Cantillon
- Department of Neurology and Psychiatry, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Lori Jacobi
- ACADIA Pharmaceuticals Inc., San Diego, CA, USA
| | - Rene Nunez
- ACADIA Pharmaceuticals Inc., San Diego, CA, USA
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16
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Bahadoran P, Varela R, De Angelis A, Paviour D, Agrawal N. Screening for depression in movement disorders clinic. Neurol Sci 2020; 42:969-978. [PMID: 32681218 DOI: 10.1007/s10072-020-04571-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Depression is the most common, though often under-recognised, neuropsychiatric disturbance in movement disorders (MD). OBJECTIVE This study aimed to establish whether a briefer screening measure such as a visual analogue screening measure (Emotions Thermometer) or Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) could be a potentially suitable screening tool for depression in MD patients. METHOD Patients attending a regional MD outpatient clinic completed the Emotional Thermometer 7-item tool (ET7), the Hospital Anxiety and Depression Scale (HADS) and the Neurological Disorders Depression Inventory for Epilepsy (NDDIE). We used the Major Depression Inventory which provided the diagnosis of depression based on ICD-10 and DSM-IV as our diagnostic gold standard to compare the performance of ET7 and its individual sub-scales, its briefer version ET4, HADS, and NDDIE. Sensitivity, specificity, positive predictive value, negative predictive value and receiver operating characteristic curves were calculated to compare the performance of the screening tools. RESULTS In total, 188 patients were included in the analysis. The most accurate tools as determined by Receiver Operating Characteristics curve were HADS-D for ICD-10 depressive episode and DepT for DSM-IV major depression. ET4 performed well as a 'rule-out' screening tool for both DSM-IV and ICD-10 depression. ET4 performance was comparable to HADS without the need for clinician scoring. The briefer ET4 performed almost as well as ET7. CONCLUSION Emotions Thermometer and NDDI-E are quick and reliable screening tools for depression in the MD population and are comparable to HADS. We suggest routine use of visual analogue ET4 as it is briefer, requires less time to complete and does not require scoring from the clinicians. It has the potential to be widely implemented across busy neurology clinics to assist in depression screening.
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Affiliation(s)
- Parviz Bahadoran
- Atkinson Morley Regional Neurosciences Centre, St. George's Hospital, London, UK.
| | - Rita Varela
- Atkinson Morley Regional Neurosciences Centre, St. George's Hospital, London, UK
| | - Andrea De Angelis
- Atkinson Morley Regional Neurosciences Centre, St. George's Hospital, London, UK
| | - Dominic Paviour
- Atkinson Morley Regional Neurosciences Centre, St. George's Hospital, London, UK
| | - Niruj Agrawal
- Atkinson Morley Regional Neurosciences Centre, St. George's Hospital, London, UK
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Abstract
Parkinson disease has historically been conceptualized as a movement disorder. In recent decades, nonmotor and neuropsychiatric symptoms have become increasingly recognized as being of paramount importance for patients with Parkinson disease. Neuropsychiatric phenomena dominate the course of the other major Lewy body disease, dementia with Lewy bodies. In this review, we survey the clinical relevance of nonmotor and neuropsychiatric symptoms to the heterogeneous presentations of Lewy body disease and their significance to ongoing research in this area. We consider how the nature of Lewy body neuropathology may help explicate the basis of nonmotor and neuropsychiatric symptoms in these two disorders.
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Affiliation(s)
- Jared T Hinkle
- Medical Scientist Training Program, Johns Hopkins School of Medicine, 1830 E Monument St, Baltimore, MD 21205, USA; Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street, Phipps 300, Baltimore, MD 21287, USA
| | - Gregory M Pontone
- Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street, Phipps 300, Baltimore, MD 21287, USA; Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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18
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Sheynin J, Baetu I, Collins-Praino LE, Myers CE, Winwood-Smith R, Moustafa AA. Maladaptive avoidance patterns in Parkinson's disease are exacerbated by symptoms of depression. Behav Brain Res 2020; 382:112473. [PMID: 31935419 DOI: 10.1016/j.bbr.2020.112473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/05/2020] [Accepted: 01/05/2020] [Indexed: 11/26/2022]
Abstract
Parkinson's disease (PD) is a chronic, progressive neurodegenerative disorder, characterized by a loss of dopaminergic neurons in the substantia nigra pars compacta. Given that dopamine is critically involved in learning and other cognitive processes, such as working memory, dopamine loss in PD has been linked both to learning abnormalities and to cognitive dysfunction more generally in the disease. It is unclear, however, whether avoidance behavior is impacted in PD. This is significant, as this type of instrumental behavior plays an important role in both decision-making and emotional (dys) function. Consequently, the aim of the present study was to examine avoidance learning and operant extinction in PD using a computer-based task. On this task, participants control a spaceship and attempt to shoot an enemy spaceship to gain points. They also learn to hide in safe areas to protect from (i.e., avoid) aversive events (on-screen explosions and point loss). The results showed that patients with PD (N = 25) acquired an avoidance response during aversive periods to the same extent as healthy age-matched controls (N = 19); however, patients demonstrated greater hiding during safe periods not associated with aversive events, which could represent maladaptive generalization of the avoidance response. Furthermore, this impairment was more pronounced during the extinction phase, and in patients who reported higher levels of depression. These results demonstrate for the first time that PD is associated with maladaptive avoidance patterns, which could possibly contribute to the emergence of depression in the disease.
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Affiliation(s)
- Jony Sheynin
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Irina Baetu
- School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Lyndsey E Collins-Praino
- Department of Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Catherine E Myers
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, NJ, USA; Department of Pharmacology, Physiology & Neuroscience, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Robyn Winwood-Smith
- School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW, Australia
| | - Ahmed A Moustafa
- School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW, Australia; The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW, Australia
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19
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Daily functioning, verbal fluency and emotional functioning of patients with Parkinson’s disease treated pharmacologically and with deep brain stimulation. HEALTH PSYCHOLOGY REPORT 2020. [DOI: 10.5114/hpr.2020.94740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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20
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Suicidal risk and demoralization in Parkinson disease. J Neurol 2019; 267:966-974. [DOI: 10.1007/s00415-019-09632-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/07/2019] [Accepted: 11/09/2019] [Indexed: 11/26/2022]
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21
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Berardelli I, Belvisi D, Pasquini M, Fabbrini A, Petrini F, Fabbrini G. Treatment of psychiatric disturbances in hypokinetic movement disorders. Expert Rev Neurother 2019; 19:965-981. [PMID: 31241368 DOI: 10.1080/14737175.2019.1636648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: We reviewed studies that assessed the treatment of psychiatric disturbances in Parkinson's disease and atypical parkinsonisms. Neuropsychiatric disturbances in these conditions are frequent and have a profound impact on quality of life of patients and of their caregivers. It is therefore important to be familiar with the appropriate pharmacological and non-pharmacological interventions for treating these disorders. Areas covered: The authors searched for papers in English in Pubmed using the following keywords: Parkinson's disease, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, Lewy body dementia, depression, apathy, anxiety, fatigue, sleep disorders, obsessive compulsive disorders, psychosis, hallucinations, delusions, impulse control disorders. Expert opinion: In Parkinson's disease, depression may benefit from the optimization of dopaminergic therapy, from the use of antidepressants acting on both the serotoninergic and noradrenergic pathways and from cognitive behavioral therapy. Psychosis in Parkinson's disease may improve with the use of clozapine; the serotonin inverse agonist pimavanserin has been shown to be effective. Treatment of impulse control disorders is primarily based on the removal of dopamine agonists. No controlled studies have investigated the treatment of neuropsychiatric disorders in multiple system atrophy, progressive supranuclear palsy or corticobasal degeneration. Acethylcholinesterase inhibitors may be used to treat hallucinations in Lewy body dementia.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | | | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome , Rome , Italy
| | - Andrea Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome , Rome , Italy
| | - Federica Petrini
- Department of Neurosciences and Mental Health, Azienda Universitaria Policlinico Umberto I° , Rome , Italy
| | - Giovanni Fabbrini
- IRCCS Neuromed , Pozzilli , Italy.,Department of Human Neurosciences, Sapienza University of Rome , Rome , Italy
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Galts CP, Bettio LE, Jewett DC, Yang CC, Brocardo PS, Rodrigues ALS, Thacker JS, Gil-Mohapel J. Depression in neurodegenerative diseases: Common mechanisms and current treatment options. Neurosci Biobehav Rev 2019; 102:56-84. [DOI: 10.1016/j.neubiorev.2019.04.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/22/2019] [Accepted: 04/02/2019] [Indexed: 12/19/2022]
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Randver R, Davel K, Toomsoo T. High-frequency repetitive transcranial magnetic stimulation to the left dorsolateral prefrontal cortex of patients with Parkinson's disease and treatment-resistant depression: a pilot study. Neurocase 2019; 25:80-90. [PMID: 31262224 DOI: 10.1080/13554794.2019.1636069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
An increasing amount of evidence is showing the therapeutic effects of rTMS on PD-related non-motor functions neuroanatomically linked to the DLPFC. This presents an ongoing need to apply an optimal combination of stimulation parameters to clinically heterogeneous patient populations, including those with neuropsychiatric problems and other comorbidities along with the neurodegenerative process. In this prospective pilot study, six patients with PD and treatment-resistant depression were thoroughly assessed and carefully monitored before, during, and after each stimulation procedure. The results can provide the basis for developing an extended rTMS protocol that is both effective and safe.
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Affiliation(s)
- René Randver
- a Institute of Psychology , University of Tartu , Tartu , Estonia.,b Neurology Center , East Tallinn Central Hospital , Tallinn , Estonia
| | - Külli Davel
- b Neurology Center , East Tallinn Central Hospital , Tallinn , Estonia
| | - Toomas Toomsoo
- b Neurology Center , East Tallinn Central Hospital , Tallinn , Estonia
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Dissanayaka NNW, Au TR, Angwin AJ, Iyer KK, O'Sullivan JD, Byrne GJ, Silburn PA, Marsh R, Mellick GD, Copland DA. Depression symptomatology correlates with event-related potentials in Parkinson's disease: An affective priming study. J Affect Disord 2019; 245:897-904. [PMID: 30699874 DOI: 10.1016/j.jad.2018.11.094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/01/2018] [Accepted: 11/12/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression is a predominant non-motor symptom of Parkinson's disease (PD), which is often under recognised and undertreated. To improve identification of depression in PD it is imperative to examine objective brain-related markers. The present study addresses this gap by using electroencephalography (EEG) to evaluate the processing of emotionally valanced words in PD. METHODS Fifty non-demented PD patients, unmedicated for depression or anxiety, completed an affective priming task while EEG was simultaneously recorded. Prime and target word pairs of negative or neutral valence were presented at a short 250 ms stimulus onset asynchrony. Participants were asked to evaluate the valence of the target word by button press. Depression was measured using an established rating scale. Repeated measures analysis of covariance and correlational analyses were performed to examine whether event-related potentials (ERP) varied as a function of depression scores. RESULTS Key ERP findings reveal reduced responses in parietal midline P300, N400 and Late Positive Potential (LPP) difference waves between congruent and incongruent neutral targets in patients with higher depression scores. LIMITATIONS Comparisons of ERPs were limited by insufficient classification of participants with and without clinical depression. A majority of PD patients who had high depression scores were excluded from the analysis as they were receiving antidepressant and/or anxiolytic medications which could interfere with ERP sensitivity. CONCLUSIONS The present study suggests that the Pz-P300, N400 and LPP are ERP markers relates to emotional dysfunction in PD. These findings thus advance current knowledge regarding the neurophysiological markers of a common neuropsychiatric deficit in PD.
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Affiliation(s)
- Nadeeka N W Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Herston, Brisbane QLD4029, Australia; Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Brisbane QLD4029, Australia; School of Psychology, The University of Queensland, St Lucia, Brisbane QLD4067, Australia.
| | - Tiffany R Au
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Herston, Brisbane QLD4029, Australia
| | - Anthony J Angwin
- School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane QLD4067, Australia
| | - Kartik K Iyer
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Herston, Brisbane QLD4029, Australia
| | - John D O'Sullivan
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Herston, Brisbane QLD4029, Australia; Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Brisbane QLD4029, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Herston, Brisbane QLD4029, Australia; Mental Health Service, Royal Brisbane & Women's Hospital, Herston, Brisbane QLD4029, Australia
| | - Peter A Silburn
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Brisbane QLD4067, Australia
| | - Rodney Marsh
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Brisbane QLD4067, Australia
| | - George D Mellick
- Griffith Institute for Drug Discovery, Griffith University, Nathan, Brisbane QLD4111, Australia
| | - David A Copland
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Herston, Brisbane QLD4029, Australia; School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane QLD4067, Australia
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Yang HJ, Ahn JH, Lee J, Lee WK, Lee J, Kim Y. Measuring Anxiety in Patients With Early-Stage Parkinson's Disease: Rasch Analysis of the State-Trait Anxiety Inventory. Front Neurol 2019; 10:49. [PMID: 30837928 PMCID: PMC6383064 DOI: 10.3389/fneur.2019.00049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/14/2019] [Indexed: 12/19/2022] Open
Abstract
The State-Trait Anxiety Inventory (STAI), composed of two 20-item subscales (STAI-state and STAI-trait), has been increasingly used to assess anxiety symptoms in patients with Parkinson's disease (PD). However, the clinimetric attributes of the STAI under the statistical framework of the item-response theory (IRT) have not been fully elucidated within this population to date. We performed an IRT-based Rasch analysis of the STAI outcomes of patients with de novo PD from the Parkinson's Progression Markers Initiative database. The unidimensionality, Rasch model fit, scale targeting, separation reliability, differential item functioning, and response category utility of the STAI were statistically evaluated. A total of 326 (209 males, 117 females) patients without cognitive dysfunction were enrolled in our study. The original versions of the STAI-state and STAI-trait had acceptable separation reliability but lacked appropriate response category functioning, exhibited scale off-targeting, and several items demonstrated poor fit to the Rasch model. The response categories were reduced from four to three, and the rescored three-point TASI-trait demonstrated a marked improvement in clinimetric properties without a significant impact on unidimensionality and separation reliability. The rescored three-point version of the STAI-state required the additional removal of four misfitting items in order to improve the Rasch model fit. To our knowledge, this is the first study to assess the measurement properties based on the IRT of the STAI in patients with PD. Our Rasch analysis identified the components requiring possible amendments in order to improve the clinimetric attributes of the STAI.
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Affiliation(s)
- Hui-Jun Yang
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Joon-Ho Ahn
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jungsun Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Won Kee Lee
- Medical Research Collaboration Center, Kyungpook National University Hospital and School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jiho Lee
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Yangho Kim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
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Dogan B, Akyol A, Memis CO, Sair A, Akyildiz U, Sevincok L. The relationship between temperament and depression in Parkinson's disease patients under dopaminergic treatment. Psychogeriatrics 2019; 19:73-79. [PMID: 30141277 DOI: 10.1111/psyg.12366] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/14/2018] [Accepted: 07/18/2018] [Indexed: 12/26/2022]
Abstract
AIM The risk factors for depressive symptoms in patients with Parkinson's disease (PD) under dopaminergic drug treatment are unclear. In this study, we examined whether some temperament traits are related to the presence of comorbid depression in PD patients, independent of the characteristics of illness and drug treatment. METHODS The participants in this study were 74 patients with idiopathic PD who were already treated with stable doses of levodopa or dopamine agonists. Depressive (n = 20) and non-depressive (n = 52) PD patients were assessed by means of the Unified Parkinson's Disease Rating Scale, Beck Depression Inventory, and Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire. The doses of levodopa and dopamine agonists were converted into levodopa equivalent daily dose. RESULTS The duration of treatment in the depressive group was significantly longer than in the non-depressive group (P = 0.03). The depressive patients had significantly higher scores on the Unified Parkinson's Disease Rating Scale than the non-depressive patients. Depressive (P < 0.0001), cyclothymic (P < 0.0001), anxious (P < 0.0001), and irritable (P = 0.02) temperament scores were significantly higher in depressive than in non-depressive patients. Hyperthymia scores were significantly higher in non-depressive patients than in depressive patients (P = 0.01). Logistic regression analysis revealed that depressive temperament traits (P = 0.03) significantly predicted the diagnosis of depression. In contrast, hyperthymic temperament seemed to be associated with the absence of depression (P = 0.006). CONCLUSION Our results indicated that the severity of PD and duration of dopaminergic treatment were not predictive of the development of depression in PD patients. Depressive temperament strongly predicted the development of depression in our sample. Hyperthymic temperament seemed to be associated with patients without depression. We suggest that depressive temperament traits seem to be related to depression, while hyperthymic temperament may have a protective role in the risk of depression in PD patients.
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Affiliation(s)
- Bilge Dogan
- Department of Psychiatry, Adnan Menderes University, Aydin, Turkey
| | - Ali Akyol
- Department of Neurology, Adnan Menderes University, Aydin, Turkey
| | - Cagdas O Memis
- Department of Psychiatry, Adnan Menderes University, Aydin, Turkey
| | - Ahmet Sair
- Department of Neurology, Adnan Menderes University, Aydin, Turkey
| | - Utku Akyildiz
- Department of Neurology, Adnan Menderes University, Aydin, Turkey
| | - Levent Sevincok
- Department of Psychiatry, Adnan Menderes University, Aydin, Turkey
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Randver R. Repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex to alleviate depression and cognitive impairment associated with Parkinson's disease: A review and clinical implications. J Neurol Sci 2018; 393:88-99. [PMID: 30149227 DOI: 10.1016/j.jns.2018.08.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/20/2018] [Accepted: 08/12/2018] [Indexed: 12/18/2022]
Abstract
The rapid methodological development and growing availability of neuromodulation techniques have spurred myriad studies investigating their clinical effectiveness. Repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) has in many instances been proven to exert antidepressant-like effects superior to placebo and equivalent to standard psychopharmacological treatment. Due to the similar neuroanatomy and neurophysiology of executive and affective control processes, rTMS to the DLPFC may be able to address multiple issues simultaneously. This review pools available literature on the therapeutic usage of rTMS on non-motor symptoms of Parkinson's disease associated with the DLPFC (i.e. mood disturbance and cognitive impairment). To the best of the author's knowledge, it is one of the few available of its' kind, up to this date. Most studies included in the review found beneficial effects of high frequency prefrontal rTMS on PD-related depression. In regard to the usability of rTMS to alleviate cognitive impairment associated with PD, definitive claims are yet to be established.
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Affiliation(s)
- René Randver
- Institute of Psychology, University of Tartu, Näituse 2-211, 50409 Tartu, Estonia; Neurology Center, East Tallinn Central Hospital, Ravi 18, 10138 Tallinn, Estonia.
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Abstract
Parkinson disease (PD) is a progressive neurodegenerative disease that affects one million people in the United States. This article reviews the etiology and pathophysiology of PD, risk factors, clinical manifestations, diagnostic criteria, and treatment of this common disease. Implications for home care clinicians are included.
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The interplay between inflammation, oxidative stress, DNA damage, DNA repair and mitochondrial dysfunction in depression. Prog Neuropsychopharmacol Biol Psychiatry 2018; 80:309-321. [PMID: 28669580 DOI: 10.1016/j.pnpbp.2017.06.036] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/05/2017] [Accepted: 06/29/2017] [Indexed: 12/13/2022]
Abstract
A growing body of evidence suggests that inflammation, mitochondrial dysfunction and oxidant-antioxidant imbalance may play a significant role in the development and progression of depression. Elevated levels of reactive oxygen and nitrogen species - a result of oxidant-antioxidant imbalance - may lead to increased damage of biomolecules, including DNA. This was confirmed in depressed patients in a research study conducted by our team and other scientists. 8-oxoguanine - a marker of oxidative DNA damage - was found in the patients' lymphocytes, urine and serum. These results were confirmed using a comet assay on lymphocytes. Furthermore, it was shown that the patients' cells repaired peroxide-induced DNA damage less efficiently than controls' cells and that some single nucleotide polymorphisms (SNP) of the genes involved in oxidative DNA damage repair may modulate the risk of depression. Lastly, less efficient DNA damage repair observed in the patients can be, at least partly, attributed to the presence of specific SNP variants, as it was revealed through a genotype-phenotype analysis. In conclusion, the available literature shows that both oxidative stress and less efficient DNA damage repair may lead to increased DNA damage in depressed patients. A similar mechanism may result in mitochondrial dysfunction, which is observed in depression.
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Toomsoo T, Randver R, Liepelt-Scarfone I, Kadastik-Eerme L, Asser T, Rubanovits I, Berg D, Taba P. Prevalence of depressive symptoms and their association with brainstem raphe echogenicity in patients with Parkinson's disease and non-PD controls. Psychiatry Res Neuroimaging 2017; 268:45-49. [PMID: 28865346 DOI: 10.1016/j.pscychresns.2017.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/13/2017] [Accepted: 08/15/2017] [Indexed: 10/19/2022]
Abstract
Despite advances in diagnostics and clinical recognition, depressive symptoms in Parkinson's disease (PD) exceeding normal limits remain effectively untreated. In this study, we report on the prevalence and severity of depressive symptoms as well as their association with brainstem raphe echogenicity in patients with PD and non-PD controls. The study included 266 Estonian PD patients and 168 age- and education-matched controls. Demographic and clinical data was documented. Brainstem raphe (BR) was visualized by transcranial sonography (TCS). The prevalence of depressive symptoms in the patient sample was found to be significantly higher than in controls. BR echogenicity in both patients and controls was directly related to their total BDI score, although we found a significantly greater reduction of BR echogenicity in patients with PD and depressive symptoms compared to depressed non-PD controls. The present results corroborate the hypothesis that morphological alteration of the BR is involved in the pathogenesis of depressive disorders. TCS of BR could be used as a non-invasive biomarker to improve detection of depressive symptoms in early PD stages where clinicians may not recognize affective disturbances in the context of PD phenomena.
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Affiliation(s)
- Toomas Toomsoo
- Neurology Center, East Tallinn Central Hospital, Ravi 18, 10138 Tallinn, Estonia
| | - René Randver
- Neurology Center, East Tallinn Central Hospital, Ravi 18, 10138 Tallinn, Estonia; Institute of Psychology, University of Tartu, Näituse 2-211, 50409 Tartu, Estonia.
| | - Inga Liepelt-Scarfone
- Department of Neurodegeneration, German Center of Neurodegenerative Diseases and Hertie Institute of Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Liis Kadastik-Eerme
- Department of Neurology and Neurosurgery, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia
| | - Toomas Asser
- Department of Neurology and Neurosurgery, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia
| | - Inna Rubanovits
- Neurology Center, East Tallinn Central Hospital, Ravi 18, 10138 Tallinn, Estonia
| | - Daniela Berg
- Department of Neurodegeneration, German Center of Neurodegenerative Diseases and Hertie Institute of Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany; Department of Neurology, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Pille Taba
- Department of Neurology and Neurosurgery, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia
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31
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Wiesli D, Meyer A, Fuhr P, Gschwandtner U. Influence of Mild Cognitive Impairment, Depression, and Anxiety on the Quality of Life of Patients with Parkinson Disease. Dement Geriatr Cogn Dis Extra 2017; 7:297-308. [PMID: 29118782 PMCID: PMC5662998 DOI: 10.1159/000478849] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/19/2017] [Indexed: 01/03/2023] Open
Abstract
Background Neuropsychiatric symptoms (NPS) and mild cognitive impairment (MCI) are common in Parkinson disease (PD) and have a negative impact on the patient's quality of life (QoL). We aim to describe the effect of NPS and MCI on each other and on QoL. Methods Sixteen MCI and 37 non-MCI PD patients completed different self-assessment questionnaires including the Parkinson's Disease Questionnaire (PDQ-39), the Beck Depression Inventory (BD), the Beck Anxiety Inventory (BAI), and the Self-Report Manic Inventory (SRMI). Linear regression with stepwise elimination was used to select the significant predictors of QoL and to control for confounding factors. Results The significant linear regression model (R2 = 0.68, p ≤ 0.01) revealed significant effects of MCI (p = 0.03), BDI (p ≤ 0.01), BAI (p ≤ 0.01), age (p = 0.03), a trend of SRMI (p = 0.06), and disease duration (p = 0.08) on QoL. Conclusions MCI, anxiety, depression, and age decrease QoL in patients with PD. NPS has the main influence in the prediction of QoL in patients with PD, whereas MCI is only of minor importance.
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Affiliation(s)
- Daniel Wiesli
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Antonia Meyer
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Peter Fuhr
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Ute Gschwandtner
- Department of Neurology, University Hospital Basel, Basel, Switzerland
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Abstract
Apart from the typical motor symptoms, Parkinson's disease is characterized by a wide range of different non-motor symptoms, which are highly prevalent in all stages of the disease and have an incisive influence on quality of life. Moreover, their treatment continues to be challenging. In this review, we critically summarize the evidence for the impact of dopaminergic therapies on non-motor symptoms in Parkinson's disease. We performed a PubMed search to identify relevant clinical studies that investigated the response of non-motor symptoms to dopaminergic therapy. In the domain of neuropsychiatric disturbances, there is increasing evidence that dopamine agonists can ameliorate depression or anxiety. Other neuropsychiatric symptoms such as psychosis or impulse control disorders can also be worsened or even be induced by dopaminergic agents. For the treatment of sleep disturbances, it is essential to identify different subtypes of sleep pathologies. While there is for example profound evidence for the effectiveness of dopaminergic medication for the treatment of restless legs syndrome and sleep fragmentation, evidence for an improvement of rapid eye movement sleep behavior disorder is lacking. With regard to the broad spectrum of autonomic disturbances, response to dopaminergic treatment seems to differ largely, with on the one hand, some evidence for an improvement of sexual function or sweating with dopaminergic treatment, while on the other hand, constipation can be worsened. Finally, the analysis of sensory deficits reveals that some forms of pain, in particular fluctuation-dependent dystonic pain, can be well addressed by adapting the dopaminergic therapy, while no effect has been seen so far for hyposmia or visual deficits. Moreover, the occurrence of non-motor fluctuations is gaining increased attention, as they can be specifically addressed by a more continuous dopaminergic intake. Taken together, there is evidence of a good response of some (but not all) non-motor symptoms to dopaminergic therapy, which must be individually adapted to the special spectrum of symptoms.
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Affiliation(s)
- Eva Schaeffer
- Department of Neurology, Christians-Albrechts University, Arnold-Heller-Str. 3, Haus 41, Kiel, 24105, Germany.
| | - Daniela Berg
- Department of Neurology, Christians-Albrechts University, Arnold-Heller-Str. 3, Haus 41, Kiel, 24105, Germany
- Department of Neurodegeneration, Hertie-Institute of Clinical Brain Research, Tuebingen, Germany
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Sharma A, Gerbarg P, Bottiglieri T, Massoumi L, Carpenter LL, Lavretsky H, Muskin PR, Brown RP, Mischoulon D. S-Adenosylmethionine (SAMe) for Neuropsychiatric Disorders: A Clinician-Oriented Review of Research. J Clin Psychiatry 2017; 78:e656-e667. [PMID: 28682528 PMCID: PMC5501081 DOI: 10.4088/jcp.16r11113] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/12/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE A systematic review on S-adenosylmethionine (SAMe) for treatment of neuropsychiatric conditions and comorbid medical conditions. DATA SOURCES Searches were conducted in PubMed, EMBASE, PsycINFO, Cochrane Library, CINAHL, and Google Scholar databases between July 15, 2015, and September 28, 2016, by combining search terms for SAMe (s-adenosyl methionine or s-adenosyl-l-methionine) with terms for relevant disease states (major depressive disorder, MDD, depression, perinatal depression, human immunodeficiency virus, HIV, Parkinson's, Alzheimer's, dementia, anxiety, schizophrenia, psychotic, 22q11.2, substance abuse, fibromyalgia, osteoarthritis, hepatitis, or cirrhosis). Additional studies were identified from prior literature. Ongoing clinical trials were identified through clinical trial registries. STUDY SELECTION Of the 174 records retrieved, 21 were excluded, as they were not original investigations. An additional 21 records were excluded for falling outside the scope of this review. Of the 132 studies included in this review, 115 were clinical trials and 17 were preclinical studies. DATA EXTRACTION A wide range of studies was included in this review to capture information that would be of interest to psychiatrists in clinical practice. RESULTS This review of SAMe in the treatment of major depressive disorder found promising but limited evidence of efficacy and safety to support its use as a monotherapy and as an augmentation for other antidepressants. Additionally, preliminary evidence suggests that SAMe may ameliorate symptoms in certain neurocognitive, substance use, and psychotic disorders and comorbid medical conditions. CONCLUSIONS S-adenosylmethionine holds promise as a treatment for multiple neuropsychiatric conditions, but the body of evidence has limitations. The encouraging findings support further study of SAMe in both psychiatric and comorbid medical illnesses.
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Affiliation(s)
- Anup Sharma
- Department of Psychiatry, University of Pennsylvania School of Medicine, 10th Floor Gates Bldg, 3400 Spruce St, Philadelphia, PA 19104.
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Patricia Gerbarg
- Department of Psychiatry, New York Medical College, Vahalla, New York, USA
| | - Teodoro Bottiglieri
- Institute of Metabolic Disease, Baylor Research Institute, Dallas, Texas, USA
| | - Lila Massoumi
- Department of Psychiatry, Michigan State University, East Lansing, Michigan, USA
| | - Linda L Carpenter
- Butler Hospital, Brown Department of Psychiatry and Human Behavior, Providence, Rhode Island, USA
| | - Helen Lavretsky
- Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
| | | | | | - David Mischoulon
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Plasma levels of miR-137 and miR-124 are associated with Parkinson's disease but not with Parkinson's disease with depression. Neurol Sci 2017; 38:761-767. [PMID: 28181066 DOI: 10.1007/s10072-017-2841-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/03/2017] [Indexed: 12/14/2022]
Abstract
MicroRNAs (miRNAs) are a class of small, non-coding RNAs that regulate gene expression at the post-transcriptional level. Recently, it was reported that miR-137, miR-124, and miR-184 were widely expressed in the central nervous system and were vital to neuronal regulation. In this study, we detected the circulating levels of miR-137, miR-124, and miR-184 in PD patients, and explored the potential role of miR-124, miR-137, and miR-184 in the diagnosis of PD. We further described the relationship between these miRNAs and PD with depression (PD-Dep). The study recruited 60 controls and 60 PD patients, which were further divided into two subgroups, PD with depression (PD-Dep, n = 24) and non-depressed group (PD-NDep, n = 36) according to Hamilton Rating Scale for Depression. Plasma levels of miR-137, miR-124, and miR-184 were detected by qRT-PCR. Receiver-operating characteristic (ROC) curve was used to evaluate miR-124 and miR-137 levels as potential diagnostic biomarkers for PD. The results demonstrated that there were no significant differences in levels of miR-184 between PD patients and controls (p > 0.05). However, miR-137 levels were increased significantly for PD patients compared to controls (p < 0.05), while miR-124 levels were down-regulated (p < 0.05). The areas under the ROC curve (AUC) of miR-137 and miR-124 were 0.707 (95% CI 0.615-0.789, p < 0.05) and 0.709 (95% CI 0.618-0.633, p < 0.05), respectively. Correlation analysis revealed that there was no relationship between these two miRNAs levels and UPDRS scores or H&Y stage. There were no significant differences in miR-137 and miR-124 levels between PD-Dep and PD-NDep (p > 0.05). Thus, plasma levels of miR-137 and miR-124 are associated with Parkinson's disease and might be potential biomarkers of the diagnosis of PD. There were no associations of plasma miR-137 and miR-124 with the severity of PD motor symptoms or PD-Dep.
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Herzallah MM, Khdour HY, Taha AB, Elmashala AM, Mousa HN, Taha MB, Ghanim Z, Sehwail MM, Misk AJ, Balsdon T, Moustafa AA, Myers CE, Gluck MA. Depression Reduces Accuracy While Parkinsonism Slows Response Time for Processing Positive Feedback in Patients with Parkinson's Disease with Comorbid Major Depressive Disorder Tested on a Probabilistic Category-Learning Task. Front Psychiatry 2017; 8:84. [PMID: 28659830 PMCID: PMC5466983 DOI: 10.3389/fpsyt.2017.00084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 04/28/2017] [Indexed: 02/05/2023] Open
Abstract
Major depressive disorder (MDD) is the most common non-motor manifestation of Parkinson's disease (PD) affecting 50% of patients. However, little is known about the cognitive correlates of MDD in PD. Using a computer-based cognitive task that dissociates learning from positive and negative feedback, we tested four groups of subjects: (1) patients with PD with comorbid MDD, (2) patients with PD without comorbid MDD, (3) matched patients with MDD alone (without PD), and (4) matched healthy control subjects. Furthermore, we used a mathematical model of decision-making to fit both choice and response time data, allowing us to detect and characterize differences between the groups that are not revealed by cognitive results. The groups did not differ in learning accuracy from negative feedback, but the MDD groups (PD patients with MDD and patients with MDD alone) exhibited a selective impairment in learning accuracy from positive feedback when compared to the non-MDD groups (PD patients without MDD and healthy subjects). However, response time in positive feedback trials in the PD groups (both with and without MDD) was significantly slower than the non-PD groups (MDD and healthy groups). While faster response time usually correlates with poor learning accuracy, it was paradoxical in PD groups, with PD patients with MDD having impaired learning accuracy and PD patients without MDD having intact learning accuracy. Mathematical modeling showed that both MDD groups (PD with MDD and MDD alone) were significantly slower than non-MDD groups in the rate of accumulation of information for stimuli trained by positive feedback, which can lead to lower response accuracy. Conversely, modeling revealed that both PD groups (PD with MDD and PD alone) required more evidence than other groups to make responses, thus leading to slower response times. These results suggest that PD patients with MDD exhibit cognitive profiles with mixed traits characteristic of both MDD and PD, furthering our understanding of both PD and MDD and their often-complex comorbidity. To the best of our knowledge, this is the first study to examine feedback-based learning in PD with MDD while controlling for the effects of PD and MDD.
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Affiliation(s)
- Mohammad M Herzallah
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Palestine.,Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, NJ, United States
| | - Hussain Y Khdour
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Palestine.,Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, NJ, United States
| | - Ahmad B Taha
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Palestine
| | - Amjad M Elmashala
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Palestine
| | - Hamza N Mousa
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Palestine
| | - Mohamad B Taha
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Palestine
| | - Zaid Ghanim
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Palestine
| | - Mahmud M Sehwail
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Palestine
| | - Adel J Misk
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Palestine
| | - Tarryn Balsdon
- School of Social Sciences and Psychology, Marcs Institute for Brain and Behavior, Western Sydney University, Sydney, NSW, Australia
| | - Ahmed A Moustafa
- School of Social Sciences and Psychology, Marcs Institute for Brain and Behavior, Western Sydney University, Sydney, NSW, Australia
| | - Catherine E Myers
- Department of Veterans Affairs, VA New Jersey Health Care System, East Orange, NJ, United States.,Department of Physiology, Pharmacology and Neuroscience, New Jersey Medical School, Rutgers University, Newark, NJ, United States
| | - Mark A Gluck
- Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, NJ, United States
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Call to Caution with the Use of Atypical Antipsychotics for Treatment of Depression in Older Adults. Geriatrics (Basel) 2016; 1:geriatrics1040033. [PMID: 31022826 PMCID: PMC6371141 DOI: 10.3390/geriatrics1040033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 11/30/2022] Open
Abstract
Atypical antipsychotics are increasingly being used to manage depression in older adults where these symptoms can often be refractory to first-line treatment with selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs). Unfortunately, atypical antipsychotics can be associated with the development of extrapyramidal symptoms (EPS), with drug-induced parkinsonism (DIP) being the most common movement disorder induced by this class of medication. The management of treatment-resistant depression in older adults is of particular concern as depression is a common feature of idiopathic Parkinson’s disease (IPD) and can manifest prior to the development of motor symptoms. Herein, we discuss the use of atypical antipsychotics for the management of depression in older adults including the risk of DIP and propose that antipsychotics may potentially unmask IPD.
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Shadfar S, Kim YG, Katila N, Neupane S, Ojha U, Bhurtel S, Srivastav S, Jeong GS, Park PH, Hong JT, Choi DY. Neuroprotective Effects of Antidepressants via Upregulation of Neurotrophic Factors in the MPTP Model of Parkinson’s Disease. Mol Neurobiol 2016; 55:554-566. [DOI: 10.1007/s12035-016-0342-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 12/02/2016] [Indexed: 12/23/2022]
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Hanganu A, Bruneau MA, Degroot C, Bedetti C, Mejia-Constain B, Lafontaine AL, Chouinard S, Monchi O. Depressive symptoms in Parkinson's disease correlate with cortical atrophy over time. Brain Cogn 2016; 111:127-133. [PMID: 27918935 DOI: 10.1016/j.bandc.2016.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/25/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Depressive symptoms are very common in patients with Parkinson's disease (PD) and have a significant impact on the quality of life. METHODS The present study analyzed the correlations between over-time changes in depressive symptoms and gray matter parameters of cortical thickness and subcortical volumes in non-demented PD patients. RESULTS A significant correlation was observed, between increased scores for depression over time and lower cortical thickness over time in the right temporo-parietal junction, right occipital medial region, right dorsolateral prefrontal cortex, right posterior cingulate region, left middle temporal as well as left supplementary motor area. Furthermore, the presence of depressive symptoms at baseline predicted increased cortical thinning over time in the left middle temporal, left anterior cingulate, right posterior cingulate and right parahippocampal cortices. Finally, a statistically significant negative correlation has been revealed between the thalamus' volume changes over time and the change in depressive symptoms scores. All other analyzed subcortical structures didn't reveal any significant correlations. CONCLUSION These results suggest that depressive symptoms in PD patients are associated with gray matter cortical thinning and thalamus volume shrinkage over time and higher scores of depressive symptoms at baseline correlate with a higher rate of cortical thinning longitudinally. The present study highlights the importance of addressing depressive symptoms in PD patients early in the disease.
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Affiliation(s)
- Alexandru Hanganu
- Department of Clinical Neurosciences and Department of Radiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, AB, Canada; Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada.
| | - Marie-Andrée Bruneau
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada.
| | - Clotilde Degroot
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada; Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada.
| | - Christophe Bedetti
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré Cœur de Montréal, Montréal, QC, Canada.
| | - Béatriz Mejia-Constain
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada.
| | - Anne-Louise Lafontaine
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada; Movement Disorders Unit, McGill University Health Centre, Montréal, QC, Canada.
| | - Sylvain Chouinard
- Unité des troubles du mouvement André Barbeau, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
| | - Oury Monchi
- Department of Clinical Neurosciences and Department of Radiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, AB, Canada; Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada; Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada.
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Borgonovo J, Allende-Castro C, Laliena A, Guerrero N, Silva H, Concha ML. Changes in neural circuitry associated with depression at pre-clinical, pre-motor and early motor phases of Parkinson's disease. Parkinsonism Relat Disord 2016; 35:17-24. [PMID: 27889469 DOI: 10.1016/j.parkreldis.2016.11.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/08/2016] [Accepted: 11/18/2016] [Indexed: 12/17/2022]
Abstract
Although Parkinson's Disease (PD) is mostly considered a motor disorder, it can present at early stages as a non-motor pathology. Among the non-motor clinical manifestations, depression shows a high prevalence and can be one of the first clinical signs to appear, even a decade before the onset of motor symptoms. Here, we review the evidence of early dysfunction in neural circuitry associated with depression in the context of PD, focusing on pre-clinical, pre-motor and early motor phases of the disease. In the pre-clinical phase, structural and functional changes in the substantia nigra, basal ganglia and limbic structures are already observed. Some of these changes are linked to motor compensation mechanisms while others correspond to pathological processes common to PD and depression and thus could underlie the appearance of depressive symptoms during the pre-motor phase. Studies of the early motor phase (less than five years post diagnosis) reveal an association between the extent of damage in different monoaminergic systems and the appearance of emotional disorders. We propose that the limbic loop of the basal ganglia and the lateral habenula play key roles in the early genesis of depression in PD. Alterations in the neural circuitry linked with emotional control might be sensitive markers of the ongoing neurodegenerative process and thus may serve to facilitate an early diagnosis of this disease. To take advantage of this, we need to improve the clinical criteria and develop biomarkers to identify depression, which could be used to determine individuals at risk to develop PD.
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Affiliation(s)
- Janina Borgonovo
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile; Center for Geroscience, Brain Health and Metabolism, Santiago, Chile
| | - Camilo Allende-Castro
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile; Center for Geroscience, Brain Health and Metabolism, Santiago, Chile
| | - Almudena Laliena
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile
| | - Néstor Guerrero
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile
| | - Hernán Silva
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile
| | - Miguel L Concha
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile; Center for Geroscience, Brain Health and Metabolism, Santiago, Chile.
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Aerobic Exercise Improves Mood, Cognition, and Language Function in Parkinson's Disease: Results of a Controlled Study. J Int Neuropsychol Soc 2016; 22:878-889. [PMID: 27655232 DOI: 10.1017/s135561771600076x] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Parkinson's disease (PD) results in a range of non-motor deficits that can affect mood, cognition, and language, and many of these issues are unresponsive to pharmacological intervention. Aerobic exercise can improve mood and cognition in healthy older adults, although only a few studies have examined exercise effects on these domains in PD. The current study assesses the effects of aerobic exercise on aspects of cognition, mood, and language production in people with PD. METHODS This study compares the effects of aerobic exercise to stretch-balance training and a no-contact control group in participants with idiopathic PD. The aerobic and stretch-balance groups trained three times a week for 16 weeks, while controls continued normal activities. Outcome measures included disease severity, mood, cognition (speed of processing, memory, and executive function), and language production (picture descriptions). Cognition and language were assessed in single and dual task conditions. RESULTS Depressive symptoms increased only in the control group (p<.02). Executive function improved in the aerobic exercise group only in the single task (p=.007) and declined in controls in the dual task. Completeness of picture descriptions improved significantly more in the aerobic group than in the stretch-balance group (p<.02). CONCLUSIONS Aerobic exercise is a viable intervention for PD that can be protective against increased depressive symptoms, and can improve several non-motor domains, including executive dysfunction and related aspects of language production. (JINS, 2016, 22, 878-889).
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Increased suicide risk and clinical correlates of suicide among patients with Parkinson's disease. Parkinsonism Relat Disord 2016; 32:102-107. [PMID: 27637284 DOI: 10.1016/j.parkreldis.2016.09.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/19/2016] [Accepted: 09/05/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is a debilitating, neurodegenerative condition frequently complicated by psychiatric symptoms. Patients with PD may be at higher risk for suicide than the general population, but previous estimates are limited and conflicting. The aim of this study is to estimate the suicide rate based on the clinical case registry and to identify risk factors for suicide among patients diagnosed with PD. METHODS The target sample consisted of 4362 patients diagnosed with PD who were evaluated at a general hospital in Seoul, South Korea, from 1996 to 2012. The standardized mortality ratio for suicide among PD patients was estimated. In order to identify the clinical correlates of suicide, case-control study was conducted based on retrospective chart review. The 29 suicide cases (age: 62.3 ± 13.7 years; females: 34.5%) were matched with 116 non-suicide controls (age: 63.5 ± 9.2 years; females 56.9%) by the year of initial PD evaluation. RESULTS The SMR for suicide in PD patients was 1.99 (95% CI 1.33-2.85). Mean duration from time of initial diagnosis to suicide among cases was 6.1 ± 3.5 years. Case-control analysis revealed that male, initial extremity of motor symptom onset, history of depressive disorder, delusion, any psychiatric disorder, and higher L-dopa dosage were significantly associated with suicide among PD patients. Other PD-related variables such as UPDRS motor score were not significantly associated with death by suicide. CONCLUSION Suicide risk in PD patients is approximately 2 times higher than that in the general population. Psychiatric disorders, and also L-dopa medication need further attention with respect to suicide.
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Neurochemical correlation between major depressive disorder and neurodegenerative diseases. Life Sci 2016; 158:121-9. [DOI: 10.1016/j.lfs.2016.06.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/14/2016] [Accepted: 06/27/2016] [Indexed: 12/13/2022]
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Rana AQ, Qureshi ARM, Mumtaz A, Abdullah I, Jesudasan A, Hafez KK, Rana MA. Associations of pain and depression with marital status in patients diagnosed with Parkinson's disease. Acta Neurol Scand 2016; 133:276-80. [PMID: 26147247 DOI: 10.1111/ane.12454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Depression and pain are significant clinical problems that are comorbid with Parkinson's disease (PD). However, the relationship of these variables with the marital status of patients with PD has not been explored in previous studies. Therefore, the goal of this study was to assess the possible relationship between depression prevalence, depression severity, and pain interference with the marital status of the sufferers of PD. METHODS This study included 40 patients and 40 healthy control participants who were assessed for depression prevalence and severity using The Hospital Anxiety and Depression Scale (HADS). The same individuals were also assessed for pain interference using the Brief Pain Inventory (BPI). RESULTS When compared to the control groups, the PD (Single) group was found to have the highest prevalence of depression, followed by the PD (Married) group whereas the Control (Single) group was found to have a higher prevalence than the Control (Married) group (P < 0.0001). A main effect was found on depression severity (P < 0.0001), but no significant differences were observed between the PD groups. Lastly, PD (Single) patients had significantly greater pain interference scores than the PD (Married) patients (P < 0.05) with no other significant case-control or control-control group differences. CONCLUSION Patient-spouse relationship, which indicates physical and emotional support may have a mitigating effect on patient outcomes of depression prevalence and pain interference.
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Affiliation(s)
- A. Q. Rana
- Parkinson's Clinic of Eastern Toronto & Movement Disorders Centre; Toronto ON Canada
| | | | - A. Mumtaz
- University of Toronto at Scarborough; Toronto ON Canada
| | - I. Abdullah
- Parkinson's Clinic of Eastern Toronto & Movement Disorders Centre; Toronto ON Canada
- University of Toronto at Scarborough; Toronto ON Canada
| | - A. Jesudasan
- Faculty of Medicine; University of Ottawa; Ottawa ON Canada
| | - K. K. Hafez
- Department of Family Medicine; University of Calgary; Calgary AB Canada
| | - M. A. Rana
- Faculty of Medicine and Dentistry; James Cook University; Townsville Qld Australia
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Abstract
BACKGROUND Assessing anxiety in Parkinson's disease (PD) has been a recent focus, and a number of studies have extensively investigated the validity of anxiety rating scales in PD. The present review aims to provide an overview of anxiety scales widely used and/or validated in PD, and to highlight recommendations for future research required in this area. METHODS A literature search was performed using terms such as Parkinson* disease, psychiatric, depress*, anxiety, assessment, scales, and valid* in PsycInfo, PubMed, and Web of Science databases. Validation studies and reviews focussed on assessment of anxiety in PD were included. RESULTS The literature search identified nine anxiety rating scales. The new Parkinson's Anxiety Scale (PAS) showed good psychometric properties. Having a simple design appropriate for older adults and items focussed on cognitive anxiety, the Geriatric Anxiety Inventory (GAI) also appeared promising for use in PD. The Beck Anxiety Inventory (BAI), Hospital Anxiety and Depression Scale, and Hamilton Anxiety Rating Scale (HAM-A) did not demonstrate satisfactory psychometric characteristics when used in PD, while other scales had limited or no evidence of validity or reliability to infer judgments. CONCLUSIONS PAS and GAI are can be recommended for use in PD without dementia. Usefulness of these scales to assess anxiety in dementia should be examined in the future. Moreover, the complex symptomatology of anxiety relating to "off" PD medication states were not addressed in these scales. Further research is required to develop an anxiety scale tailored for PD.
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Podurgiel SJ, Milligan MN, Yohn SE, Purcell LJ, Contreras-Mora HM, Correa M, Salamone JD. Fluoxetine Administration Exacerbates Oral Tremor and Striatal Dopamine Depletion in a Rodent Pharmacological Model of Parkinsonism. Neuropsychopharmacology 2015; 40:2240-7. [PMID: 25759301 PMCID: PMC4613615 DOI: 10.1038/npp.2015.69] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/15/2015] [Accepted: 01/31/2015] [Indexed: 02/06/2023]
Abstract
The cardinal motor symptoms of Parkinson's disease (PD) include resting tremor, akinesia, bradykinesia, and rigidity, and these motor abnormalities can be modeled in rodents by administration of the VMAT-2 (type-2 vesicular monoamine transporter) inhibitor tetrabenazine (9,10-dimethoxy-3-(2-methylpropyl)-1,3,4,6,7, 11b hexahydrobenzo[a]quinolizin-2-one; TBZ). Depression is also commonly associated with PD, and clinical data indicate that selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine ((±)-N-methyl-γ-[4-(trifluoromethyl)phenoxy]benzenepropanamine hydrochloride; FLX) are frequently used to treat depression in PD patients. The aim of the present study was to characterize the effect of FLX on the motor dysfunctions induced by a low dose of TBZ (0.75 mg/kg), and investigate the neural mechanisms involved. This low dose of TBZ was selected based on studies with rat models of depressive symptoms. In rats, coadministration of FLX (2.5, 5.0, and 10.0 mg/kg) increased TBZ-induced oral tremor (tremulous jaw movements), and decreased locomotor activity compared with administration of TBZ alone. Coadministration of the serotonin 5-HT2A/2C antagonist mianserin (2.5 and 5.0 mg/kg) attenuated the increase in oral tremor induced by coadministration of TBZ (0.75 mg/kg) with FLX (5.0 mg/kg). Consistent with these behavioral data, coadministration of TBZ and FLX decreased DA tissue levels in the rat ventrolateral neostriatum compared with TBZ alone, and coadministration of mianserin with TBZ and FLX attenuated this effect, increasing DA tissue levels compared with the TBZ/FLX condition. These data suggest that SSRI administration in PD patients may result in worsening of motor symptoms, at least in part, by exacerbating existing DA depletions through 5-HT2A/2C-mediated modulation of DA neurotransmission.
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Affiliation(s)
| | | | - Samantha E Yohn
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Laura J Purcell
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | | | - Mercè Correa
- Àrea de Psicobiologia, Universitat Jaume I, Castelló, Spain
| | - John D Salamone
- Department of Psychology, University of Connecticut, Storrs, CT, USA
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Moretti M, Neis VB, Matheus FC, Cunha MP, Rosa PB, Ribeiro CM, Rodrigues ALS, Prediger RD. Effects of Agmatine on Depressive-Like Behavior Induced by Intracerebroventricular Administration of 1-Methyl-4-phenylpyridinium (MPP(+)). Neurotox Res 2015; 28:222-31. [PMID: 26156429 DOI: 10.1007/s12640-015-9540-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 06/26/2015] [Accepted: 07/01/2015] [Indexed: 12/21/2022]
Abstract
Considering that depression is a common non-motor comorbidity of Parkinson's disease and that agmatine is an endogenous neuromodulator that emerges as a potential agent to manage diverse central nervous system disorders, this study investigated the antidepressant-like effect of agmatine in mice intracerebroventricularly (i.c.v.) injected with the dopaminergic neurotoxin 1-methyl-4-phenylpyridinium (MPP(+)). Male C57BL6 mice were treated with agmatine (0.0001, 0.1 or 1 mg/kg) and 60 min later the animals received an i.c.v. injection of MPP(+) (1.8 µg/site). Twenty-four hours after MPP(+) administration, immobility time, anhedonic behavior, and locomotor activity were evaluated in the tail suspension test (TST), splash test, and open field test, respectively. Using Western blot analysis, we investigated the putative modulation of MPP(+) and agmatine on striatal and frontal cortex levels of tyrosine hydroxylase (TH) and brain-derived neurotrophic factor (BDNF). MPP(+) increased the immobility time of mice in the TST, as well as induced an anhedonic-like behavior in the splash test, effects which were prevented by pre-treatment with agmatine at the three tested doses. Neither drug, alone or in combination, altered the locomotor activity of mice. I.c.v. administration of MPP(+) increased the striatal immunocontent of TH, an effect prevented by the three tested doses of agmatine. MPP(+) and agmatine did not alter the immunocontent of BDNF in striatum and frontal cortex. These results demonstrate for the first time the antidepressant-like effects of agmatine in an animal model of depressive-like behavior induced by the dopaminergic neurotoxin MPP(+).
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Affiliation(s)
- Morgana Moretti
- Department of Pharmacology, Center of Biological Sciences, Universidade Federal de Santa Catarina, Florianópolis, SC, 88049-900, Brazil,
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Kadastik-Eerme L, Rosenthal M, Paju T, Muldmaa M, Taba P. Health-related quality of life in Parkinson's disease: a cross-sectional study focusing on non-motor symptoms. Health Qual Life Outcomes 2015; 13:83. [PMID: 26088201 PMCID: PMC4474578 DOI: 10.1186/s12955-015-0281-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 06/06/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The objective of this study was to investigate factors affecting health-related quality of life (HRQoL) among Estonian persons with Parkinson's disease (PD). METHODS 268 persons with PD were evaluated using: the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS); the Hoehn and Yahr scale (HY); the Schwab and England Activities of Daily Living scale (SE-ADL); the Beck Depression Inventory (BDI); the Mini Mental State Examination (MMSE); the Parkinson's Disease Questionnaire (PDQ-39). Additional questions on clinical and socio-demographic variables were asked during a semi-structured interview. Predictors of HRQoL were tested using multiple regression analysis. RESULTS The main predictors of low HRQoL were depression and motor and non-motor aspects of daily living. 59.9 % of the variation in the PDQ-39 summary index (SI) score was explained by the predictive variables identified in this study. None of the socio-demographic variables (age, gender, urban/rural living, marital status, living alone/with others, education level) were significant predictors of HRQoL. Prevalence of non-motor Parkinson's symptoms were high (99.6 %); cognitive impairment, sleep and urinary problems were the most common. All non-motor symptoms correlated significantly with low HRQoL, except the features of impulse control disorders (ICDs). CONCLUSIONS Depression and motor and non-motor daily living experiences were found to be significant and independent factors of low HRQoL in persons with PD. Depression was the strongest determinant of low HRQoL. Our results highlight the importance of recognition and management of non-motor symptoms, as these features had more impact on patients' HRQoL than clinically assessed motor symptoms.
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Affiliation(s)
- Liis Kadastik-Eerme
- Department of Neurosurgery and Neurology, Tartu University Hospital, L. Puusepa 8, Tartu, 51014, Estonia.
| | - Marika Rosenthal
- Department of Neurosurgery and Neurology, Tartu University Hospital, L. Puusepa 8, Tartu, 51014, Estonia.
| | - Tiiu Paju
- Department of Neurosurgery and Neurology, Tartu University Hospital, L. Puusepa 8, Tartu, 51014, Estonia.
| | - Mari Muldmaa
- Department of Neurosurgery and Neurology, Tartu University Hospital, L. Puusepa 8, Tartu, 51014, Estonia.
| | - Pille Taba
- Department of Neurosurgery and Neurology, Tartu University Hospital, L. Puusepa 8, Tartu, 51014, Estonia.
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Dyduch A, Załuska M. Depression in Parkinson's disease: the effectiveness and risk of pharmacotherapy. Clinical review. Psychogeriatrics 2015; 15:147-153. [PMID: 25377773 DOI: 10.1111/psyg.12078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 08/28/2014] [Accepted: 09/02/2014] [Indexed: 01/16/2023]
Abstract
Parkinson's disease (PD) is a neurological disease with a heterogeneous pattern of neurological symptoms and concomitant psychiatric syndromes. These syndromes are triggered by alterations to neurotransmission that are likely common for both neurological and psychiatric symptoms. Syndromes such as depression, anxiety, or cognitive impairment can precede motor symptoms of PD and delay its diagnosis. Recently, questions related to aetiological factors and treatment strategies of depression in PD have become a growing concern of PD researchers. This article describes the main features of depression in PD and presents current hypotheses on its aetiology and recommended treatment modes.
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Affiliation(s)
| | - Maria Załuska
- IV Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
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Pistacchi M, Gioulis M, Contin F, Sanson F, Marsala SZ. Cognitive profiles in Mild Cognitive Impairment (MCI) patients associated with Parkinson's disease and cognitive disorders. Ann Indian Acad Neurol 2015; 18:200-5. [PMID: 26019419 PMCID: PMC4445197 DOI: 10.4103/0972-2327.150611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/21/2014] [Accepted: 11/20/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Mild cognitive impairment (MCI) is rapidly becoming one of the most common clinical manifestations affecting the elderly and represents an heterogeneous clinical syndrome that can be ascribed to different etiologies; the construct of MCI in Parkinson's disease (PD) (MCI-PD) is more recent but the range of deficits is still variable. Early recognition and accurate classification of MCI-PD could offer opportunities for novel therapeutic interventions to improve the natural pathologic course. OBJECTIVE To investigate the clinical phenotype of amnestic mild cognitive impairment (aMCI) and in patients with PD and MCI (MCI-PD). MATERIALS AND METHODS Seventy-three patients with aMCI and in 38 patients with MCI-PD were enrolled. They all underwent Mini-mental State Examination (MMSE), the Rey auditory-verbal learning test and the immediate visual memory (IVM) item of the Mental Deterioration Battery, the Rey auditory-verbal learning test included the Rey-immediate (Rey-I), and the delayed recall of the word list (Rey test deferred, Rey-D). The Geriatric Depression Scale (GDS) was used for mood assessment. RESULTS The results of the Rey-I and Rey-D and of the IVM item showed statistically significant differences between the aMCI and the MCI-PD group. The mean Rey-I and Rey-D score was significantly lower as well as the IVM score was higher in patients with aMCI than in those with MCI-PD, aMCI patients showed greater impairment in long-term memory, whereas more aMCI than MCI-PD patients had preserved attention, computation, praxis, and conceptualization. CONCLUSIONS Our findings demonstrate that the cognitive deficit profile is specific for each of the two disorders: Memory impairment was a typical feature in aMCI patients while MCI-PD patients suffered from executive functions and visuospatial attention deficits.
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Affiliation(s)
- Michele Pistacchi
- Neurology Service, Santorso Hospital, Garziere street 73, Santorso, Italy
| | - Manuela Gioulis
- Neurology Service, San Martino Hospital, Belluno, viale europa 22 Belluno, Italy
| | - Franco Contin
- Radiology Service, Santorso Hospital, Garziere street 73, Santorso, Italy
| | - Flavio Sanson
- Neurology Service, Santorso Hospital, Garziere street 73, Santorso, Italy
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The Quantitative Measurement of Reversible Acute Depression after Subthalamic Deep Brain Stimulation in a Patient with Parkinson Disease. Case Rep Neurol Med 2015; 2015:165846. [PMID: 26090244 PMCID: PMC4450288 DOI: 10.1155/2015/165846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 04/30/2015] [Indexed: 12/04/2022] Open
Abstract
Background. Depression is the most commonly reported mood symptom affecting 2–8% of patients after deep brain stimulation (DBS). Usually, symptoms develop gradually; however there have been cases of reproducible events that the mood symptoms were elicited within seconds to minutes after stimulation and were immediately reversible upon cessation of the stimulus. In the current study, we applied a self-reported questionnaire to assess the patient's mood state. Objective. To objectively measure the reversible acute depression induced by DBS in a patient with Parkinson disease (PD). Methods. A statistically validated Spanish version of the Beck Depression Inventory Short Form (BDI-SF) was used. The questionnaire was administered three times. Results. The patient became acutely depressed within ninety seconds of monopolar stimulation on the right side. His symptoms resolved immediately after changing the setting to bipolar stimulation. The BDI-SF scores during stimulation off, on, and off again were 15, 19, and 6, respectively. Conclusions. The BDI-SF scores increased during stimulation and decreased after cessation. This is consistent with a reversible depressive state. The poststimulation BDI-SF score decreased to less than half of the baseline score. This may suggest that the depression was more severe than the patient was able to express during the stimulation.
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