Prevalence of Obsessive-Compulsive Symptoms in Elderly Parkinson Disease Patients: A Case-Control Study

Early visual perceptual processing is altered in obsessive-compulsive disorder

OBJECTIVE

Existing studies have shown changes in attention and emotion processing of disorder-relevant visual stimuli in those with obsessive compulsive disorder (OCD). However, early visual processing in OCD has not been assessed, as previous studies did not examine the entire time course of visual processing but instead assessed potential differences in pre-determined visual evoked potentials (VEPs). This study investigates the entire visual processing stream in OCD compared to healthy age-matched controls (HC) using emotionally-neutral visual stimuli and a data-driven rather than hypothesis-driven approach.

METHODS

35 HC and 26 participants with OCD underwent EEG recording while completing a modified Eriksen flanker task. Permutation-controlled t-tests were used to identify group differences in the data's full time course of visual evoked potentials. Baseline-corrected amplitudes at time points where the groups were significantly different were analyzed using ANCOVAs with BDI, BAI, and SNAP-inattentiveness scores included as covariates.

RESULTS

This analysis identified enhanced P1 amplitudes to two visual stimuli (the initial flanker and the stimulus), corresponding to time windows of 65-93 ms and 157-187 ms post-flanker presentation in the OCD group compared to controls. Group (OCD vs. HC) was the strongest predictor of VEP amplitude during both time windows, with no significant influences of any covariates.

CONCLUSIONS

This study showed an enhanced P1 component in people with OCD to neutral visual stimuli, potentially reflecting either inefficient or excessive early visual processing in this population. Additional inquiry is necessary to determine whether altered visual processing is associated with the sensory hypervigilance observed in those with OCD.

SIGNIFICANCE

This work identifies early visual processing alterations in OCD using neutral stimuli and a data-driven approach.

Identifying psychiatric and neurological comorbidities associated with hoarding disorder through network analysis

BACKGROUND

The relationships between hoarding disorder (HD) and other neurological and psychiatric disorders remain largely unknown. Although psychiatric burden in those with HD is high, less is known about neurological disorders. Furthermore, which disorders are primarily associated with HD vs which can be better explained via a relationship with another disorder has not been determined. To address these questions, we examined comorbidity patterns of psychiatric and neurological disorders in a large online registry of adults using network analyses.

METHODS

We first examined psychiatric comorbidity among 252 participants completing clinician administered psychiatric assessments. Using the Brain Health Registry (BHR) (N = 15,978), we next analyzed prevalence of self-reported neurological and psychiatric disorders among participants with no/minimal hoarding, subclinical hoarding, and clinically significant hoarding and used network analyses to identify direct and indirect relationships between HD and the assessed psychiatric and neurological disorders.

RESULTS

The most prevalent comorbidity in clinically assessed participants with HD was major depressive disorder (MDD, 62%), followed by generalized anxiety disorder (GAD, 32%). Network analyses in the BHR indicated that the strongest direct relationships with HD were attention-deficit hyperactivity disorder (ADHD), major depressive disorder (MDD), and obsessive-compulsive disorder (OCD). The relationships between HD and neurological disorders, including mild cognitive impairment, were weak or non-existent after controlling for other disorders.

CONCLUSIONS

ADHD, MDD, and OCD form a triad of psychiatric disorders directly associated with HD. Despite their high comorbidity rates, the associations among anxiety disorders and HD were weak or indirect.

Behavioral and psychological symptoms in neurodegenerative dementias: harbinger, follower, or constant collateral?

Neurodegenerative dementias such as the behavioral variant of frontotemporal dementia, Alzheimer’s disease, and Parkinson’s disease dementia are linked to various behavioral and psychological abnormalities. Whether these abnormalities precede, coincide or follow the onset of cognitive symptoms is still controversial in existing literature, with trajectories available so far dependent on types of dementia. The authors aim to review the different kinds of premorbid behavioral symptoms/personality traits associated with an increased risk of developing specific types of neurodegenerative dementia. Neuroticism has been associated with an increased risk of Alzheimer’s disease and late-onset behavioral abnormalities with the behavioral variant of frontotemporal dementia. The presence of obsessive–compulsive spectrum disorders in Parkinson’s disease dementia is also not rare. Analyzing this evidence, we propose “behavioral biomarkers” as neuroticism in Alzheimer’s disease, late-onset behavioral abnormalities in behavioral variant of frontotemporal dementia, and obsessive–compulsive traits in Parkinson’s disease dementia. These noninvasive behavioral biomarkers will be of immense help, particularly in developing countries, and will prevent the need for costlier investigations and aid in therapeutic strategies.

Social and psychological impact of the COVID-19 pandemic on people with Parkinson's disease: a scoping review

Objectives

The COVID-19 pandemic caused countries across the globe to impose restrictions to slow the spread of the virus, with people instructed to stay at home and reduce contact with others. This reduction in social contact has the potential to negatively impact mental health and well-being. The restrictions are particularly concerning for people with existing chronic illnesses such as Parkinson's disease, who may be especially affected by concerns about the pandemic and associated reduction of social contact. The aim of this review was to synthesise published literature on the impact of the COVID-19 pandemic on the social and psychological well-being of people with Parkinson's disease.

Study design

The design of this study is a scoping review.

Methods

We searched five electronic databases for English language articles containing primary data on this topic.

Results

Thirty-one relevant studies were found and included in the review. Six main themes were identified: impact of the pandemic on physical and mental health; COVID-19 concerns; access to health care; impact on daily and social activities; impact on physical activity and impact on caregivers. Levels of perceived risk of COVID-19 differed across studies, but most participants had adopted preventive measures such as staying at home and reducing social contacts. Participants in many studies reported a discontinuation of regular healthcare appointments and physiotherapy, as well as concerns about being able to obtain medication. Loss of daily activities and social support was noted by many participants. There was mixed evidence on the impact of the pandemic on physical exercise, with some studies finding no change in physical activity and others reporting a reduction; generally, participants with reduced physical activity had poorer mental health and greater worsening of symptoms. Caregivers of people with Parkinson's disease were more likely to be negatively affected by the pandemic if they cared for people with complex needs such as additional mental health problems.

Conclusions

The COVID-19 pandemic has had negative effects on the physical and mental health of people with Parkinson's disease, perhaps due to disruption of healthcare services, loss of usual activities and supports and reduction in physical activity. We make recommendations for policy, practice and future research.

New pharmacological and neuromodulation approaches for impulsive-compulsive behaviors in Parkinson's disease

INTRODUCTION

A significant proportion of patients with Parkinson's disease (PD) display a set of impulsive-compulsive behaviors at some point during the course of illness. These behaviors range from the so-called behavioral addictions to dopamine dysregulation syndrome, punding and hoarding disorders. These behaviors have been consistently linked to the use of dopaminergic medications used to treat PD motor symptoms (dopamine agonists, levodopa, and other agents) and less consistently to neuromodulation techniques such as deep brain stimulation (DBS). Since there are still no approved treatments for these conditions, their pharmacological management is still a big challenge for clinicians.

METHODS

We conducted an extensive review of current pharmacological and neuromodulation literature for the management of impulsive-compulsive disorders in PD patients.

RESULTS

Pharmacological treatment approaches for impulsive-compulsive behaviors and DDS in PD patients include reduction of levodopa (LD), reduction/cessation of dopamine agonist (DA), and initiation of infusion therapies (apomorphine infusion and duodopa). Also, atomoxetine, a noradrenergic agent approved for the treatment of attention deficit hyperactivity disorder, showed some interesting preliminary results but there is still a lack of controlled longitudinal studies. Finally, while DBS effects on impulsive-compulsive disorders are still controversial, non-invasive techniques (such as transcranial magnetic stimulation and transcranial direct current stimulation) could have a potential positive effect but, again, there is still a lack of controlled trials.

CONCLUSION

Managing impulsivity and compulsivity in PD patients is still a non-evidence-based challenge for clinicians. Controlled trials on promising approaches such as atomoxetine and non-invasive neuromodulation techniques are needed.

COVID-19 Pandemic and Psychiatric Symptoms: The Impact on Parkinson's Disease in the Elderly

Background: The coronavirus disease 2019 (COVID-19) pandemic represents a condition of increased vulnerability and frailty for elderly patients with Parkinson's disease (PD). Social isolation may worsen the burden of the disease and specifically exacerbate psychiatric symptoms, often comorbid with PD. This study aimed at identifying risk/protective factors associated with subjective worsening of psychiatric symptomatology during the COVID-19 outbreak in a sample of individuals with PD aged 65 years or older. Methods: Patients with PD routinely followed at the outpatient clinic of Gemelli University Hospital, Rome, were assessed for subjective worsening of psychiatric symptoms through a dedicated telephone survey, after Italy COVID-19 lockdown. Patients' medical records were reviewed to collect sociodemographic and clinical data, including lifetime psychiatric symptoms and pharmacological treatment. Results: Overall, 134 individuals were assessed and 101 (75.4%) reported lifetime psychiatric symptoms. Among those, 23 (22.8%) presented with subjective worsening of psychiatric symptomatology during the COVID-19 outbreak. In this group, the most frequent symptom was depression (82.6%), followed by insomnia (52.2%). Subjective worsening of neurological symptoms (Wald = 24.03, df = 1, p = 0.001) and lifetime irritability (Wald = 6.35, df = 1, p = 0.020), together with younger age (Wald = 5.06, df = 1, p = 0.038) and female sex (Wald = 9.07 df = 1, p = 0.007), resulted as specific risk factors for ingravescence of psychiatric presentation. Lifetime pre-existing delusions, having received antipsychotics, and not having received mood stabilizer were also associated with subjective worsening of psychiatric symptomatology due to the COVID-19 pandemic. Conclusions: Individuals with PD and lifetime history of psychiatric symptoms may be exposed to increased vulnerability to the stressful effect of COVID-19 outbreak. Interventions aimed at reducing irritability and mood instability might have an indirect effect on the health of patients with PD during the COVID-19 pandemic.