Occurrence Risk and Structure of Depression in Parkinson Disease With and Without Dementia: Results From the GEPAD Study

Technische Universitaet Dresden, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany.
Journal of Geriatric Psychiatry and Neurology (Impact Factor: 2.24). 03/2010; 23(1):27-34. DOI: 10.1177/0891988709351833
Source: PubMed


This study examined the age- and gender-specific risk of depression in demented and non-demented participants, its symptom structure, and associated clinical factors in a nationwide random sample of n = 1449 outpatients with Parkinson disease (PD).
Depression ratings were based on a cross-sectional clinical assessment including the clinical Montgomery-Asberg Depression Rating Scale (MADRS > or = 14). Parkinson disease severity was rated according to Hoehn and Yahr (HY) and the Unified Parkinson's Disease Rating Scale. Diagnosis of dementia was based on Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition; DSM-IV) criteria.
25.2% (CI: 22.8-27.5) of all patients met study criteria for depression. Additionally, 8.4% of patients did not exceed the MADRS cut-off but were currently being treated with antidepressants, possibly suggesting a corrected (upper limit) total prevalence of 33.6%. Females were more likely depressive than males (29.3% vs 22.4%). In both genders, depression risk was elevated 2- to 4-fold depending on HY stage. Overall, highest rates in non-demented patients were found in females at stages IV to V (53.7%, CI: 37.7-69.6). Demented patients were more likely to meet depression criteria than non-demented (up to 76.2%, 95% CI: 60.5-87.9). Depression symptom profiles for demented PD patients (as compared to non-demented) revealed no structural differences but consistently higher symptom scores. Neither age at onset of PD nor duration of disease were significantly linked with depression.
Depression rates are already substantially elevated at early PD stages, emphasizing the need for a thorough examination of mood disorders in all patients with PD. Depression is associated with PD severity and dementia but not with age, age at onset of PD, or disease duration. The differential associations with dementia and the statistical independence of dementia and depression also suggest that depression could not be regarded as a mere demoralisation syndrome.

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    • "33% of our Parkinson’s patients developed depression. This is in line with the 25–72% range found in the literature [8], [15], [27]. Several Parkinson’s drugs are suspected to cause depression: L-dopa, amantadine, Baclofen, and bromocriptine [29]. "
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    ABSTRACT: Aim of the study: To investigate the comorbidity of Alzheimer’s/dementia, epilepsy, multiple sclerosis and Parkinson’s with depression. Methods: 42,914 patients who were newly diagnosed with the four comorbid diseases were included in the study. We analyzed how many of these patients developed depression within five years. Results: Between 21% (males with epilepsy) and 39% (women with Parkinson’s)/44% (Alzheimer’s patients under 60 years) developed depression within five years. Conclusion: We recommend routine checks for depression in patients diagnosed with one of these diseases, especially in the most comorbid ones.
    German medical science : GMS e-journal 01/2013; 11:Doc02. DOI:10.3205/000170
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    • "However, there is little research on the use of CBT in the more advanced stages of the illness. Although the duration of PD appears not to be directly related to depression severity (Riedel et al. 2010), those who have had the illness for longer are more likely to have limited physical functioning which presents a number of challenges to clinicians. The case study described here demonstrates that adaptations can be made even when there is severe physical disability. "
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    ABSTRACT: Parkinson's disease (PD) is associated with significant symptoms of depression. Cognitive behaviour therapy (CBT) has been shown to be effective for depression in PD. However, much of the previous research focuses on working with younger adults in the earlier stages of the disease, despite evidence for greater risk of depression when PD symptoms are more severe. This paper provides a case illustration of using CBT for depression with an 84-year-old man with advanced PD. The results of an assessment are described and a psychological formulation is presented. The specific adaptations made to the therapy and illustrations of the content of therapy are discussed. This intervention resulted in improvements in global mental health and moderate reductions in depression. However, there was no effect on anxiety. This case highlights the complexity of conducting CBT with this population, and further research is needed to determine the modifications necessary to make such interventions effective.
    The Cognitive Behaviour Therapist 09/2012; 5(2-3). DOI:10.1017/S1754470X12000049
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    • "Other limitations of this study relate to the generalizability of findings in a cohort of male U.S. veterans: our findings may not be generalizable to non-veterans or to women, as they were not represented in our cohort. Previous epidemiological surveys have suggested gender differences in PD; Men have been described to have earlier symptom onset [46], increased incidence of cognitive impairment [47], increased risk of pathological gambling [48] and decreased rates of depression [49]. Women have cited greater disability and lower health-related quality of life in comparison to men with PD [50]. "
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    ABSTRACT: To apply a scaled, preference-based measure to the evaluation of health-related quality of life (HRQoL) in Parkinson's disease (PD); to evaluate the relationship between disease-specific rating scales and estimated HRQoL; and to identify predictors of diminished HRQoL. Scaled, preference-based measures of HRQoL ("utilities") serve as indices of impact of disease, and can be used to generate quality-adjusted estimates of survival for health-economic evaluations. Evaluation of utilities for PD and their correlation with standard rating scales have been limited. Utilities were generated using the Health Utilities Index Mark III (HUI-III) on consecutive patients attending a PD Clinic between October 2003 and June 2006. Disease severity, medical, surgical (subthalamic nucleus deep brain stimulation (STN-DBS)), and demographic information were used as model covariates. Predictors of HUI-III utility scores were evaluated using the Wilxocon rank-sum test and linear regression models. 68 men with a diagnosis of PD and a mean age of 74.0 (SD 7.4) were included in the data analysis. Mean HUI-III utility at first visit was 0.45 (SD 0.33). In multivariable models, UPDRS-II score (r2 = 0.56, P < 0.001) was highly predictive of HRQoL. UPDRS-III was a weaker, but still significant, predictor of utility scores, even after adjustment for UPDRS-II (P = 0.01). Poor self-care in PD reflected by worsening UPDRS-II scores is strongly correlated with low generic HRQoL. HUI-III-based health utilities display convergent validity with the UPDRS-II. These findings highlight the importance of measures of independence as determinants of HRQoL in PD, and will facilitate the utilization of existing UPDRS data into economic analyses of PD therapies.
    Health and Quality of Life Outcomes 08/2010; 8(1):91. DOI:10.1186/1477-7525-8-91 · 2.12 Impact Factor
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