Occurrence risk and structure of depression in Parkinson disease with and without dementia: results from the GEPAD Study.
ABSTRACT 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.
Aktuelle Neurologie 12/2013; 40(10-10):574-587. DOI:10.1055/s-0033-1359892 · 0.32 Impact Factor
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ABSTRACT: The high rate of coexistent emotional disorders in neurological diseases is challenging. As a rule this coexistence comprises a more dramatic subjective suffering, reduced psychological coping, possible negative interferences with somatic treatments and rehabilitation, an impaired quality of life and higher grades of psychosocial disability. It may also lead to an overall increased risk of somatic morbidity and even mortality in the further course of illness. The complex interrelations may be favorably integrated within a biopsychosocial model. Psychological and psychosocial stressors can be appreciated on their own discrete levels but have to be reflected in their neurobiological correlates. Both neurological and emotional disorders frequently share decisive pathogenetic mechanisms, i.e. the underlying process of neurological disease may contribute to major affective problems also in a somatopsychic direction. From a perspective of multimorbidity the prevalence and clinical relevance of coexistent depressive and anxiety disorders, common pathogenetic mechanisms and implications for treatment will be described for stroke and Parkinson's disease, as selected neurological disorders.Der Nervenarzt 03/2014; DOI:10.1007/s00115-013-3936-z · 0.86 Impact Factor
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ABSTRACT: Reduction of 18F-fluorodeoxyglucose uptake in PET (hypometabolism) and grey matter volume in MRI (atrophy) are found in the cerebral cortex of patients with Parkinson’s disease (PD). This doctoral thesis studied the relationship between hypometabolism and atrophy in successive stages of cognitive decline in PD: cognitively normal, mild cognitive impairment (PD-MCI) and dementia (PDD); as well as the biochemical profile of hypometabolic and atrophic areas. Z-score maps for atrophy and hypometabolism, obtained by comparing individual images to a data set of healthy control subjects, were compared using a direct voxel-based technique (paired Student’s t-test p<0.05 FDR corrected). Additionally, areas with hypometabolism and atrophy were biochemically characterized by proton magnetic resonance spectroscopy (MRS). In PD-MCI patients hypometabolism exceeded atrophy in the angular gyrus, occipital, orbital and anterior frontal lobes. In PDD patients the hypometabolic areas observed in PD-MCI group were replaced by areas of atrophy, which were surrounded by extensive zones of hypometabolism. In both groups, areas where atrophy was more extended than hypometabolism were found in the precentral and supplementary motor areas in the temporal lobe and hippocampus. In the MRS study, the areas of hypometabolism and atrophy showed significant differences in resonance frequencies (1.27, 1.31, 1.62, 2.23 and 3.11 ppm) whose correlate is uncertain. In conclusion, these findings suggest a gradient of severity in cortical changes associated with the development of cognitive impairment in PD, in which hypometabolism and atrophy represent consecutive stages of the same process. MRS technique may provide biochemical markers to be investigated in the near future.09/2013, Degree: MD, PhD, Supervisor: José A. Obeso, María C. Rodríguez-Oroz