To estimate the pattern of cognitive impairment in early Parkinson's disease (PD) associated with depression. Also, the prediction of potentially relevant demographic/clinical factors in early PD on cognitive functioning was tested.
The study comprised 80 consecutive early PD patients (16 with major depression (PDMD), 10 PD patients with dysthimic disorder (PDDD), and 54 nondepressed PD patients (PDND)). Thirty_seven healthy subjects matched for age, gender and education were also included in the study. The cognitive evaluation included the comprehensive classical neuropsychological battery and the Cambridge Neuropsychological Test Automated Battery (CANTAB).
The two different patterns of cognitive impairment in early PD patients were obtained even when the confounding influences of general cognitive abilities and motor slowness were taken in account. One pattern was common to all PD patients either they were depressed or not, and it is conceived etiologically as dysexecutive. The PDDD group presented only the quantitative increment of the common deficit observed in PD. The second pattern was present in PDMD patients, involved episodic/working memory and language deficits alongside with background executive impairment. Depression was extensively associated with the cognitive dysfunction in early PD, whereas severity of the disease, age at onset and treatment were less favorable as predictors.
This study provides evidence that the pattern of cognitive impairment in early PD may be predicted by depression severity. Therefore, the recognition and treatment of depressive disorder in early PD is important.
"Negative effects of depression on EF seem to be strongest in patients with low level of education (Kummer et al., 2009). Although across all executive and non-executive tests, cognitive performance is worse in depressed compared with non-depressed patients, the deficits in EF are among those particularly susceptible to depression (Stefanova et al., 2006). Independent of depression, apathy is another common symptom in PD associated with executive dysfunction (Butterfield, Cimino, Oelke, Hauser, & Sanchez-Ramos, 2010; Dujardin, Sockeel, Delliaux, Dest ee, & Defebvre, 2009; Pluck & Brown, 2002; Zgaljardic et al., 2007). "
[Show abstract][Hide abstract] ABSTRACT: Executive dysfunction can be present from the early stages of Parkinson's disease (PD). It is characterized by deficits in internal control of attention, set shifting, planning, inhibitory control, dual task performance, and on a range of decision-making and social cognition tasks. Treatment with dopaminergic medication has variable effects on executive deficits, improving some, leaving some unchanged, and worsening others. In this review, we start by defining the specific nature of executive dysfunction in PD and describe suitable neuropsychological tests. We then discuss how executive deficits relate to pathology in specific territories of the basal ganglia, consider the impact of dopaminergic treatment on executive function (EF) in this context, and review the changes in EFs with disease progression. In later sections, we summarize correlates of executive dysfunction in PD with motor performance (e.g., postural instability, freezing of gait) and a variety of psychiatric (e.g., depression, apathy) and other clinical symptoms, and finally discuss the implications of these for the patients' daily life.
Journal of Neuropsychology 09/2013; 7(2):193-224. DOI:10.1111/jnp.12028 · 2.49 Impact Factor
"The association between such psychological and biological underpinnings would contribute to make the patient more vulnerable to the development of depression , which reinforces the hypotheses that the etiopathogenesis of depression in patients with PD is complex   . Stefanova et al.  found that depression would speed up the progression of PD and, accordingly, would increase the functional impairment. On the other hand, we agree with Bertucci et al.  and Silberman et al.  who recognized the complex interplay between depression and PD as a bidirectional process, where each condition is supposed to mutually aggravate the other. "
[Show abstract][Hide abstract] ABSTRACT: Depression is a frequently observed neuropsychiatric phenomenon in Parkinson's disease (PD) and it has been lately considered as a manifestation of such disease. The aim of the study was to investigate the relationship between depression and clinical aspects of PD and to assess the impact of the co-occurrence of such condition on the burden imposed by PD. Fifty outpatients diagnosed with idiopathic PD according to the London Brain Bank criteria were examined. PD was evaluated using Hoehn & Yahr staging (H&Y), United Parkinson's Disease Rating Scale (UPDRS) and Schwab & England (S&E) functional capacity evaluation. A semi-structured clinical interview was used. The diagnosis of PD was made by neurologist experts on movement disorders, and the diagnosis of depression was made by a psychiatrist, according to the ICD-10 diagnostic criteria. Depressive symptoms were additionally measured using the Montgomery-Asberg Depression Scale. The analysis of quantitative data was performed using descriptive statistics, univariate linear regression, T-Student Test and ANOVA. Seventeen (34%) patients were diagnosed as clinically depressed and, when compared to the non-depressed ones, presented the following results: H&Y: 3.2 vs. 2.8; UPDRS total: 75.7 vs. 65.3; S&E: 53.5% vs. 65.8% and PD duration: 114.4 months vs. 125.8 months. Depressed patients showed more advanced staging (H&Y), a more severe global clinical condition (UPDRS) and also a greater decrease in their functional capacity (S&E). These data reinforce the hypothesis that depression is associated to poorer functioning in patients with PD.
Journal of the Neurological Sciences 06/2008; 272(1-2):158-63. DOI:10.1016/j.jns.2008.05.018 · 2.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Depression is the most frequent psychiatric disorder in patients with Parkinson's disease. The rate of depression as published in a number of studies varies from 4% to 75%. There are several pos- sible approaches for the treatment of depression in Parkinson's disease. Drug treatment (TCAs, SSRIs, MAOIs and SNRI) is often, but not always necessary. Although antidepressant medications commonly used to treat depression in Parkinson's disease, only limited information is available re- garding their safety and efficacy in this condition. There may be a role for other therapeutic app- roaches such as cognitive behavioral therapies, individual or family counseling and supportive app- roach. In addition, ECT and TMS have been used to treat depression in Parkinson's disease. ÖZET Depresyon, Parkinson hastal›¤›nda (PH) en s›k görülen psikiyatrik rahats›zl›kt›r. Parkinson hastal›- ¤›ndaki depresyon görülme s›kl›¤› çeflitli araflt›rmalarda deiflmekle birlikte, %4 ilâ %75 oran›nda belirtilmektedir. Parkinson hastal›¤›ndaki depresyonun tedavisine yönelik farkl› yaklafl›mlar bulun- maktad›r. S›kl›kla ilâç tedavileri (TCAs, SSRIs, MAOIs ve SNRI) uygulanmakla birlikte, biliflsel davra- n›flç›, kifliye ve âileye dan›flmanl›k ve destekleyici yaklafl›mlar gibi tedavilerde uygulanmaktad›r. An- tidepresanlar›n PH ile birlikte görülen depresyonda yayg›n olarak kullan›l›yor olmalar›na karfl›n et- kinlik ve güvenilirliklerine iliflkin bilgiler s›n›rl›d›r. Ayr›ca, elektrokonvülsif terapi (EKT) ve transkra- niyal manyetik stimülasyon (TMS) de Parkinson hastal›¤›nda görülen depresyonda kullan›lan dier tedavi seçenekleridir. Anahtar kelimeler: Parkinson hastal›¤›, depresyon, tedavi
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