Depression in Parkinson's Disease: Conceptual Issues and Clinical Challenges

Department of Psychiatry, Maastricht University Hospital, PO Box 5800, 6202 AZ, the Netherlands.
Journal of Geriatric Psychiatry and Neurology (Impact Factor: 2.24). 10/2004; 17(3):120-6. DOI: 10.1177/0891988704267456
Source: PubMed


Depression frequently accompanies Parkinson's disease (PD) and may have a negative impact on activities of daily living, cognitive performance, and quality of life. Because of the symptom overlap between the 2 disorders, it may be difficult to recognize depression in PD. Moreover, the partially shared pathophysiology may make it difficult to treat depressive symptoms without influencing motor or cognitive function.
To review the current knowledge of the epidemiology, etiology, pathophysiology, and treatment of depression in patients with Parkinson's disease.
Discussion of recent studies and relevant literature.
Not only conceptually but also in terms of etiology, pathophysiology, and treatment, the relationship between PD and depression remains a challenge. There are still many questions to be answered. In the therapeutic domain, large, placebo-controlled trials are necessary to evaluate the efficacy of antidepressant treatment and allow the development of evidence-based guidelines.

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    • "Depression is one of the most common non-motor symptoms in PD patients (Schrag et al., 2007; Picillo et al., 2009). It is estimated that roughly 40% of PD patients show depressive symptoms (Slaughter et al., 2001; McDonald et al., 2003; Leentjens, 2004; Schrag et al., 2007; clinical manifestations, etiology, and treatment of depression in PD). These depressive symptoms include social withdrawal and anhedonia (inability to experience pleasure). "
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    ABSTRACT: Parkinson's disease (PD) is a neurological disorder, associated with rigidity, bradykinesia, and resting tremor, among other motor symptoms. In addition, patients with PD also show cognitive and psychiatric dysfunction, including dementia, mild cognitive impairment (MCI), depression, hallucinations, among others. Interestingly, the occurrence of these symptoms-motor, cognitive, and psychiatric-vary among individuals, such that a subgroup of PD patients might show some of the symptoms, but another subgroup does not. This has prompted neurologists and scientists to subtype PD patients depending on the severity of symptoms they show. Neural studies have also mapped different motor, cognitive, and psychiatric symptoms in PD to different brain networks. In this review, we discuss the neural and behavioral substrates of most common subtypes of PD patients, that are related to the occurrence of: (a) resting tremor (vs. nontremor-dominant); (b) MCI; (c) dementia; (d) impulse control disorders (ICD); (e) depression; and/or (f) hallucinations. We end by discussing the relationship among subtypes of PD subgroups, and the relationship among motor, cognitive, psychiatric factors in PD.
    Frontiers in Systems Neuroscience 12/2013; 7:117. DOI:10.3389/fnsys.2013.00117
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    • "This could be an indication of a further advanced and widespread disease state (Pålhagen et al., 2008). There is also debate on whether depression appears in PD as a natural part of the disease process or whether there is a convergence of two independent pathological processes (Leentjens, 2004). "
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    ABSTRACT: In this review, we focus on the relationship among Parkinson's disease (PD), stress and depression. Parkinson's disease patients have a high risk of developing depression, and it is possible that stress contributes to the development of both pathologies. Stress dysfunction may have a role in the etiology of preclinical non-motor symptoms of PD (such as depression) and, later in the course of the disease, may worsen motor symptoms. However, relatively few studies have examined stress or depression and the injured nigrostriatal system. This review discusses the effects of stress on neurodegeneration and depression, and their association with the symptoms and progression of PD.
    Experimental Neurology 01/2012; 233(1):79-86. DOI:10.1016/j.expneurol.2011.09.035 · 4.70 Impact Factor
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    • "In the literature, the presence of apathy has often been reported in PD patients (Pluck & Brown; 2002; Aarsland, Litvan & Larsen; 2001; Starkstein, Fedoroff, Price, Leiguarda & Robinson; 1992), as well as anxiety and depression (Leentjens, 2004; Slaughter, Slaughter, "
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    ABSTRACT: The concept of awareness of illness refers to the ability that people have in recognizing their disturbances. The presence of a possible unawareness of illness is well described in different clinical pathologies. The awareness of deficits may be sometimes altered in patients suffering from Parkinson's disease (PD). In order to have a greater clinical utility, theoretical models of unawareness, should allow for the possibility of integrating neurobiological and neuropsychological levels of explanation and should comprehend convergent analyses of these levels. With the aim of integrating such levels of explanations, a series of variables of interest will be considered from a convergent perspective at the neurobiological, neuropsychological and psychological-psychiatric levels. In particular, this chapter will focus on a specific analysis of awareness of movement disorders in non-demented patients with PD and motor fluctuations. So far, only one study has analyzed differences in the awareness of deficits in PD patients by comparing the on and off states using an extensive battery of cognitive and behavioral functioning (Amanzio, Monteverdi, Giordano, Soliveri, Filippi & Geminiani; 2010). The results of this study demonstrated that PD patients have a selective reduced awareness of dyskinesias when in the on state, while being aware of their hypokinesias in the off state. Interestingly, such a reduced awareness of dyskinesia-related movement disorders was associated with executive functions in the on state. In contrast, no association with executive functions was found in the off state. We believe that this study together with more in depth analysis of the phenomenon of unawareness of deficits may add important elements to the literature on neuropsychological impairments observed in unaware -non-demented patients with PD
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