Anhedonia, Depression, and Motor Functioning in Parkinson’s Disease During Treatment With Pramipexole

Ruhr-Universität Bochum, Bochum, North Rhine-Westphalia, Germany
Journal of Neuropsychiatry (Impact Factor: 2.82). 02/2005; 17(2):214-20. DOI: 10.1176/appi.neuropsych.17.2.214
Source: PubMed


Anhedonia, a core symptom of depression, correlates with motor alterations in major depressive disorder and has been assumed to be frequent in depressed patients with Parkinson's disease (PD). In the present study, the authors assessed for the first time frequency of anhedonia in patients with idiopathic Parkinson's disease (N = 657) and the relationship of anhedonia and parkinsonian motor deficits during treatment with pramipexole. Mild depression was present in 47% of the patients and moderate to severe depression in 22%. Anhedonic individuals included 45.7% of all patients and 79.7% of depressed Parkinson's disease patients. Anhedonic Parkinson's disease patients had greater motor deficits, restrictions in activities of daily living, and depression compared to nonanhedonic patients. Frequency of anhedonia and depression was significantly reduced during treatment with pramipexole. Future studies should further investigate antianhedonic efficacy of dopamine agonists including pramipexole in depressed patients with Parkinson's disease.

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    • "Dopamine replacement therapies have revolutionized outcomes of motor function and pre-clinical research is currently largely focused on characterizing and targeting effects that go beyond the dopamine system, including a panoply of motor and non-motor symptoms with no specific symptom or domain obviously dominating the patient experience. Better management of many non-motor symptoms awaits success of these pre-clinical efforts [3] [4] [5]. "
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    ABSTRACT: Parkinson's Disease (PD) involves well known motor symptoms such as tremor, rigidity, bradykinesia, and altered gait but there are also non-locomotory motor symptoms (e.g., changes in handwriting and speech) and even non-motor symptoms (e.g., disrupted sleep, depression) that can be measured, monitored, and possibly better managed through activity based monitoring technologies. This will enhance quality of life (QoL) in PD through improved self-monitoring, and also provide information which could be shared with a health care provider to help better manage treatment. Until recently, non-motor symptoms ("soft signs") had been generally overlooked in clinical management yet these are of primary importance to patients and their QoL. Day-to-day variability of the condition, the high variability in symptoms between patients, and the isolated snapshots of a patient in periodic clinic visits makes better monitoring essential to the proper management of PD. Continuously monitored patterns of activity, social interactions, and daily activities could provide a rich source of information on status changes, guiding self correction and clinical management. The same tools can be useful in earlier detection of PD and will improve clinical studies. Remote medical communications in the form of telemedicine, sophisticated tracking of medication use, and assistive technologies that directly compensate for disease related challenges are examples of other near term technology solutions to PD problems. Ultimately, a sensor technology is no good if it is not used. The Parkinson's community is a sophisticated early adopter of useful technologies and a group for which engineers can provide near term gratifying benefits.
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    • "Six studies [4] [6]-[10] have compared the scores on the SHAPS, which rates anhedonia state, or the prevalence of anhedonia using the cut off of 3 on this scale, between PD patients and controls. Four of these studies [6]-[9] reported significant differences and two [4] [10] non-significant differences. It is interesting to note that the two studies that reported non-significant differences used non-healthy control group (osteoarthritis or non- Parkinson motor neurological disease). "

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    • "An illustration of this theory is shown in the case of pramipexole, a dopamine D 3 /D 2 receptor agonist used in the treatment of Parkinson symptoms. Pramipexole reduces depressive symptoms in Parkinson's patients suffering from depression (Lemke et al., 2005; 2006). A low dose of pramipexole (0.3 mg/kg i.p.) reduced the OBX-induced hyperactivity after 7 and 14 days of pretreatment. "
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