Frontal functions in depressed and nondepressed Parkinson's disease patients: Impact of severity stages (original) (raw)
Related papers
Major and minor depression in Parkinson's disease: a neuropsychological investigation
2006
Previous studies have failed to distinguish the differential contribution of major and minor depression to cognitive impairment in patients with idiopathic Parkinson's disease (PD). This study was aimed at investigating the relationships among major depression (MD), minor depression (MiD) and neuropsychological deficits in PD. Eighty-three patients suffering from PD participated in the study. MD and MiD were diagnosed by means of a structured interview (SCID-I) based on the DSM-IV criteria, and severity of depression was evaluated by the Beck Depression Inventory. For the neuropsychological assessment, we used standardized scales that measure verbal and visual episodic memory, working memory, executive functions, abstract reasoning and visual-spatial and language abilities. MD patients performed worse than PD patients without depression on two long-term verbal episodic memory tasks, on an abstract reasoning task and on three measures of executive functioning. The MiD patientsÕ performances on the same tests fell between those of the other two groups of PD patients but did not show significant differences. Our results indicate that MD in PD is associated with a qualitatively specific neuropsychological profile that may be related to an alteration of prefrontal and limbic cortical areas. Moreover, the same data suggest that in these patients MiD and MD may represent a gradual continuum associated with increasing cognitive deficits.
Parkinson's disease and depression
Brain, 1986
The possibility of an 'organically' based depression intrinsic to the pathophysiology of Parkinson's disease (PD) and comparable to endogenous depression (Major Depressive Episode) has been raised. It has also been argued that signs of depression observed in PD are merely the natural reaction of the patients to their progressive and inevitable physical limitations and loss of independent function. Because conventional depression rating scales are limited in scope, a psychometric investigation of depression in PD was pursued. Based on the known impairment of short-term memory (STM) in endogenous depression, which was confirmed in a group of psychiatric patients in the present study, measures of STM were also obtained in groups of depressed and nondepressed PD patients and in 15 normal control subjects. Regardless of depression severity, PD patients performed as well as control subjects and both these groups consistently obtained scores significantly better than those of the endogenously depressed patients. A relative weakness in the PD patients on order-dependent STM tests was further explored and interpreted as an indication of mild frontal lobe dysfunction. It was concluded that PD patients are frequently depressed when confronted with their behavioural limitations and that this reaction may be exacerbated by a form of emotional lability related to pathophysiological processes which may involve prefrontal cortical areas.
Arquivos de Neuro-Psiquiatria, 2014
Objective: To test the hypothesis that severity of cognitive impairment modifies the association between depression and Parkinson's disease (PD). Method: One-phase population-based door-to-door surveys. This is a secondary analysis of 1,451 people aged 65 years and older with cognitive impairment living in defined catchment areas. Depression was estimated according to ICD-10, self-reported PD, disability according to WHODAS-II and cognitive status according to the CSI-D. Results: The mean age of the sample was 79.3 years old and most (69%) were women. Of the total sample, 16.1% had depression and it was significantly higher among participants with PD. There was an increase on the ORs of the association between depression and PD with decreased scores in the cognitive test (Adjusted OR from 0.98 to 8.04). Conclusion: The association between depression and PD increases with the severity of the cognitive impairment.
The assessment of depression in Parkinson’s disease
European Journal of Neurology, 2008
Background: Motor symptoms form the hallmark of ParkinsonÕs Disease (PD), although features like depression are often present. Depression rating scales [e.g. Montgomery-Å sberg Depression Rating Scale (MADRS)] used in PD measure affective, cognitive and somatic symptoms. An important clinical question is which items of the MADRS are likely to be influenced by PD symptoms. Methods: Depression was assessed in 43 PD patients who scored below the cutoff of the MADRS and who differed widely in motor severity. Results: ParkinsonÕs Disease patients scored relatively highest on Concentration difficulties, Reduced sleep and Inner tension. Reduced sleep, Lassitude and Suicidal thoughts were associated with motor severity and specifically with Bradykinesia, Rigidity and Axial impairment, however not with Tremor. To avoid a possible influence on our results of coincidentally included PD patients with a depression, all associations between somatic MADRS items and motor severity were corrected for the influence of affective symptoms of depression. All associations remained significant. Discussion: In conclusion, the items Reduced sleep and Lassitude of the MADRS are likely to be influenced by motor symptoms. The high score on Concentration difficulties is suggested to be a reflection of cognitive dysfunction in PD. Thus, when assessing depression in PD, using a depression rating scale like the MADRS, adjusted cutoff scores are required.
Cognitive impairments and depression in Parkinson's disease: a follow up study
Journal of Neurology, Neurosurgery, and Psychiatry, 1990
The presence of depression and cognitive impairments was examined in seventy patients with Parkinson's disease (PD). Forty nine patients of this original cohort were reexamined between three and four years after the first evaluation. While both depressed and non-depressed patients showed a significant decline in cognitive function during the follow up period, intellectual decline was significantly more severe for the depressed group. Depressed patients also showed a faster rate of progression of motor signs (mainly tremor) than the non-depressed group. Patients that died during the follow up period showed significantly more cognitive impairments than patients who were alive at follow up. These findings suggest that either there may be two forms of PD: one with depression and rapid cognitive decline and one without depression and a gradual cognitive decline; or that the mechanisms of cognitive impairment in PD and depression may interact to produce a more rapid evolution in cognitive impairment among PD patients with a previous depression than among patients without a previous depression.
Influence of depression in mild Parkinson's disease on longitudinal motor and cognitive function
Parkinsonism & related disorders, 2015
Studies have suggested a relationship between non-motor symptoms with motor fluctuations in patients with Parkinson's disease (PD). We studied the influence of depression on longitudinal motor and cognitive function among mild PD patients. A 1.5 years longitudinal study of 102 patients with mild idiopathic PD. Patients were assessed with a standardized clinical assessment battery including motor and non-motor scales. Patients also underwent serial neurocognitive testing that assessed global cognition, memory, attention, language, visuospatial and executive function. 81 patients with mean age of 64.9(SD = 7.9) years and mean Hoehn & Yahr of 1.9(SD = 0.4) completed baseline and follow-up visits. 22 patients had clinically significant depression at baseline with mean Geriatric Depression Scale of 6.9(SD = 2.4). These patients presented with concomitant apathy and anxiety and were more likely to be females with longer duration of PD. At baseline, patients with depression had poorer ...
Depression, intellectual impairment, and Parkinson disease
Neurology, 1981
To the Editor: Dr. Mayeux and his colleagues make an interesting contribution to the study of intellectual and emotional disturbances in patients with subcortical disease.I However, I would like to comment on several issues, with particular reference to the specificity of their findings to Parkinson disease. For example, 67% of a sample of consecutively admitted neurological patients' showed evidence of cognitive deficit, emotional disturbance, or both, using instruments similar to those employed by Mayeux et al. This figure is considerably higher than for the general medical populations and may account, in part, for the fact that "when equally disabled patients with other medical diseases were used for comparison, the prevalence of depression in PD was always significantly higher" (page 6471.' As the authors pointed out, attention and memory are frequently impaired in depressed patients; this is a common observation even when the cognitive disturbance is not severe enough to warrant a diagnosis of "dementia syndrome with depression." In addition, we have frequently encountered disturbances in calculations, constructional ability, and memory in patients with early Alzheimer disease, when language, praxis, and gnostic functions were still intact. In practice, the "characteristic" symptoms of "subcortical dementia" seem to describe many patients with mild cognitive impairment of diverse etiology (e.g., atherosclerotic or demyelinating disease). Adequate description of this impairment requires more than the correlation of single items from the mental status examination. The most striking aspect of the intellectual and emotional disturbances in PD appears to be their surprisingly strong correlations with akinesia and rigidity.l Mayeux et a1 suggest that the degeneration of dopaminergic neurons in the substantia nigra and locus ceruleus cannot account for this finding; yet, they do not consider the possible contribution of the mesolimbic and mesocortical dopamine systems, both of which may be affected in PD,56 and which might account for the observed relation between the movement and psychologic disorders. Their alternative hypothesis of neuronal loss in the tuberal and posterolateral hypothalamus merits further consideration, although one might then expect to observe a relationship between cognitive/emotional status and autonomic vegetative symptoms in these patients. Further exploration of these factors would surely enhance the specificity and value of their findings.
Relationship between depression and cognitive dysfunctions in Parkinson’s disease without dementia
Journal of Neurology, 2009
To explore the relationship between depression and cognitive impairment in non-demented PD patients, we evaluated neurological and neuropsychological asset in 65 patients with a diagnosis of major depressive disorder (dPD) according to DSM-IV criteria and 60 patients without depression (nPD). Compared with nPD patients, dPD patients had significantly higher scores on behavioral rating scales and performed worse on the Frontal
Frontal assessment battery scores and non-motor symptoms in parkinsonian disorders
Neurological Sciences, 2011
Using data from the PRIAMO study, we investigated non-motor symptoms (NMS) versus frontal lobe dysfunction in patients with idiopathic Parkinson disease (PD); 808 patients with PD and 118 with atypical parkinsonisms (AP) were consecutively enrolled at 55 Centers in Italy. Twelve categories of NMS were investigated. Cognitive impairment was defined as a Mini-Mental Status Evaluation score B23.8 and frontal lobe dysfunction as a Frontal Assessment Battery (FAB) score B13.48. Multivariable logistic regression was used to identify predictor of frontal lobe dysfunction in 524 PD patients, and a generalized linear model was used for each of the six FAB items. Not only the total FAB scores but also the single FAB items were lower in AP versus PD (p B 0.005). Age (OR = 1.05), cognitive impairment (OR = 9.54), lack of cardiovascular symptoms (OR = 3.25), attention or memory problems (OR = 0.59) and treatment with L-DOPA (OR = 5.58) were predictors of frontal lobe dysfunction. MMSE was negatively associated with all FAB items (b B-0.16) and age with all FAB items but prehension behavior (b B-0.01). Previous use of L-DOPA was On behalf of the PRIAMO study group.
Depressive symptoms in Parkinson’s disease and in non-neurological medical illnesses
Neuropsychiatric Disease and Treatment, 2013
Background: Patients with neurological and non-neurological medical illnesses very often complain of depressive symptoms that are associated with cognitive and functional impairments. We compared the profile of depressive symptoms in Parkinson's disease (PD) patients with that of control subjects (CS) suffering from non-neurological medical illnesses. Methods: One-hundred PD patients and 100 CS were submitted to a structured clinical interview for identification of major depressive disorder (MDD) and minor depressive disorder (MIND), according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR), criteria. The Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory (BDI) were also administered to measure depression severity. Results: When considering the whole groups, there were no differences in depressive symptom frequency between PD and CS apart from worthlessness/guilt, and changes in appetite reduced rates in PD. Further, total scores and psychic and somatic subscores of HDRS and BDI did not differ between PD and CS. After we separated PD and CS in those with MDD, MIND, and no depression (NODEP), comparing total scores and psychic/somatic subscores of HDRS and BDI, we found increased total depression severity in NODEP PD and reduced severity of the psychic symptoms of depression in MDD PD, with no differences in MIND. However, the severity of individual symptom frequency of depression was not different between PD and CS in MDD, MIND, and NODEP groups. Conclusion: Although MDD and MIND phenomenology in PD may be very similar to that of CS with non-neurological medical illnesses, neurological symptoms of PD may worsen (or confound) depression severity in patients with no formal/structured DSM-IV-TR, diagnosis of depressive mood disorders. Thus, a thorough assessment of depression in PD should take into consideration the different impacts of neurological manifestations on MDD, MIND, and NODEP.