الگوی علائم افسردگی در بیماری پارکینسون

Background Depressive symptoms are common in Parkinson's disease (PD); however, it is unclear whether there are specific depressive symptom patterns in patients with PD and comorbid depression (dPD). Objective The goal of this study is to examine the frequency and correlates of specific depressive symptoms in PD. Method : A sample of 158 individuals with PD completed the self-rated Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS). By multiple-regression analysis, the authors examined the association between HANDS total and subscale scores and various demographic variables. Results The frequency of depression was 37% (N = 58). Patients with a history of depression before PD had significantly more serious depression than those who had no such history. Of those who were more depressed, the most common symptoms of depression endorsed were low energy, difficulty with concentration/making decisions, feeling blue, feeling hopeless, and having poor sleep. Conclusion There is a relatively high prevalence of dPD. Items on the HANDS that discriminated best between depressed and nondepressed subjects with PD included feeling blue, feeling hopeless, feeling worthless, lack of interest, and self-blame. It remains to be defined whether dPD should be understood primarily as a psychological reaction to a physical disability or perceived impending one, or as a direct expression of the neuropathology of PD.

Parkinson's disease (PD), first described almost two centuries ago (1817) by James Parkinson as the “shaking palsy,” is the second most common neurodegenerative disorder, affecting approximately 500,000 individuals in the United States.1 Depression is a significant health problem, and is associated with worsened health status across a variety of diseases.2 Since the 1920s, depression has been reported as a common feature of PD,3 and, indeed, is the most studied psychiatric disorder in PD patients. Reports of prevalence rates vary, ranging from 7% to 90%, with a general consensus that depression in some form (i.e., either major or non-major depression) appears to occur in approximately 40% of PD patients.4,5 It can be difficult to diagnose depression accurately in PD patients (dPD), in part because the motor impairments of PD may overlap with common depressive symptoms, such as reduced energy, psychomotor retardation, mental slowing, difficulties concentrating, and insomnia.6 As part of the NINDS/NIMH Work Group on Depression and Parkinson's Disease, Marsh and colleagues7 reviewed the difficulties of accurately diagnosing depression within the context of PD. Symptoms of PD may mask symptoms of depression, leading to symptoms that cannot be identified. It is also common for clinicians, as well as patients, to discount depressive symptoms when they occur in the presence of a major medical illness such as PD. They endorse an “inclusive” strategy for managing symptom assessment; counting symptoms toward both conditions, not one or the other.7 In terms of rating scales, there are several from which to choose, depending on the clinical or research goal.8 Currently, there is no specific dPD scale. Disabilities due to motor impairments, such as tremor, rigidity, and slowness, dominate the clinical manifestations of PD, but mood changes and even psychoses are being recognized as major sources of disability. Depression may be associated with specific impairments in PD. Weintraub and others9 found that depression significantly contributes to a PD patient's disability. Norman and colleagues5 found that depression in PD was associated with more rapid disease progression, cognitive decline, memory difficulties, and functional disability. Yamamoto3 proposed that depression accounts for about 58.2% of impairment in quality of life (QOL) in PD patients, affecting QOL more than severity of motor disability. Given the co-occurrence of dPD and the impact of dPD, we conducted a cross-sectional study to identify the prevalence and specific symptoms of depression in a cohort of PD patients attending an outpatient clinic. This is an exploratory analysis; we did not have a priori hypotheses, and we were interested in seeing whether we could detect depressive symptom patterns.

Because depression is one of the most disabling symptoms of PD, the value of regular depression screening and treatment has been repeatedly emphasized.12., 13. and 14. However, very little is known about the factors that influence depression severity or the nature of specific depression symptoms in PD. In general, studies have found certain characteristics of PD to be associated with depression severity. For example, Rojo and colleagues15 found that female gender and high Hoehn and Yahr scores were significantly related to depressive symptoms. Stefanova and colleagues16 found that cognitive impairment in early PD was predicted by depression severity. Cubo and colleagues,17 for example, found that cognitive impairment, high axial bradykinesia, and gait and balance impairment are significant predictors of dPD. Weintraub and others9 found that depression severity is related to global functioning, as measured by the Schwab and England Scale. The purpose of this study was to evaluate symptom patterns of dPD, using a validated self-rating instrument, and to examine which symptoms most clearly differentiate PD patients with and without depression. Depression appears to be relatively common in our sample of PD patients. We found that about 37% of our sample was depressed, based upon the cutoff used by our group with the HANDS, which is consistent with a relatively recent review that looked at 45 studies and found that the rate of dPD is about 31%.18 In PD patients, depressive symptoms affect all domains, including physical, affective, and cognitive domains. In a previous study that examined the symptom-profile of dPD patients, it was found that depressed mood, tension, loss of interest, and loss of concentration were the most common depressive symptoms, whereas feelings of guilt, self-blame, appetite disturbance, and suicidal ideation were not as common.19 Another previous study found that low mood, anhedonia, and lack of interest constituted the most prominent symptoms in dPD patients, and that reduced appetite and early morning awakening are two somatic items that discriminate between PD patients with and without depression.20 The symptoms that showed a marked difference (more than 3 times higher) in rates between depressed and nondepressed PD patients were lack of interest (64% versus 8%), feelings of worthlessness (60% versus 3%), and feelings of hopelessness (77% versus 15%), feeling blue (88% versus 25%), and blaming self (61% versus 13%). In this study, poor sleep appears to be related to younger age, and PD severity to hopelessness. Also, a history of depression before PD was related to symptoms of low energy, suicidal ideas, and poor concentration. Depression may be part of the PD process, but not necessarily. The clinical implications of our findings are that depressive symptoms appear common, despite attempts to treat depression; 66% of our subjects, who had a HANDS score of ≥6, were on an antidepressant and, and 32%, with a HANDS score of <6, were also on an antidepressant.