Depression and anxiety among patients with Parkinson’s disease: frequency, risk factors, and impact on quality of life

Eman M. Khedr1, Adel B. Abdel‐Rahman1, Yasser M. Elserogy1, Ahmed Zaki2, Ayman Gamea2
1Department of Neuropsychiatry, Faculty of Medicine, Assiut University Hospital, Assiut, Egypt
2Department of Neuropsychiatry, South Valley University Hospital, Qena, Egypt

Tóm tắt

Abstract Background Depression and anxiety are non-motor symptoms of Parkinson’s disease (PD) that are often overlooked and underrated. This study aimed to highlight the frequency and risk factors of depression and anxiety among subjects with PD. Methods Sixty-four patients with PD who were diagnosed according to United Kingdom Parkinson’s Disease Society (UKPDS) Brain Bank Criteria and 50 sex- and age-matched healthy control subjects are evaluated for depression and anxiety. PD severity and staging were assessed using Unified Parkinson’s Disease Rating Scale (UPDRS) and Hoehn and Yahr scale. Depression and anxiety were diagnosed using DSM-IV TR criteria and scored using Hamilton Depression and Hamilton Anxiety Rating Scales (HAM-D and HAM-A). The World Health Organization Quality of Life (WHOQOL)-BREF was used to assess impact of depression and anxiety on quality of life. Results 31.25% of patients with PD had depression while 40.6% of patients had anxiety disorder. Depression was higher in females and patients with history of depression and low socioeconomic status (SES). Anxiety was common in young patients and those who had history of anxiety. Overlap between depression and anxiety was recorded in 23.4%. Total UPDRS and Hoehn and Yahr scale accounted for 33.4% of variance for depression. Total UPDRS and earlier age of onset accounted for 39% of variance for anxiety. Advanced disease stage and severity were independent predictors for depression while disease severity and younger age of onset were the main predictors for anxiety. Depression and anxiety have a negative impact on the overall quality of life of PD patients especially on physical and psychosocial domains. Conclusion Depression and anxiety are relatively common in PD. Female gender, low SES, and history of depression were the main risk factors for developing depression. Young age and history of anxiety were risk factors for anxiety. Both had negative impact on quality of life.

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Tài liệu tham khảo

Postuma RB, Berg D, Stern M, Stern M, Poewe W, Olanow CW, et al. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord. 2015;30:1591–600.

Khedr EM, El Fetoh NA, Khalifa H, Ahmed MA, El Beh KM. Prevalence of non-motor features in a cohort of Parkinson’s disease patients. Clin Neurol Neurosurg. 2013;115(6):673–7.

Weintraub D, Burn D. Parkinson’s disease: the quintessential neuropsychiatric disorder. Mov Disord. 2011;26:1022–31.

Hely MA, Morris JG, Reid WG, Trafficante R. Sydney multicenter study of Parkinson’s disease: non-L-dopa-responsive problems dominate at 15 years. Mov Disord. 2005;20:190–9.

Dobkin RD, Rubino JT, Friedman J, Allen LA, Gara MA, Menza M. Barriers to mental health care utilization in Parkinson’s disease. J Geriatr Psychiatry Neurol. 2013;26:105–16.

Nilsson FM, Kessing LV, Sorensen TM, Andersen PK, Bolwig TG. Major depressive disorder in Parkinson’s disease: a register-based study. Acta Psychiatr Scand. 2002;106:202–11.

Aarsland D, Påhlhagen S, Ballard CG, Ehrt U, Svenningsson P. Depression in Parkinson disease–epidemiology, mechanisms and management. Nat Rev Neurol. 2012;8:35–47.

Burn DJ. Depression in Parkinson’s disease. Eur J Neurol. 2002;9:44–54.

Meyer PM, Strecker K, Kendziorra K, Becker G, Hesse S, Woelpl D, et al. Reduced α4β2*–nicotinic acetylcholine receptor binding and its relationship to mild cognitive and depressive symptoms in Parkinson disease. Arch Gen Psychiatry. 2009;66(8):866–77.

Weintraub D, Mamikonyan E. The neuropsychiatry of Parkinson disease: a perfect storm. Am J Geriatr Psychiatry. 2019;27:998–1018.

Gibb WR, Lees AJ. The significance of the Lewy body in the diagnosis of idiopathic Parkinson’s disease. Neuropathol Appl Neurobiol. 1989;15:27–44.

Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease. A clinico-pathological study of 100 cases. JNNP. 1992;55:181–4.

Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.

Farrag A, Farwiz HM, Khedr EH, Mahfouz RM, Omran SM. Prevalence of Alzheimer’s disease and other dementing disorders: Assiut-upper Egypt study. Dement Geriatr Cogn Dis. 1998;9(6):323–8.

Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology. 1967;17(5):427–42.

Fahn S, Elton R. Members of the UPDRS development committee. In: Fahn S, Marsden CD, Calne DB, Goldstein M, editors. Recent developments in Parkinson’s disease, vol. 2. Florham Park: Macmillan Health Care Information; 1987. 153-163:293-304.

El-Tawab A. Socioeconomic status scale, faculty of education, department of psychology. Assiut University; 2004.

First MB, Spitzer RL, Gibbon M, Williams JBW, Benjamin LS. Structured clinical interview for DSM-IV-clinician version (SCID-CV) (user’s guide interview). Washington, DC: American Psychiatric Press; 1997.

El Missiry A, Sorour A, Sadek A, Fahy T, Abdel Mawgoud M, Asaad T. Homicide and psychiatric illness: an Egyptian study [MD thesis]. Cairo: Faculty of Medicine, Ain Shams University; 2004.

Alhadi AN, Alarabi MA, Alshomrani AT, Shuqdar RM, Alsuwaidan MT, McIntyre RS. Arabic translation, validation and cultural adaptation of the 7-item Hamilton depression rating scale in two community samples. SQUMJ. 2018;18:2.

Hallit S, Haddad C, Hallit R, Akel M, Obeid S, Haddad G, et al. Validation of the Hamilton anxiety rating scale and state trait anxiety inventory a and B in Arabic among the Lebanese population. Clin Epidemiol Glob Health. 2019;7(3):464–70.

Williams J, Hirsch E, Anderson K, Bush A, Goldstein S, Grill S, et al. A comparison of nine scales to detect depression in Parkinson disease: which scale to use? Neurology. 2012;78(13):998–1006.

Leentjens AFG, Dujardin K, Marsh L, Richard IH, Starkstein SE, Martinez-Martin P. Anxiety rating scales in Parkinson’s disease: a validation study of the Hamilton anxiety rating scale, the Beck anxiety inventory, and the hospital anxiety and depression scale. Mov Disord. 2011;26(3):407–15.

Leentjens AFG, Dujardin K, Marsh L, Martinez-Martin P, Richard IH, Starkstein SE, et al. Anxiety rating scales in Parkinson’s disease: critique and recommendations. Mov Disord. 2008;23(14):2015–25.

Ohaeri JU, Awadalla AW. The reliability and validity of the short version of the WHO quality of life instrument in an Arab general population. Ann Saudi Med. 2009;29(2):98–104.

Shalash AS, Hamid E, Elrassas HH, Bedair AS, Abushouk AI, Khamis M, et al. Non-motor symptoms as predictors of quality of life in Egyptian patients with Parkinson’s disease: a cross-sectional study using a culturally adapted 39-item Parkinson's disease questionnaire. Front Neurol. 2018;9:357.

Ragab OA, Elheneedy YA, Bahnasy WS. Non-motor symptoms in newly diagnosed Parkinson’s disease patients. Egypt J Neurol Psychiatr Neurosurg. 2019;55(1):24.

Zheng J, Yang X, Zhao Q, Tian S, Huang H, Chen Y, et al. Association between gene polymorphism and depression in Parkinson’s disease: a case-control study. J Neurol Sci. 2017;375:231–4.

Timmer M, van Beek M, Bloem B, Esselink R. What a neurologist should know about depression in Parkinson’s disease. Pract Neurol. 2017;17:359–68.

Chuquilín-Arista F, Álvarez-Avellón T, Menéndez-González M. Prevalence of depression and anxiety in Parkinson disease and impact on quality of life: a community-based study in Spain. J Geriatr Psychiatry Neurol. 2020;33(4):207–13.

Nègre-Pagès L, Grandjean H, Lapeyre-Mestre M, Montastruc J, Fourrier A, Lépine J, et al. Anxious and depressive symptoms in Parkinson’s disease: the French cross-sectional DoPa MiP study. Mov Disord. 2009;25(2):157–66.

Reijnders J, Ehrt U, Weber W, Aarsland D, Leentjens A. A systematic review of prevalence studies of depression in Parkinson’s disease. Mov Disord. 2008;23(2):183–9.

Van der Hoek TC, Bus BA, Matui P, van der Marck MA, Esselink RA, Tendolkar I. Prevalence of depression in Parkinson’s disease: effects of disease stage, motor subtype and gender. J Neurol Sci. 2011;310:1–2.

Broen M, Narayen N, Kuijf M, Dissanayaka N, Leentjens A. Prevalence of anxiety in Parkinson’s disease: a systematic review and meta-analysis. Mov Disord. 2016;31(8):1125–33.

Leentjens AFG, Dujardin K, Marsh L, Martinez-Martin P, Richard IH, Starkstein SE. Anxiety and motor fluctuations in Parkinson’s disease: a cross-sectional observational study. Parkinsonism Relat Disord. 2012;18:1084–108.

Cui S-S, Du J-J, Fu R, Lin Y-Q, Huang P, He Y-C, et al. Prevalence and risk factors for depression and anxiety in Chinese patients with Parkinson disease. BMC Geriatr. 2017;17(1):270.

Zhu K, van Hilten JJ, Marinus J. Associated and predictive factors of depressive symptoms in patients with Parkinson’s disease. J Neurol. 2016;263(6):1215–25.

Riedel O, Heuser I, Klotsche J, Dodel R, Wittchen H. Occurrence risk and structure of depression in Parkinson disease with and without dementia: results from the GEPAD study. J Geriatr Psychiatry Neurol. 2010;23(1):27–34.

Reiff J, Schmidt N, Riebe B, Breternitz R, Aldenhoff J, Deuschl G, et al. Subthreshold depression in Parkinson’s disease. Mov Disord. 2011;26(9):1740–3.

Farabaugh A, Locascio J, Yap L, Weintraub D, McDonald W, Agoston M, et al. Pattern of depressive symptoms in Parkinson’s disease. Psychosomatics. 2009;50(5):448–54.

Zhu K, van Hilten JJ, Marinus J. Onset and evolution of anxiety in Parkinson’s disease. Eur J Neurol. 2017;24:404–11.

Jasinska-Myga B, Putzke JD, Wider C, Wszolek ZK, Uitti RJ. Depression in Parkinson’s disease. Can J Neurol Sci. 2010;37(1):61–6.

Becker C, Brobert G, Johansson S, Jick S, Meier C. Risk of incident depression in patients with Parkinson disease in the UK. Eur J Neurol. 2010;18(3):448–53.

Schrag. Quality of life and depression in Parkinson’s disease. J Neurol Sci. 2006;248:151–7.

Ziropadja L, Stefanova E, Petrovic M, Stojkovic T, Kostic VS. Apathy and depression in Parkinson’s disease: the Belgrade PD study report. Parkinsonism Relat Disord. 2012;18:339–42.

Fereshtehnejad S-M, Hadizadeh H, Farhadi F, Shahidi GA, Delbari A, Lökk J. Comparison of the psychological symptoms and disease-specific quality of life between early- and typical- onset Parkinson’s disease patients. Parkinson’s Dis. 2014;819260:1.

Zhu J, Lu L, Pan Y, Shen B, Xu S, Hou Y, et al. Depression and associated factors in nondemented Chinese patients with Parkinson’s disease. Clin Neurol Neurosurg. 2017;163:142–8.

Borek L, Kohn R, Friedman J. Mood and sleep in Parkinson’s disease. J Clin Psychiatry. 2006;67(06):958–63.

Herath TB, Withana M, Rodrigo C, Gamage R, Gamage C. Prevalence and associations for symptoms of depression in patients with Parkinson’s disease: a Sri Lankan experience. Int J Ment Heal Syst. 2016;10:47.

Worku DK, Yifru YM, Postels DG, Gashe FE. Prevalence of depression in Parkinson’s disease patients in Ethiopia. J Clin Mov Disord. 2014;1:10.

Arun MP, Bharath S, Pal PK, Singh G. Relationship of depression, disability, and quality of life in Parkinson’s disease: a hospital-based case-control study. Neurol India. 2011;59:185–9.

Yamanishi T, Tachibana H, Oguru M, Matsui K, Toda K, Okuda B, et al. Anxiety and depression in patients with Parkinson’s disease. Intern Med. 2013;52(5):539–45.

Lee Y, Oh JS, Chung SJ, Lee JJ, Chung SJ, Moon H, et al. The presence of depression in de novo Parkinson’s disease reflects poor motor compensation. PLoS One. 2018;13(9):e0203303.

Kanda F, Oishi K, Sekiguchi K, Kuga A, Kobessho H, Shirafuji T, et al. Characteristics of depression in Parkinson’s disease: evaluating with Zung’s self-rating depression scale. Parkinsonism Relat Disord. 2008;14:19–23.

Piccinni A, Marazziti D, Veltri A, Ceravolo R, Ramacciotti C, Carlini M, et al. Depressive symptoms in Parkinson’s disease. Compr Psychiatry. 2012;53:727–31.

Dissanayaka NN, Sellbach A, Matheson S. Anxiety disorders in Parkinson’s disease: prevalence and risk factors. Mov Disord. 2010;25(7):838–45.

Jacob EL, Gatto NM, Thompson A, Bordelon Y, Ritz B. Occurrence of depression and anxiety prior to Parkinson’s disease. Parkinsonism Relat Disord. 2010;16:576–81.

Leentjens AF, Dujardin K, Marsh L, Martinez-Martin P, Richard IH, Starkstein SE. Symptomatology and markers of anxiety disorders in Parkinson’s disease: a cross-sectional study. Mov Disord. 2011a;26:484–92.

Leentjens AF, Moonen AJ, Dujardin K, Marsh L, Martinez-Martin P, Richard IH. Modeling depression in Parkinson disease: disease-specific and non-specific risk factors. Neurology. 2013;81:1036–43.

Dissanayaka NN, Sellbach A, Silburn PA, O'Sullivan JD, Marsh R, Mellick GD. Factors associated with depression in Parkinson’s disease. J Affect Disord. 2011b;132(1–2):82–8.

Lee WJ, Tsai CF, Gauthier S, Wang SJ, Fuh JL. The association between cognitive impairment and neuropsychiatric symptoms in patients with Parkinson’s disease dementia. Int Psychogeriatr. 2012;24:1980–7.

Foster PS, Drago V, Mendez K, Witt JC, Crucian GP, Heilman KM. Mood disturbances and cognitive functioning in Parkinson’s disease: the effects of disease duration and side of onset of motor symptoms. J Clin Exp Neuropsychol. 2013;35:71–82.

Burn DJ, Landau S, Hindle JV. Parkinson’s disease motor subtypes and mood. Mov Disord. 2012;27:379–86.

Menon B, Nayar R, Kumar S, Cherkil S, Venkatachalam A, Surendran K, et al. Parkinson’s disease, depression, and quality-of-life. Indian J Psychol Med. 2015;37(2):144–8.

Soh SE, Morris ME, McGinley JL. Determinants of health-related quality of life in Parkinson’s disease: a systematic review. Parkinsonism Relat Disord. 2011;17:1–9.

Lawrence BJ, Gasson N, Kane R, Bucks RS, Loftus AM. Activities of daily living, depression, and quality of life in Parkinson’s disease. PLoS One. 2014;9(7):e102294.

Hanna K, Cronin-Golomb A. Impact of anxiety on quality of life in Parkinson’s disease. Parkinsons Dis. 2012;2012:640–707.

Quelhas R, Costa M. Anxiety, depression and quality of life in Parkinson’s disease. J Neuropsychiatr Clin Neurosci. 2009;21:413–9.

Jeffrey S. Psychiatric symptoms have greater impact in early vs late PD. Medscape medical news; 2007.

Shearer J, Green C, Counsell CE, Zajicek JP. The impact of motor and non-motor symptoms on health state values in newly diagnosed idiopathic Parkinson’s disease. J Neurol. 2011;259(3):462–8.