Abstract Depression is a prominent non-motor symptom in Parkinson's disease (PD). Assessing depression in PD remains a challenge due to the overlap of somatic symptoms between depression and PD. ...Other neuropsychiatric manifestations associated with PD, such as cognitive decline, also complicate assessment of depression. Therefore it is critical to investigate the validity of depression rating scales for use in PD. This will allow evaluation of observer- and self-report instruments to be administered in neurologically ill geriatric populations such as PD, and identification of appropriate scales to use in cognitively challenged PD patients. The present review includes all studies examining the validity of depression rating scales in PD. It discusses the usefulness of 13 depression rating scales in PD. The clinician-rated and widely used HAMD-17 and the self-report GDS scales are recommended for screening and measuring severity of depression in PD. The GDS-15 may be a preferred choice due to its brevity and ease of use design for older adults. Other valid and reliable instruments to use in PD include self-rated scales, such as the HADS-D, HDI, and the BDI, and the observer-report, MADRS. The CSDD displayed satisfactory validity and reliability for identification of PD patients with and without dementia. The PHQ-2, PHQ-10, SDS, CES-D, UPDRS-Depression item, IDS-SR, and IDS-C each showed some evidence of validity or reliability, however further research on the psychometric properties of these scales when used in a PD population are required.
Abstract Background Depression is common in Parkinson's disease (PD) and contributes significantly to a reduced quality of life in PD patients. The determinants of depression in PD are complex and ...poorly understood. We investigated the factors associated with depression in PD. Methods PD patients were recruited from Neurology clinics. A validated method was used to screen for a lifetime history of depression. ‘Depressed’ patients were identified by a score of > 6 in the Geriatric Depression Scale (GDS-15) or by having had prescribed treatment for depression. ‘Never depressed’ patients were recognised by a score of < 5 in the GDS-15 with no signs of a history of depression. A newly developed and validated questionnaire was used to collect other information. Results Depression was identified in 66% of the 639 PD patients who met the inclusion criteria. Depression was associated with an increased severity of illness as evidenced by higher Unified PD Rating Scale scores and a higher Hoehn and Yahr stage. Other clinical factors associated with disease severity were also more frequently observed in depressed patients. Similar to findings in non-PD samples, depressed PD patients were more likely to have a lower education level, a history of smoking and to regularly use non-aspirin based NSAIDs or analgesics. Comorbidities such as anxiety, memory problems, hallucinations, sleep disturbances and postural hypotension were more common in depressed PD patients. Limitations To avoid patient exhaustion of over-surveying, some factors within the psychological domain were not examined. Conclusion Our results provide a focus for future intervention strategies.
To identify the prevalence of anxiety symptoms using a variety of instruments in an Australian memory clinic sample.
This is an exploratory cross-sectional study using a purposive consecutive series ...sample of 163 individuals and their carers who attended a Brisbane, Australia, memory clinic in 2012-2015. Descriptive statistics and correlation analyses were performed to explore different approaches to measuring anxiety in the sample, using clinician-rated, self-report and carer-report measures.
The mean age of participants was 78 years, nearly 53% were females. Over 70% of participants with mild cognitive impairment (MCI) and dementia (n = 163) experienced mild to moderate anxiety per a clinician-rated measure (HAM-A), which moderately correlated with carer-report anxiety (IQAD; r
s
=.59, p < .001). Only weak correlations of these measures with self-report anxiety (GAI) were detected.
Mild to moderate anxiety symptoms were frequent in memory clinic attendees diagnosed with MCI or dementia using the HAM-A, suggesting experiences of subclinical anxiety symptoms.
Self- as well as carer-report screening tools should be used in memory clinics in addition to routinely administered neuropsychiatric assessments to support early identification of anxiety symptoms and mapping of available post-diagnostic care pathways for people diagnosed with cognitive impairment.
Abstract Introduction Anxiety and mild cognitive impairment (MCI) are prevalent non-motor manifestations of Parkinson's disease (PD). While few studies have demonstrated a possible link between ...cognitive dysfunction and anxiety in PD, to our knowledge, no studies have directly examined the association between them. This study investigated the association between anxiety and cognitive deficits in newly diagnosed PD patients. Methods Patients with newly diagnosed PD (N = 185) were recruited from community and outpatient clinics. Anxiety was assessed using the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) clinician rated anxiety item, which has previously been validated against a standardized criteria for the diagnosis of anxiety disorders in PD. Participants scoring ≥2 were classified as anxious. A threshold of 1 SD below normative values (obtained from controls) was used to define cognitive impairment. Impairments in specific cognitive domains were identified as being >1 SD below controls in ≥1 test per domain. Results After controlling for age, education and motor severity, patients with anxiety were three times more likely to have cognitive impairment compared to those without anxiety (OR = 3.0, 95% CI = 1.2–7.3, p < 0.05). Patients with anxiety were more than twice as likely to be classified as having cognitive impairment due to impairment in the memory domain compared with PD without anxiety (OR = 2.3, 95% CI = 1.0–5.1, p < 0.05), whilst no associations were found between anxiety and performance on other cognitive domains. Conclusion This study shows an association between anxiety and cognitive impairment (specifically memory impairment). Examining the neural basis of this association warrants future research in this developing field.
•Tremor severity changes psychological and social functioning exacerbating disability.•In ET greater impairment is experienced in social situations.•Tremor severity and tremor disability in ET, ...exhibit weak association.•ET patients exhibit cognitive abnormalities and higher avoidant personality types.•Proposed model present behavioral and cognitive factors that exacerbate disability.
Growing evidence suggests that patients with essential tremor (ET) show impairment in psychosocial functions and subsequently increasing vulnerability to anxiety. Here we review evidence supporting a positive relationship between self-reported motor disability and psychological symptoms in ET and critically analyze evidence suggesting how psychosocial factors enhance tremor disability in ET. Theories related to motor competency, behavioral conditioning, and social anxiety have been proposed to relate self-concepts to self-reported tremor disability. We review these theories and then propose a new model in an effort to focus on the self-concepts among ET patients as a factor in tremor disability. Patients with ET exhibited cognitive abnormalities, depression, anxiety, and a higher prevalence of avoidant personality types. Although anxiety, depression and personality types may influence tremor disability in ET, self-concepts may better explain perceived tremor disability in social situations. We conclude by discussing a proposed biopsychosocial model and suggesting future research on ET specific assessment tools and intervention methods.
Changes in reward circuitry have been studied extensively in substance and behavioural addictions. However, comparatively little is known about the neurobiology underlying impulse control disorders ...(ICDs) in Parkinson’s disease, which show roughly similar risk factors and behavioural presentations to both stimulant and behavioural addictions. ICDs occur in a subset of susceptible patients with Parkinson’s disease (PD) following intake of dopamine replacement therapy (DRT). These behavioural disorders often have debilitating effects on a patient’s quality of life and increase caregiver burden. This comprehensive review examined findings of 40 neuroimaging studies of ICDs in PD to determine (a) whether there are putative neurobiological commonalities between traditional substance and behavioural addictions and DRT-induced ICD in PD and (b) opportunities for future studies to advance current neurobiological understanding of the phenomenon. Results revealed that strikingly similar (a) deficits in dopaminergic receptor expression, (b) connectivity changes in corticostriatal circuitry and (c) neural responses to cue exposure are observed in both ICDs in PD and addictive disorders. These findings point to the value of adopting a transdiagnostic approach when studying addicted populations and pave the way for demystifying this peculiar, often-devastating phenomenon in PD that has so far proven extremely difficult to treat and predict with any precision.
Abstract Background Delirium has conventionally been considered a disorder of consciousness. Alertness and arousal are used as surrogates in clinical practice but are insufficient for the purposes of ...a more dimensional assessment of consciousness. We present a process of development and validation of candidate measures of phenomenal consciousness that could be applied to the diagnosis of delirium. Methods First, a narrative review of available instruments in the fields of phenomenal consciousness, including prereflective consciousness, the phenomenal-sensed experience and reflective thought, was undertaken. Eligibility of tools in the context of applicability to delirium was based upon objectivity in test interpretation and the requirement for tester administration. Second, where there was a gap in suitable cognitive tools, new items were derived using the silent generation technique. A process of face and construct validity using a diverse panel of experts was performed, and readability was evaluated. Results 814 articles were screened from the literature review. Fourteen candidate tools were reported from the three domains of phenomenal consciousness. One of these met the eligibility criteria for a delirium assessment. Fifty-seven new tests of phenomenal consciousness were identified. After a process of item reduction, a total of 26 individual tests were identified. After content validity, 22 of the 26 items were retained. The scale average content validity index was 0.89. The agreement between raters was between 80% and 97%. 100% of responses for face validity were rated as positive. Flesch Reading Ease Score was 91.6 (very easy to read). Conclusions Candidate measures of phenomenal consciousness are described, and early validity studies are promising.
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