Depression and anxiety are common in Parkinson's disease (PD) and although clinically important remain poorly understood and managed. To date, research has tended to treat depression and anxiety as ...distinct phenomena. There is growing evidence for heterogeneity in PD in the motor and cognitive domains, with implications for pathophysiology and outcome. Similar heterogeneity may exist in the domain of depression and anxiety.
To identify the main anxiety and depression related subtype(s) in PD and their associated demographic and clinical features.
A sample of 513 patients with PD received a detailed assessment of depression and anxiety related symptomatology. Latent Class Analysis (LCA) was used to identify putative depression and anxiety related subtypes. Results LCA identified four classes, two interpretable as 'anxiety related': one anxiety alone (22.0%) and the other anxiety coexisting with prominent depressive symptoms (8.6%). A third subtype (9%) showed a prominent depressive profile only without significant anxiety. The final class (60.4%) showed a low probability of prominent affective symptoms. The validity of the four classes was supported by distinct patterns of association with important demographic and clinical variables.
Depression in PD may manifest in two clinical phenotypes, one 'anxious-depressed' and the other 'depressed'. However, a further large proportion of patients can have relatively isolated anxiety. Further study of these putative phenotypes may identify important differences in pathophysiology and other aetiologically important factors and focus research on developing more targeted and effective treatment.
Parkinson's disease (PD) is a common neurodegenerative disease and the diagnosis of its idiopathic form remains challenging. The diagnosis of idiopathic form is based on clinical features which can ...have poor sensitivity with about 25% of patients diagnosed as having the disease actually having other conditions. In this study we assess the suitability and clinical value of a low cost computer-based system as an aid to diagnosis of PD, in particular the presence of tremor. All participants (12 patients and 10 controls) performed a shape-tracing task using a graphic tablet attached to a laptop. To assess the presence of tremors in the collected data, a statistical spectral analysis of the moment-to-moment fluctuations in the position signal of the output from the digitising tablet was performed. This allowed the comparison of power spectrums obtained from the control and patient responses respectively. A peak in log power between the 5 Hz & 6 Hz can clearly be identified in the patient's spectrum and is indicative of Parkinson's related tremor and no similar peak could be seen in the control's spectrum, suggesting this type of sequential task and automated data analysis may be useful in the diagnosis of tremor.
Anticholinergic drugs have been associated with cognitive changes when used for treating Parkinson's disease. 4 Changes in mental state secondary to oxybutynin have not been described in the ...literature and are not referred to in the British National Formulary. 5 The Committee on Safety of Medicines has received reports of 73 psychiatric adverse reactions to oxybutynin; these include 13 of confusion, 1 of paranoia, and 13 of hallucinations (Committee on Safety of Medicines, personal communication). The deficit in acetylcholine in patients who have Alzheimer's disease is due to loss of forebrain neurones that innervate the cortex. 6 Several studies have shown reduced activity of acetylcholine transferase (a marker of cholinergic innervation) in the frontal cortex in Parkinson's disease. 7 Atrophy of Meynert's nucleus, which is the source of cholinergic innervation of the cortex, has been found in Alzheimer's and Parkinson's disease. 8 Changes in muscarinic receptor density, sensitivity, and binding in the frontal cortex have also been described. 11 12 11 Oxybutynin crosses the blood-brain barrier and may cause electroencephalographic abnormalities in healthy volunteers. 12 Muscarinic receptors are widespread in the central nervous system, especially postsynaptic M1 and M2 receptors. 13 Oxybutynin acts primarily on M1 receptors; hence unwanted central nervous system side effects should be expected.
Gait disturbance is common in patients with Alzheimer's disease (AD). The aim of this study was to analyse the clinical gait syndromes of patients with AD using Nutt's classification. Fifty-five ...patients who satisfied the NINCDS-ADRDA criteria for probable AD and 55 controls were recruited from a geriatric and a psychogeriatric unit. Patients with classical musculoskeletal or neurological syndromes causing gait disturbance were excluded. A standardized neurological examination was carried out in all subjects. Twenty-two (40%) patients and ten (18%) controls had a higher level gait disorder (p < 0.01). The pattern of gait disturbance in AD patients varied according to the stage of the disease. Cautious gait was the commonest gait disorder in AD patients with mild dementia, while frontal gait disorder was the commonest disturbance in patients with severe dementia. The prevalence of frontal release signs (gegenhalten or any primitive reflex) was highest among patients with frontal gait disorder.
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