Occurrence Risk and Structure of Depression in Parkinson Disease With and Without Dementia: Results From the GEPAD Study

Abstract

Background: This study examined the age- and gender-specific risk of depression in demented and non-demented participants, its symptom structure, and associated clinical factors in a nationwide random sample of n = 1449 outpatients with Parkinson disease (PD). Methods: Depression ratings were based on a cross-sectional clinical assessment including the clinical Montgomery-Asberg Depression Rating Scale (MADRS ≥ 14). Parkinson disease severity was rated according to Hoehn and Yahr (HY) and the Unified Parkinson's Disease Rating Scale. Diagnosis of dementia was based on Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition; DSM-IV) criteria. Results: 25.2% (CI: 22.8-27.5) of all patients met study criteria for depression. Additionally, 8.4% of patients did not exceed the MADRS cut-off but were currently being treated with antidepressants, possibly suggesting a corrected (upper limit) total prevalence of 33.6%. Females were more likely depressive than males (29.3% vs 22.4%). In both genders, depression risk was elevated 2- to 4-fold depending on HY stage. Overall, highest rates in non-demented patients were found in females at stages IV to V (53.7%, CI: 37.7-69.6). Demented patients were more likely to meet depression criteria than non-demented (up to 76.2%, 95% CI: 60.5-87.9). Depression symptom profiles for demented PD patients (as compared to non-demented) revealed no structural differences but consistently higher symptom scores. Neither age at onset of PD nor duration of disease were significantly linked with depression. Conclusions: Depression rates are already substantially elevated at early PD stages, emphasizing the need for a thorough examination of mood disorders in all patients with PD. Depression is associated with PD severity and dementia but not with age, age at onset of PD, or disease duration. The differential associations with dementia and the statistical independence of dementia and depression also suggest that depression could not be regarded as a mere demoralisation syndrome.

Keywords

Parkinson disease depression non-motor symptoms MADRS cognitive impairment dementia

Get full access to this article

View all access options for this article.

References

Chaudhuri KR , Healy DG , Schapira AH , and the National Institute for Clinical Excellence. Non-motor symptoms of Parkinson’s disease: diagnosis and management . Lancet Neurol. 2006;5(3): 235-245.

Aarsland D. , Zaccai J. , Brayne C. A systematic review of prevalence studies of dementia in Parkinson’s disease. Movement Disord. 2005;20(10):1255-1263.

Riedel O. , Klotsche J. , Spottke A. , et al. Cognitive Impairment in 873 patients with idiopathic Parkinson’s disease: results from the German Study on Epidemiology of Parkinson’s Disease with Dementia (GEPAD). J Neurol. 2008 ;255(2):255-264.

Reijnders J. , Ehrt U. , Weber W. , Aarsland D. , Leentjens A. A systematic review of prevalence studies of depression in Parkinson’s disease. Movement Disord . 2008;23(2):183-189.

McKinlay A. , Grace RC , Dalrymple-Alford JC , Anderson T. , Fink J. , Roger D. A profile of neuropsychiatric problems and their relationship to quality of life for Parkinson’s disease patients without dementia. Parkinsonism Relat Disord. 2008;14(1):37-42.

Lemke M. Depressive symptoms in Parkinson’s disease. Eur J Neurol . 2008;15(suppl 1):21-25.

Matsui H. , Nishinaka K. , Oda M. , et al. Depression in Parkinson’s disease-diffusion tensor imaging study. J Neurol. 2007;254(9): 1170-1173.

Aarsland D. , Larsen JP , Karlsen K. , Lim NG , Tandberg E. Mental symptoms in Parkinson’s disease are important contributors to caregiver distress. Int J Geriatr Psychiatry. 1999;14(10):866-874.

Miyashita M. , Narita Y. , Sakamoto A. , et al. Care burden and depression in caregivers caring for patients with intractable neurological diseases at home in Japan . J Neurol Sci. 2009; 276(1-2):148-152.

10.

Muslimovic D. , Post B. , Speelman J. , Schmand B. , de Haan R. Determinants of disability and quality of life in mild to moderate Parkinson disease. Neurology. 2008;70(23):2241-2247.

11.

Schrag A. , Jahanshahi M. , Quinn N. What contributes to depression in Parkinson’s disease? Psychol Med. 2001;31(1):65-73.

12.

Gelb D. , Oliver E. , Gilman S. Diagnostic criteria for Parkinson’s disease. Arch Neurol . 1999;56(1):33-39.

13.

Fahn S. Unified Parkinson’s disease rating scale. In: Fahn S , Calne D , eds. Recent Developments in Parkinson’s Disease. Florham Park, NJ: MacMillan Healthcare Information; 1987:153-163.

14.

Hoehn M. , Yahr M. Parkinsonism: onset, progression and mortality. Neurology . 1967;17(5):427-442.

15.

Cummings J. , Mega M. , Gray K. The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44(12):2308-2314.

16.

Essau CA , Wittchen HU An overview of the Composite International Diagnostic Interview (CIDI) . Int J Methods Psychiatr Res. 1993;3(2):79-85.

17.

Montgomery SA , Asberg M. A new depression scale, designed to be sensitive to change. Br J Psychiatry. 1979;134:382-389.

18.

Leentjens A. , Verhey F. , Lousberg R. , Spitsbergen H. , Wilmink F. The validity of the Hamilton and Montgomery-Asberg depression rating scales as screening and diagnostic tools for depression in Parkinson’s disease. Int J Geriart Psychiatry. 2000;15(7):644-649.

19.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-Text revision . 4th ed., Washington, DC: American Psychiatric Association; 2000.

20.

Zaudig M. , Hiller W. , Geiselmann B. , et al. SIDAM-Strukturiertes Interview für die Diagnose einer Demenz vom Alzheimer Typ, der Multiinfarkt-(oder vaskulären) Demenz und Demnzen anderer Ätiologien nach DSM-III-R, DSM-IV und ICD-10. Göttingen: Hogrefe; 1996.

21.

Folstein M. , Folstein S. , McHugh P. ‘‘Mini-mental state’’. A practical method for grading the mental state of patients by the clinician . J Psychiatr Res. 1975;12(3):189-198.

22.

Royall RM Model robust confidence intervals using maximum likelihood estimators . Int Statist Rev. 1986;54(2):221-226.

23.

Wichowicz H. , Slawek J. , Derejko M. , Cubala W. Factors associated with depression in Parkinson’s disease: a cross-sectional study in a Polish population. Eur Psychiat. 2006;21(8):516-520.

24.

Wittchen HU , Jacobi F. Size and burden of mental disorders in Europe-a critical review and appraisal of 27 studies. Eur Neuropsychopharm . 2005;15(4):357-376.

25.

Ehrt U. , Bronnick K. , Leentjens A. , Larsen JP , Aarsland D. Depressive symptom profile in Parkinson’s disease: a comparison with depression in elderly patients without Parkinson’s disease. Int J Geriatr Psychiatry. 2006;21(3):252-258.

26.

Brown R. , MacCarthy B. Psychiatric morbidity in patients with Parkinson’s disease. Psychol Med. 1990;20(1):77-87.

27.

Leentjens AF , Marinus J. , van Hilten JJ , Lousberg R. , Verhey FR The contribution of somatic symptoms to the diagnosis of depressive disorder in Parkinson’s disease: A discriminant analytic approach. J Neuropsychiatry Clini Neurosci. 2003;15(1):74-77.

28.

Reijnders K. , Ehrt U. , Lousberg R. , Aarsland D. , Leentjens A. The association between motor subtypes and psychopathology in Parkinson’s disease. Parkinsonism Relat Disord. 2009;15(5): 379-382.

29.

Rickards H. Depression in neurological disorders: an update . Curr Opin Psychiatry. 2006;19(3):294-298.

30.

Marsh L. Neuropsychiatric aspects of Parkinson’s disease. Psychosomatics . 2000;41(1):15-23.

31.

Marsh L. , McDonald W. , Cummings J. , Ravina B. Provisional diagnostic criteria for depression in parkinson’s disease: report of an NINDS/NIMH Work Group. Movement Disord . 2006;21(2): 148-158.