The purpose of this study was to investigate the prevalence and clinical correlates of apathy and depression in Parkinson disease (PD), and to clarify whether apathy can be dissociated from depression. One hundred fifty patients with PD completed the Beck Depression Inventory Second Edition (BDI-II), Starkstein’s Apathy Scale (AS), and a quality of life (QOL) battery. Hoehn and Yahr (HY) staging, the Unified Parkinson’s Disease Rating Scale (UPDRS), and the Mini-Mental State Examination (MMSE) were performed on the same day. Apathy (AS score ≥ 16) was diagnosed in 60% of patients and depression (BDI-II score ≥ 14) in 56%. Apathy coexisted with depression in 43% of patients, compared with depression without apathy in 13% and apathy without depression in 17%. Apathy scale score was significantly correlated with UPDRS scores, HY stage, and age, whereas BDI-II score was correlated only with UPDRS scores. Both AS and BDI-II scores were negatively correlated with QOL. However, multiple regression analysis revealed that depression was strongly and negatively associated with emotional well-being and communication, whereas apathy was mainly associated with cognition and stigma. These findings suggest that apathy and depression may be separable in PD, although both are common in patients with PD and are associated with QOL.
Marin RS, Firinciogullari S., Biedrzycki RCGroup differences in the relationship between apathy and depression . J Nerv Ment Dis. 1994;182(4):235-239.
4.
Levy ML, Cummings JL, Fairbanks LA, et al. Apathy is not depression. J Neuropsychiatry Clin Neurosci. 1998;10(3):314-319.
5.
Kirsch-Darrow L., Fernandez HF, Marsiske M., et al. Dissociating apathy and depression in Parkinson’s disease. Neurology . 2006 ; 67(1):33-38.
6.
Schrag A., Jahanshahi M., Quinn N.What contributes to quality of life in patients with Parkinson’s disease ? J Neurol Neurosurg Psychiatry. 2000;69(3):308-312.
7.
Slaweka J., Derejko M., Lass P.Factors affecting the quality of life of patients with idiopathic Parkinson’s disease-a cross-sectional study in outpatient clinic attendees . Parkinsonism Relat Disord. 2005;11(7):465-468.
8.
Carod-Artal FJ , Vargous AP, Martinez-Martin P.Determinants of quality of life in Brazilian patients with Parkinson’s disease. Mov Disord. 2007;22(10):1408-1415.
9.
Rahman S., Griffin KJ, Quinn NP, Jahanshahi M.Quality of life in Parkinson’s disease: the relative importance of the symptoms. Mov Disord. 2008;23(10):1428-1434.
10.
Hughes AJ, Daniel SE, Kilford L., Lees AJAccuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinicopathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992;55(3):181-184.
11.
Deuschl G., Schade-Brittinger C., Krack P., et al. A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med. 2006;355(9):896-908.
12.
Fahn S., Elton RLUnified Parkinson’s Disease Rating Scale. In: Fahn S, Marsden CD, Calne D, et al., eds. Recent developments in Parkinson’s disease. Florham Park, NJ: McMillan Health Care Information; 1987:153-163.
13.
Folstein MF , Folstein SE, McHugh PRMini-mental state. A practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res. 1975;12(3):189-198.
14.
Levin BE, Lllabre MM, Weiner WJParkinson’s disease and depression: psychometric properties of the Beck Depression Inventory. J Neurol Neurosurg Psychiatry . 1988;51(11):1401-1404.
15.
Starkstein SE, Mayberg HS, Preziosi T., Andrezejewski P., Leiguarda R., Robinson RGReliability, validity, and clinical correlates of apathy in Parkinson’s disease. J Neurophychiatry Clin Neurosci. 1992;4(2):134-139.
16.
Schrag A., Selai C., Jahanshahi M., Quinn NP. The EQ-5D-a generic quality of life measure is a useful instrument to measure quality of life in patients with Parkinson’s disease . J Neurol Neurosurg Psychiatry. 2000;69(1):67-73.
Beck AT, Steer RA, Brown GKJapanese version BDI-II (Beck Depression Inventory, Second Edition) , Nihon Bunka Kagakusho, Tokyo , 2003 :2-11.
19.
Okada K., Kobayashi S., Aoki K., et al. Assessment of motivational loss in poststroke patients using the Japanese version of Starkstein’s Apathy Scale. Jpn J Stroke. 1998;20(3):318-323.
20.
Leentjens AFG , Dujardin K., Marsh L., et al. Apathy and anhedonia rating scales in Parkinson’s disease. Critique and recommendations. Mov Disord. 2008;23(14):2004-2014.
21.
Japanese EuroQoL Translation Team.The development of the Japanese EuroQoL instrument. Iryo to Shakai. 1998;8(1):109-123.
22.
Kohmoto J., Ohbu S., Nagaoka M., et al. Validation of the Japanese version of the Parkinson’s disease questionnaire. Clin Neurol. 2003;43(3):71-76.
23.
Hobson DE, Lange AE, Martin WR, Razmy A., Rivest J., Fleming J.Excessive daytime sleepiness and sudden-onset sleep in Parkinson’s disease: a survey by the Canadian Movement Disorders Group. JAMA. 2002;287(4):455-463.
24.
Shulman LM, Taback RL, Bean J., Weiner WJComorbidity of the nonmotor symptoms of Parkinson’s disease . Mov Disord. 2001;16(3):507-510.
25.
Aarsland D. , Larsen JP, Lim NG, et al. Range of neuropsychiatric disturbances in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1999;67(4):492-496.
26.
Pluck GC, Brown RGApathy in Parkinson’s disease. J Neurol Neurosurg Psychiatry . 2002;73(6):636-649.
27.
Isella V., Melzi P., Grimaldi M., et al. Clinical, neuropsychological, and morphometric correlates of apathy in Parkinson’s disease. Mov Disord. 2002;17(2):366-371.
28.
Dujardin K. , Sockeel P., Deros D., et al. Characteristics of apathy in Parkinson’s disease. Mov Disord. 2007;22(6):778-784.
29.
Pederson KFm Larsen JP, Alves G., Aarsland D.Prevalence and clinical correlates of apathy in Parkinson’s disease: a community-based study . Parkinsonism Relat Disord. 2009; 15(4):295-299.
30.
Sockeel P., Dujardin K., Devos D., et al. The Lille apathy rating scale (LARS), a new instrument for detecting and quantifying apathy: validation in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2006;77(5):579-584.
31.
Kusumi M., Nakashima K., Harada H., Nakayama H., Takahashi K.Epidemiology of Parkinson’s disease in Yonago city, Japan -comparison with a study carried out 12 years ago. Neuro-epidemiology . 1996;15(4):201-207.
32.
Cole SA, Woodard JL, Juncos JL, Kogos JL, Youngstrom EA, Watts RLDepression and disability in Parkinson’s disease: a quantitative and qualitative analysis. J Neuropsychiatry Clin Neurosci . 1996;8(1):20-25.
33.
Starkstein SE, Preziosi TJ, Bolduc PL, Robinson RGDepression in Parkinson’s disease. J Nerv Ment Dis. 1990;178(1):27-31.
34.
Fleminger S.Left-sided Parkinson’s disease is associated with greater anxiety and depression. Psychol Med. 1991;21(3): 629-638.
35.
Richard IHApathy does not equal depression in Parkinson’s disease. Why we should care. Neurology. 2006;67(1):10-11.
36.
Mayeux R., Stern Y., Rosen J., Leventhal J.Depression, intellectual impairment, and Parkinson’s disease . Neurology. 1981;31(6): 645-650.
37.
Starkstein SE, Preziosi TJ, Nerthier ML, Bolduc PL, Mayberg HS, Robinson RGDepression and cognitive impairment in Parkinson’s disease. Brain . 1989;112(pt 5):1141-1153.
38.
Wichowicz HM , Stawek J., Derejko M., Cubała WJFactors associated with depression in Parkinson’s disease: a cross-sectional study in a Polish population. Eur Psychiatry. 2006; 21(8):516-520.
39.
Stella F., Banzato CE, Barasnevicius Quagliato EM, Viana MADepression in patients with Parkinson’s disease: impact on functioning . J Neurol Sci. 2008;272(1-2):158-163.
40.
Ehmann TS, Beninger RJ, Gawel MJ, Riopelle RJDepression synptoms in Parkinson’s disease: a comparison with disabled control subjects. J Geriatr Psychiatry Neurol. 1990;3(1):3-9.
41.
Kanda F., Oishi K., Sekiguchi K., et al. Characteristics of depression in Parkinson’s disease: evaluating with Zung’s self-rating depression scale. Parkinsonism Relat Disord. 2008;14(1):19-23.
Den Oudsten B., Van Heck GL, De Vries J.Quality of life and related concepts in Parkinson’s disease: a systematic review. Mov Disord. 2007;22(11):1528-1537.
