Abstract
Objective: To investigate the clinical features and neurochemical changes in Parkinson's disease with depression (PD-D).Methods: A total of 478 PD patients were divided into PD-D and PD patients without depression (PD-ND) groups according to the 24-item Hamilton Depression Rating Scale (HAMD) score. Demographic variables, motor and non-motor symptoms and activities of daily living were evaluated. The independent influencing factors of PD-D were investigated via binary logistic regression analysis. The levels of neurotransmitters in cerebrospinal fluid (CSF) were measured and their correlations with HAMD score were analyzed.Results: The proportion of PD-D was 59.0%, of which 76.95, 20.92, and 2.13% had mild, moderate, and severe depression, respectively. Anxiety/somatization was the most prevalent sub-factor of HAMD in PD-D. The scores of UPDRS III, postural instability/gait difficulty (PIGD) type and the scores of 14-item Hamilton Anxiety Scale (HAMA) and 14-item Chalder Fatigue Scale (FS) were independently associated with PD-D. The levels of dopamine (DA) and 5-hydroxytryptamine (5-HT) were all significantly reduced in PD-D group compared with those in PD-ND group. HAMD scores were negatively correlated with the DA levels in CSF.Conclusions: PD patients have a high proportion of depression, mainly of mild and moderate levels. The profile of depression in PD population is subtly different from that of the general population. Motor symptoms, PIGD type, anxiety and fatigue are the significant influencing factors of PD-D. Compared to 5-HT, DA may play a more important role in PD-D.
Highlights
Parkinson’s disease (PD) is a common neurodegenerative disorder with both the characteristic motor symptoms and a variety of non-motor symptoms
Anxiety/somatization was the most common subfactor reported in PD with depression (PD-D) group at 99.30%, followed by retardation symptoms (97.51%) and hopelessness symptoms (89.71%)
Anxiety/somatization occurred in the largest frequency of PD-ND patients, but compared with those of PD-D, the frequency of each sub-factor of Hamilton Depression Scale (HAMD) was much lower
Summary
Parkinson’s disease (PD) is a common neurodegenerative disorder with both the characteristic motor symptoms and a variety of non-motor symptoms. Depression, one of the most common non-motor symptoms of PD [1], used to be regarded as a psychological reaction to PD, and frequently be underestimated and undertreated. There were few studies that investigated the relationship between clinical type of PD and PD-D. For non-motor symptoms, most studies agreed that anxiety was the independent influencing factor [8], but other non-motor symptoms, for instance, fatigue, cognitive decline and sleep disturbances, had considerably varied reports [4, 9]. There are few studies investigating the sub-factors of the 24-item Hamilton Depression Scale (HAMD) in PD-D
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