Anxiety and depression in Parkinson's disease patients in Saudi Arabia Global neurology

Abstract

Parkinson's disease is the most common movement disorder in Saudi Arabia. Among the most common non-motor symptoms of PD are anxiety and depression. Mental health disorders, however, still remain taboo subjects in the region. This brief article sheds light on a small study conducted on Saudi PD patients, and discusses current challenges for managing them in the region. Given the wider readership of JNS's Global Neurology, this piece is hoped to appeal to the appropriate audience. Classically a motor disorder, Parkinson's disease (PD) results in many non-motor symptoms, some of which have been recognised since the first description of the “shaking palsy” by James Parkinson [1]. Only recently, however, research on non-motor symptoms of PD has gainedmomentum [2–4]. The PRIAMO study evaluated 1072 Italian PD patients and observed that 98.6% of PD patients experienced such symptoms [5]. Psychological complaints were the most common, including anxiety in 56% and depression in 22.5% patients [5]. Sociocultural factors have been shown to influence the prevalence [6,7], perception [8] and even clinical presentation of anxiety and depression [9,10]. Large-scale epidemiological studies on mental health disorders are largely lacking in Saudi Arabia, as most studies involve selective patient samples (e.g. medical students or dialysis patients) [11–13]. In a cross-sectional study from South-eastern Saudi Arabia on general practice patients (n = 280), around 10% screened positively for depression [14]. Little is known about the prevalence and nature of anxiety and depression in PD patients in Saudi Arabia. In a clinical study [15] that alluded to non-motor symptoms in 54 PD patients in Saudi Arabia, depression was the second most prevalent symptom, exceeded only by constipation. The only available data on anxiety and depression come from a small cohort (n=18) of Saudi PD patients (Alamri, unpublished).When compared with another ageand sex-matched cohort from New Zealand (n = 30), Saudi PD patients scored significantly higher on the HADS depression subscale (mean 11.7 vs. 9.5, p = 0.004), but not anxiety subscale (4.7 vs. 5.6, p = 0.36) or the total HADS scores (11.7 vs. 9.5, p = 0.23).