Effect of depressive symptoms on quality of life in middle-aged and elderly patients with Parkinson's disease: a 4-year follow-up study

Abstract

Objective To analyze the impact of depressive symptoms on quality of life in patients with Parkinson's disease(PD)based on middle- and long-term follow-up study, and to explore predictors for the reduced quality of life in PD patients. Methods Clinical data of 80 PD patients were searched from the electronic database in our research center.Patients who had complete general information and the following data of unified Parkinson's disease rating scale(UPDRS), Hoehn and Yahr scale(HY), mini-mental state examination(MMSE), Hamilton depression rating scale(HAMD), Hamilton rating scale for anxiety(HAMA), the 39-item Parkinson's disease questionnaire(PDQ-39), etc.after one-year follow-up were included in this study.The differences in quality of life were analyzed and compared among the non-depression group(n=38), depression remission group(n=22)and depression group(n=20). A follow-up visit was conducted after four years.The disease progression and decline in quality of life were compared between the depression and non-depression groups according to the baseline value of the Hamilton Depression Rating Scale.According to the change in PDQ-39 value, cluster analysis was used to reclassify patients into fast-decline group and slow-decline group.Logistic regression analysis was used to determine independent risk factors for the decline of quality of life. Results At the end of 1 year follow-up, the quality of life was decreased in the depression group as compared with the baseline(P=0.017), and the score of PDQ-39 was higher in the depression group than in the non-depression group and depression remission group.At the end of 4-year follow-up, UPDRS total score, UPDRSⅢ score, HY stage and PDQ-39 score were increased as compared with the baseline, the quality of life decreased more significantly, and the disease progressed faster in the depression group than the other two groups(P<0.05). The differences in the disease course, total score of UPDRS, HY stage and HAMD score were statistically significant between the fast-decline group and slow-decline group(P=0.001, 0.039, 0.003 and <0.001, respectively). Logistic regression analysis showed that disease course(OR=1.254, P=0.020), and baseline HAMD score(OR=1.450, P=0.003)were the independent risk factors for the decline of quality of life. Conclusions The quality of life of PD patients is worse in the depression group than in the depression remission group and non-depression group.In PD patients with depressive symptoms, the illness progression is faster, and the quality of life is decreased more significantly.The disease course and depression can predict the decline of quality of life in PD patients. Key words: Parkinson's disease; Depression; Quality of life; Follow-up studies