Depression in Patients with Parkinson’s Disease and the Associated Features

The study was aimed to examine the prevalence of depression in patients with Parkinson’s disease （PD） and identify its features. A total of 131 out-patients, diagnosed as having idiopathic PD in accordance with the United Kingdom Parkinson’s Disease Society Brain Bank criteria, were interviewed with questionnaire and evaluated by Mini-Mental State Examination （MMSE）, Unified Parkinson’s Disease Rating Scale （UPDRS）, Hohen ＆Yahr staging （H＆Y staging） and Hamilton Rating Scale for Depression （HRSD）. Patients were divided into three groups in terms of HRSD score： depression group, sub-threshold depression group and non-depression group. The clinical variables and symptom profiles were obtained and compared among the three groups. The results showed that 27 patients （20.6%） fell into the depression group, 71 （54.2%） into the sub-threshold depression group, and 33 （25.2%） into the non-depression group. There were no differences in age, gender or tremor score among the groups （P〉0.05）. Significant differences were found in duration of PD, UPDRS score, rigidity score and H＆Y stage between the sub-threshold depression group （or the depression group） and the non-depression group （P〈0.05）. Moreover, the clinical variables in the subthreshold depression group had the trend of increasing with the severity of PD and their values were similar to those in the depression group. Anhedonia, feeling of incapability, sleep disturbance, gastrointestinal symptoms and depressive moods were most common in the depression group. And these symptoms also were more common in the other two groups. It is concluded that depression and sub-threshold depression are common in PD and share similar clinical features. Furthermore, subthreshold depression might be the prodrome of depression and may develop into depression as the condition progresses.

Prevalence, clinical features and treatment of depression in Parkinson's disease: An update

Parkinson's disease(PD) is one of the most prevalent neurodegenerative diseases which typically affects individuals over 65 years. Although the symptomatology is predominantly motor, neuropsychiatric manifestations, e.g., depression, apathy, anxiety, and cognitive impairment occur in the course of the illness and can have a great impact on the quality of life in these patients. Parkinson's disease is commonly comorbid with depression with prevalence rates of depression, generally higher than those reported in general population. Depression in PD is frequently underestimated andconsequently undertreated, which have significant effects on the quality of life in these patients. The neurobiology of depression in PD is complex and involves alterations in dopaminergic, serotonergic, noradrenergic and possibly other neurotransmitter systems which are affected in the course of the disease. The tricyclic antidepressants and the selective serotonin reuptake inhibitors are the two classes of antidepressant drugs used for depressive symptoms in PD. Several published studies suggested that both classes are of comparable efficacy. Other serotonergic antidepressants, e.g., nefazodone and trazodone have also been of benefit. Meanwhile, there are limited data available on other drugs but these suggest a benefit from the serotonin and noradrenaline reuptake inhibitors such as mirtazapine, venlafaxine, atomoxetine and duloxetine. Some of the drugs used in symptomatic treatment of PD, e.g., the irreversible selective inhibitors of the enzyme monoamine oxidase-B, rasagiline and selegiline as well as the dopamine receptor agonist pramipexole are likely to have direct antidepressant activity independent of their motor improving action. This would make these drugs an attractive option in depressed subjects with PD. The aim of this review is to provide an updated data on the prevalence, clinical features of depression in subjects with PD. The effects of antiparkinsonian and antidepressant drugs on depressive symptoms in these patients are also discussed.

A novel method for evaluating brain function and microstructural changes in Parkinson's disease

In this study,microstructural brain damage in Parkinson＇s disease patients was examined using diffusion tensor imaging and tract-based spatial statistics.The analyses revealed the presence of neuronal damage in the substantia nigra and putamen in the Parkinson＇s disease patients.Moreover,disease symptoms worsened with increasing damage to the substantia nigra,confirming that the substantia nigra and basal ganglia are the main structures affected in Parkinson＇s disease.We also found that microstructural damage to the putamen,caudate nucleus and frontal lobe positively correlated with depression.Based on the tract-based spatial statistics,various white matter tracts appeared to have microstructural damage,and this correlated with cognitive disorder and depression.Taken together,our results suggest that diffusion tensor imaging and tract-based spatial statistics can be used to effectively study brain function and microstructural changes in patients with Parkinson＇s disease.Our novel findings should contribute to our understanding of the histopathological basis of cognitive dysfunction and depression in Parkinson＇s disease.

Efficacy of Pramipexole for Treatment of Apathy in Parkinson’s Disease

Background: Apathy occurs frequently in patients with Parkinson’s disease (PD), and has a negative impact on activities of daily living through loss of motivation. Pramipexole (PPX), which shows preferential affinity for D3 dopamine receptor in the mesolimbic system, is thought to influence mood and motivation. Therefore, we conducted an open-label case-control study to examine the effect of PPX on apathy in PD. Methods: We studied 36 PD patients (mean age, 70.4 ± 8.1 years), who had been treated only with L-DOPA. PPX was added to L-DOPA treatment in 24 patients (PPX group) and other 12 patients continued with L-DOPA alone (non-PPX group). The study period was 8 weeks. Apathy was assessed using the revised apathy scale for Japanese. Motor function was assessed with part III of the Unified Parkinson’s Disease Rating Scale (UPDRS). Results: Seventeen of 36 patients (47%) were diagnosed as having apathy. In the PPX group, apathy scale significantly improved from 17.3 to 13.8 at week 8 (p < 0.05). Motor function also improved significantly from 16.1 to 7.6 at week 8 (p < 0.0001). In the non-PPX group, apathy scale and UPDRS both showed no change during the study period. There was no correlation between changes in apathy scale and UPDRS in either the PPX or non-PPX group. Conclusion: PPX may be effective for treating apathy as well as motor dysfunction in PD.

Clinical features and relative factors of constipation in a cohort of Chinese patients with Parkinson's disease

BACKGROUND Constipation as a most common non-motor symptom of Parkinson's disease(PD),has a higher prevalence compared to the general population.The etiologies of constipation in PD are diverse.In addition to physical weakness and other factors of disease,the lifestyles and eating habits are also important factors.Therefore,the prevalence and influencing factors of constipation may vary among different populations.AIM To determine the prevalence of constipation and analyze relative factors in a cohort of Chinese patients with PD.METHODS All the patients diagnosed with PD according to the movement disorders society criteria were consecutively collected by a self-developed questionnaire.Rome III diagnostic criteria were used to assess functional constipation and Wexner score was used to estimate the severity of constipation.Non-motor symptoms(NMS)were assessed with the non-motor symptoms assessment scale(NMSS).Unified Parkinson's disease Rating Scale III(UPDRS III)was used to evaluate the severity of motor symptoms.The modified Hoehn-Yahr stage was used to evaluate the severity of PD.Cognitive function was assessed using Montreal cognitive assessment(MoCA).Depression and anxiety were rated with the Hamilton depression scale(HAMD)and the Hamilton anxiety scale(HAMA).Quality of life was assessed using the Parkinson’s disease Questionnaire-39 items(PDQ-39).RESULTS Of 166 patients enrolled,87(52.41%)were accompanied with constipation,and 30(34.48%)experienced constipation for 6.30±5.06 years before motor symptoms occurred.Age,Hoehn-Yahr stage,disease duration,levodopa medication times,incidence of motor complications,the scores of UPDRS total,UPDRS III,NMSS,HAMD,HAMA,and PDQ-39 in the constipation group were higher than those in the non-constipation group(P<0.05),but there was no difference in the scores of MoCA,clinical types,or medications between the two groups(P>0.05).There was a higher incidence of depression in patients with constipation(P<0.05),but there were no difference in the incidence of anxiety and cognitive impairment between the two groups(P>0.05).As Hoehn-Yahr stages increased,the severity of constipation increased(P<0.05),but not the incidence of constipation(P>0.05).Pearson correlation analysis showed that constipation was moderately positively correlated with age,Hoehn-Yahr stage,and scores of NMSS,UPDRS III,UPDRS total,PDQ-39,HAMD,and HAMA(r=0.255,0.172,0.361,0.194,0.221,0.237,0.238,and 0.207,P<0.05).Logistic regression analysis showed that only NMSS score was an independent risk factor for constipation(P<0.001).CONCLUSION Our findings confirm that constipation has a relatively high frequency in patients with PD.PD patients with constipation have a higher incidence of depression,which leads to worse quality of life.

Abnormal white matter microstructure in Parkinson's disease revealed by diffusion tensor imaging A non-randomized concurrent control observation

BACKGROUND： Imaging has been used to determine gray matter volume and metabolism in subjects with depressed Parkinson＇s disease （DPD）. OBJECTIVE： To reveal abnormalities in orbitofrontal white matter and the anterior cingulate bundle in depressed and non-depressed Parkinson＇s disease （NDPD） patients using diffusion tensor imaging. DESIGN, TIME AND SETTING： A non-randomized, concurrent, control, neuroimaging study was performed at the Laboratory of Neurodegenerative Diseases and Center of Neuroimage, Xuanwu Hospital of Capital Medical University from July 2008 to January 2009. PARTICIPANTS： A total of 30 Parkinson＇s disease patients, including 14 males and 16 females, were included in the present study. All patients met Brain Bank criteria for idiopathic Parkinson＇s disease formulated by the United Kingdom Parkinson＇s Disease Society. Patients, who underwent previous head surgery, exhibited abnormal density on T2-weighted images, or Mini-Mental State Examination scores 〈 corresponding education level, were excluded from the study. METHODS： All 35 patients underwent MRI scans, including traditional T2-weighted and DTI scans. The patients were assigned to DPD （n = 16） and NDPD （n = 14） groups according to the Diagnostic and Statistical Manual of Mental Disorders-IV （DSM-IV） criteria. The fractional anisotropy values of regions of interest were compared between the NDPD and DPD groups. MAIN OUTCOME MEASURES： Abnormalities in the orbitofrontal white matter and anterior cingulate bundle. RESULTS： Compared with the NDPD group, the DPD group exhibited significantly lower fractional anisotropy values in orbitofrontal white matter and anterior cingulate bundle （P 〈 0.05）. CONCLUSION： Microstructure abnormalities existed in the orbitofrontal and anterior cingulate regions in DPD patients. This is the first report of abnormalities in the orbitofrontal white matter region in DPD patients.

The interaction between the dopaminergic and the serotonergic systems in the 6-OHDA rat model of Parkinson’s disease

This review summarizes published results that are related to the coupling between the dopaminergic and the serotonergic systems and their association to Parkinson’s disease. We focus on the 6-hydroxydopamine rat model of Parkinson’s disease to better understand how dopamine dysfunction affects the serotonergic system, and furthermore to investigate whether a bidi-rectional coupling exists and how it affects functionality and behavior. The accumulated evidence supports a proposed mechanism for this coupling that evolves the lateral habenula.

Is State Anhedonia Characteristic of Parkinson’s Disease?

Anhedonia, the lowered ability to experience pleasure, is one of the non-motor symptoms in Parkinson’s disease. Recently, the distinction between consummatory and anticipatory anhedonia has been proposed and anhedonia, notably in PD, could constitute a stable characteristic (anhedonia-trait) or secondary symptom (anhedonia-state). Several studies, using healthy control groups, reported high state consummatory and anticipatory anhedonia in PD using the Snaith Hamilton Pleasure Scale (SHAPS), but when control groups included subjects with different illnesses no significant differences were reported. The aim of the present study was to compare PD subjects with subjects presenting a non-Parkinson motor neurological disease on the anhedonia subscale of the Beck Depression Inventory (BDI-II). This subscale rated consummatory and anticipatory anhedonia state. No significant difference was reported. This result confirmed that PD subjects were not characterized by high levels of state anhedonia when the subjects were compared to subjects with a different disease. Contrary to trait consummatory anhedonia, state anhedonia could be nonspecific to Parkinson’s disease.

Parkinson’s disease and affective disorder: The temporal relationship

In relationship between the affective disorders and Parkinson’s disease (PD) it was found that comorbidity was higher than expected in the majority of the studies. Patients with PD are at increased risk of developing depression and, conversely, recent studies have shown that patients with depressive disorders have increased risk of incident PD. However, the temporal associations between the disorders are not fully elucidated. From this review it could be learned that the temporal aspects strongly suggest that a neurobiological association exists between affective disorder and PD. This is illustrated with hitherto unpublished data. Some of these issues may be investigated in case register studies, e.g. by linkage of registers of somatic and psychiatric illness, and suggestions for future research are given. For GP’s, psychiatrists, geriatricians, and neurologists these new findings will lead to a better understanding and better treatment for patients with complicated comorbid conditions. Here timing is important!

Current application and future directions of photobiomodulation in central nervous diseases

Photobiomodulation using light in the red or near-infrared region is an innovative treatment strategy for a wide range of neurological and psychological conditions.Photobiomodulation can promote neurogenesis and elicit anti-apoptotic,antiinflammatory and antioxidative responses.Its therapeutic effects have been demonstrated in studies on neurological diseases,peripheral nerve injuries,pain relief and wound healing.We conducted a comprehensive literature review of the application of photobiomodulation in patients with central nervous system diseases in February 2019.The NCBI PubMed database,EMBASE database,Cochrane Library and ScienceDirect database were searched.We reviewed 95 papers and analyzed.Photobiomodulation has wide applicability in the treatment of stroke,traumatic brain injury,Parkinson’s disease,Alzheimer’s disease,major depressive disorder,and other diseases.Our analysis provides preliminary evidence that PBM is an effective therapeutic tool for the treatment of central nervous system diseases.However,additional studies with adequate sample size are needed to optimize treatment parameters.

Reserpine-Induced Progressive Parkinsonism in Mice Predisposed and Non-Predisposed to Depressive-Like Behavior

Parkinson’s disease (PD) is a progressive degenerative condition that mainly affects the elderly. The disease comprises motor symptoms such as tremors at rest, loss of voluntary movement, decreased muscle strength, propensity to lean forward and acceleration of the walking pace. These signs are related to the degeneration of the nigrostriatal dopaminergic pathway. Patients also have non-motor symptoms, among which sleep alterations, cognitive deficits, fatigue, pain and depression stand out. Although depression has been described as the most prevalent non-motor symptom, it is not clear whether this mood disorder is due to PD or patients would already have a greater predisposition. The present study evaluated the relationship between the predisposition to depressive-like behavior and the development of motor alterations in a progressive pharmacological model of PD in mice. Mice were classified into groups of depressive-like propensities and submitted to the pharmacological model. Reserpine was administrated at 0.1 mg/kg on alternate days for 40 days. The catalepsy and oral movement tests were used to evaluate motor alterations, the sucrose preference test was used to evaluate anhedonia, and the open field test was applied to evaluate general activity. Reserpine promoted parkinsonian motor impairments, and there were no differences between animals from different depressive-like behavior profiles. Thus, it was not possible to find a relationship between parkinsonism and the propensity to depression based on the basal sucrose preference test. More studies with other evaluations of depressive-like behavior are needed to confirm the results found in our study.

Treating refractory depression in Parkinson’s disease:a meta-analysis of transcranial magnetic stimulation

Background:Parkinson’s disease(PD)is often accompanied by clinically identified depression.Providing effective pharmacotherapies that concomitantly treat both motor and psychological symptoms can pose a challenge to physicians.For this reason,alternatives to standard anti-depressant treatments,such as repetitive transcranial magnetic stimulation(rTMS),have been evaluated within the Parkinson’s population.Methods:A literature search was conducted on the PubMed database for all studies that evaluated rTMS as a treatment in patients with both depression and PD.A meta-analysis was performed on all studies that reported mean pre-and post-rTMS depression inventory scores.Widely used depression inventories included both self-report and clinician-administered measures.Effect size for individual study groups and across all studies was calculated.Results:Six of 7 studies meeting inclusion criteria reported significantly improved depression scores,large effect sizes,and significant p-values.Total weighted average effect size was calculated at 1.32 across all study groups that applied rTMS.Conclusions:Across all but one study,rTMS appears to effectively reduce depression scores among self-reported and clinician administered inventories.The total weight average effect size showed that,when considering study sample sizes and degree of findings,this form of neurostimulation can relieve PD patients of their depressive symptoms.Further,rTMS is a promising alternative to traditional anti-depressant therapies when treating refractory depression in patients with PD.

Brain delivery of fibronectin through bioactive phosphorous dendrimers for Parkinson’s disease treatment via cooperative modulation of microglia

Effective treatment of Parkinson’s disease(PD),a prevalent central neurodegenerative disorder particularly affecting the elderly population,still remains a huge challenge.We present here a novel nanomedicine formulation based on bioactive hydroxyl-terminated phosphorous dendrimers(termed as AK123)complexed with fibronectin(FN)with anti-inflammatory and antioxidative activities.The created optimized AK123/FN nanocomplexes(NCs)with a size of 223 nm display good colloidal stability in aqueous solution and can be specifically taken up by microglia through FN-mediated targeting.We show that the AK123/FN NCs are able to consume excessive reactive oxygen species,promote microglia M2 polarization and inhibit the nuclear factor-kappa B signaling pathway to downregulate inflammatory factors.With the abundant dendrimer surface hydroxyl terminal groups,the developed NCs are able to cross blood-brain barrier(BBB)to exert targeted therapy of a PD mouse model through the AK123-mediated anti-inflammation for M2 polarization of microglia and FN-mediated antioxidant and anti-inflammatory effects,thus reducing the aggregation ofα-synuclein and restoring the contents of dopamine and tyrosine hydroxylase to normal levels in vivo.The developed dendrimer/FN NCs combine the advantages of BBB-crossing hydroxyl-terminated bioactive per se phosphorus dendrimers and FN,which is expected to be extended for the treatment of different neurodegenerative diseases.

Pingchan granule for depressive symptoms in parkinson’s disease:A randomized,double-blind,placebo-controlled trial

Background:Depression in Parkinson’s disease(dPD)is closely related to quality of life.Current studies have suggested that Pingchan Granule(PCG)might be effective for treating dPD.Objective:This study determines the efficacy of PCG for depressive symptoms in Parkinson’s disease(PD).Design,setting,participants and interventions:This was a randomized,double-blind,placebo-controlled trial,conducted in Longhua Hospital,Shanghai,China.Patients diagnosed with idiopathic PD and clinically significant depressive symptoms(defined by a 24-item Hamilton Rating Scale for Depression[HAM-D]score≥8)were included in this study,randomly assigned to PCG or placebo group in a 1:1 ratio and followed for 24 weeks.Main outcome measures:The primary outcome was the change from baseline to week 24 in HAM-D score among the set of patients who completed the study following the treatment protocol(per-protocol set).Secondary outcomes included changes in scores on the Unified Parkinson’s Disease Rating Scale(UPDRS)part 2(UPDRS-Ⅱ),UPDRS part 3(UPDRS-Ⅲ),Parkinson’s Disease Sleep Scale(PDSS)and Hamilton Rating Scale for Anxiety(HAM-A),between baseline and week 24.Results:Eighty-six patients were enrolled,and 85 patients were included in the per-protocol set.HAM-D scores decreased by an adjusted mean of 11.77(standard error SE 0.25)in the PCG group and 3.86(SE0.25)in the placebo group(between-group difference=7.91,95%confidence interval[7.22,8.80],P<0.001),in the multivariable linear regression.Improvements in scores on the UPDRS-II,UPDRS-III,PDSS,and HAM-A scales were also observed.Conclusion:Treatment with PCG was well tolerated and improved depressive symptoms and motor and other non-motor symptoms in PD.Trial registration:Chinese Clinical Trial Register:ChiCTR-INR-17011949.

Effectiveness of Bushen Huoxue Granule (补肾活血颗粒) on 5-Serotonin and Norepinephrine in the Brain of Parkinson's Disease Patients with Depressive State

Objective：To observe the clinical curative effect of Chinese medicine Bushen Huoxue Granule（补肾活血颗粒,BHG） on Parkinson＇s disease（PD） patients with depressive state.Methods：Sixty-two PD patients with depressive state were randomly assigned to two groups by using a random number table,31 in each group.Madopar was given to all as the conventional treatment.The fluoxetine hydrochloride dispersible tablet was given to the patients in the control group and BHG was given to those in the treatment group.The therapeutic course for all was 12 weeks.Before and after treatment,Hamilton depression rating scale（HAMD） was applied to judge the curative effect,and the changes of cerebral neurotransmitters levels in the brain of patients were detected by encephalofluctuograph technique.Results：The scores of HAMD in the two groups were decreased markedly after 12-week treatment.It was lower in the treatment group than that in the control group with significant difference（P〈0.01）.The contents of norepinephrine（NE） and 5-serotonin（5-HT） in the PD patients were obviously lower than normal value.There was no significant difference between the two groups before treatment（P〉0.05）.The contents of NE and 5-HT were all increased in the two groups after treatment（P〈0.05）,with significant differences between the two groups（P〈0.01）.Conclusion：BHG could increase the contents of NE and 5-HT in PD patients＇ brain to improve the depressive state of PD patients.

基于ERAS理念的针对性护理干预在帕金森病围术期患者中的应用

目的:探讨基于快速康复外科(ERAS)理念的针对性护理干预在帕金森病围术期患者中的应用方法及效果。方法:将98例帕金森病行脑深部电刺激术患者按入院日期分为观察组47例和对照组51例,对照组实施传统快速康复护理,观察组实施基于ERAS理念的针对性护理干预,比较两组护理效果。结果:观察组护理后焦虑自评量表(SAS)、抑郁自评量表(SDS)评分及术后视觉模拟评分法(VAS)评分低于对照组(P<0.05);两组术后住院时间、术后下床时间及满意度比较差异有统计学意义(P<0.05)。结论:基于ERAS理念的针对性护理干预可缓解患者的紧张、焦虑情绪,缩短住院时间,提高患者的满意度。

Biomarkers for Parkinson’s Disease: How Good Are They?

Parkinson’s disease(PD)is a complex neurodegenerative disorder with no cure in sight.Clinical challenges of the disease include the inability to make a definitive diagnosis at the early stages and difficulties in predicting the disease progression.The unmet demand to identify reliable biomarkers for early diagnosis and management of the disease course of PD has attracted a lot of attention.However,only a few reported candidate biomarkers have been tried in clinical practice at the present time.Studies on PD biomarkers have often overemphasized the discovery of novel identity,whereas efforts to further evaluate such candidates are rare.Therefore,we update the new development of biomarker discovery in PD and discuss the standard process in the evaluation and assessment of the diagnostic or prognostic value of the identified potential PD biomarkers in this review article.Recent developments in combined biomarkers and the current status of clinical trials of biomarkers as outcome measures are also discussed.We believe that the combination of different biomarkers might enhance the specificity and sensitivity over a single measure that might not be sufficient for such a multiplex disease.

Clinical features of Parkinson’s disease with and without rapid eye movement sleep behavior disorder

Background:Rapid eye movement sleep behavior disorder(RBD)and Parkinson’s disease(PD)are two distinct clinical diseases but they share some common pathological and anatomical characteristics.This study aims to confirm the clinical features of RBD in Chinese PD patients.Methods:One hundred fifty PD patients were enrolled from the Parkinson`s disease and Movement Disorders Center in Department of Neurology,Shanghai General Hospital from January 2013 to August 2014.This study examined PD patients with or without RBD as determined by the REM Sleep Behavior Disorder Screening Questionnaire(RBDSQ),assessed motor subtype by Unified PD Rating Scale(UPDRS)III at“on”state,and compared the sub-scale scores representing tremor,rigidity,appendicular and axial.Investigators also assessed the Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD),Mini-Mental State Examination(MMSE),Clinical Dementia Rating(CDR),and Parkinson’s disease Sleep Scale(PDSS).Results:One hundred fourty one PD patients entered the final study.30(21.28%)PD patients had probable RBD(pRBD)diagnosed with a RBDSQ score of 6 or above.There were no significant differences for age,including age of PD onset and PD duration,gender,smoking status,alcohol or coffee use,presence of anosmia or freezing,UPDRS III,and H-Y stages between the pRBD+and pRBD−groups.pRBD+group had lower MMSE scores,higher PDSS scores,and pRBD+PD patients had more prominent proportion in anxiety,depression,constipation,hallucination and a greater prevalence of orthostatic hypotension.Conclusion:pRBD+PD patients exhibited greater changes in non-motor symptoms.However,there was no increase in motor deficits.

FGFs在神经和精神疾病中的研究进展

成纤维细胞生长因子(FGFs)是一大类具有高度同源性的生长因子,其通过与成纤维细胞生长因子受体结合,参与机体的多个生物学和病理生理学过程,包括神经系统控制、血管生成、伤口愈合、胚胎发育、代谢调节、肿瘤发生与转移等。近年来,FGFs在精神和神经系统疾病方面的作用受到广泛关注。随着社会进步,焦虑、抑郁、脑血管病以及老年变性疾病的逐年增多,对社会产生的负担也越来越重。因此,研究FGFs在精神和神经疾病方面的作用,可能会对这些疾病的治疗及预后改善提供新的思路。

Caregiver burden is increased in Parkinson’s disease with mild cognitive impairment (PD-MCI)

Background:There is limited evidence on caregiver outcomes associated with mild cognitive impairment in patients with Parkinson’s disease(PD-MCI)and the coping strategies used by these caregivers.Methods:To investigate this relationship,we examined levels of burden,depression,anxiety,coping strategies and positive aspects of caregiving in the informal caregivers of 96 PD patients.The PD patients were classified using MDS-Task Force Level II criteria as showing either normal cognition(PD-N;n=51),PD-MCI(n=30)or with dementia(PDD;n=15).Results:Mean Zarit Burden Interview(ZBI)score increased significantly between carers of PD-N(M=13.39,SD=12.22)compared to those of PD-MCI patients(M=22.00,SD=10.8),and between carers of PD-MCI and PDD patients(M=29.33,SD=9.59).Moreover,the proportion of carers showing clinically significant levels of burden(ZBI score≥21)also increased as the patients’cognitive status declined(18% for PD-N;60% for PD-MCI;and 80%for PDD)and was mirrored by an increasing amount of time spent providing care by the caregivers.Caregiver ZBI score was independent of patient neuropsychiatric symptoms,motor function,disease duration and time that caregivers spent caregiving.Caregiver use of different coping strategies increased with worsening cognition.However,we found only equivocal evidence that the use of problem-focused,emotion-focused and dysfunctional coping mediated the association between patient cognitive status and caregiver burden,because the inverse models that used caregiver burden as the mediator were also significant.Conclusions:The study highlights the impact of Parkinson’s disease on those providing care when the patient’s cognition is poor,including those with MCI.Caregiver well-being has important implications for caregiver support,nursing home placement and disease course.