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Frequency of dementia, depression, and other neuropsychiatric symptoms in 1,449 outpatients with Parkinson’s disease

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Abstract

Neuropsychiatric symptoms (NPS) of Parkinson’s disease (PD) are of growing diagnostic and therapeutic importance. Data on their prevalence and characteristics have been primarily derived from highly selective clinical populations. We have conducted a national study in the outpatient care sector to provide a fuller characterization of the frequency of dementia, depression, and other NPS in PD outpatients. We also examined associations with biosocial and neurological variables. A nationwide representative sample of 1,449 PD outpatients was examined with a standardized clinical interview. PD severity was rated with the Hoehn and Yahr (HY) scale and the Unified Parkinson’s Disease Rating Scale. Depression was measured with the Montgomery-Asberg Depression Rating Scale. Cognitive impairment and dementia were assessed with the Mini-Mental State Exam and according to diagnostic criteria. Logistic regression analyses were used to investigate associations. At least one NPS occurred in 71% of all patients with PD. The estimated prevalences (ranges) by age group and HY-stage were: depression, 25% (13.2–47.9%), dementia, 29% (12.2–59.4%), and psychotic syndromes, 12.7% (3.1–40.9%). Other frequent complications were sleep disturbances (49%) and anxiety (20%). Depression was associated with gender but not with age. Dementia was associated with age. The rates and comorbidity of depression and dementia were driven by PD severity. NPS were highly prevalent in our comprehensive patient sample, largely representative of management problems occurring in an outpatient setting. PD outpatients are at an increased risk for all neuropsychiatric conditions, increasing with PD severity but not with age or age of onset (except dementia), revealing challenging symptom patterns.

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References

  1. Aarsland D, Andersen K, Larsen JP, Lolk A, Kragh-Soerensen P (2003) Prevalence and characteristics of dementia in Parkinson’s disease: an 8-year prospective study. Arch Neurol 60:387–392

    Article  PubMed  Google Scholar 

  2. Aarsland D, Andersen K, Larsen JP, Lolk A, Nielsen H, Kragh-Soerensen P (2001) Risk of dementia in Parkinson’s disease: a community-based, prospective study. Neurology 56:730–736

    CAS  PubMed  Google Scholar 

  3. Aarsland D, Bronnick K, Ehrt U, De Deyn P, Tekin S, Emre M, Cummings J (2007) Neuropsychiatric symptoms in patients with Parkinson’s disease and dementia: frequency, profile and associated caregiver stress. J Neurol Neurosurg Psychiatry 78:36–42

    Article  CAS  PubMed  Google Scholar 

  4. Aarsland D, Larsen JP, Karlsen K, Lim NG, Tandberg E (1999) Mental symptoms in Parkinson’s disease are important contributors to caregiver distress. Int J Geriatr Psych 14:866–874

    Article  CAS  Google Scholar 

  5. Aarsland D, Zaccai J, Brayne C (2005) A systematic review of prevalence studies of dementia in Parkinson’s disease. Mov Disord 20:1255–1263

    Article  PubMed  Google Scholar 

  6. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders: text revision. American Psychiatric Association, Washington, DC

    Book  Google Scholar 

  7. Berr C, Wancata J, Ritchie K (2005) Prevalence of dementia in the elderly in Europe. Eur Neuropsychopharmacol 15:463–471

    Article  CAS  PubMed  Google Scholar 

  8. Chaudhuri K, Healy D, Schapira A (2006) Non-motor symptoms of Parkinson’s disease: diagnosis and management. Lancet Neurol 5:235–245

    Article  PubMed  Google Scholar 

  9. Cullen B, Fahy S, Cunningham C, Coen R, Bruce I, Greene E, Coakley D, Walsh JB, Lawlor B (2005) Screening for dementia in an Irish community sample using MMSE: a comparison of norm-adjusted versus fixed cut-points. Int J Geriatr Psych 20:371–376

    Article  Google Scholar 

  10. Cummings J, Mega M, Gray K (1994) The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology 44:2308–2314

    CAS  PubMed  Google Scholar 

  11. Emre M (2004) Dementia in Parkinson’s disease: cause and treatment. Curr Opin Neurol 17:399–404

    Article  PubMed  Google Scholar 

  12. Emre M, Aarsland D, Albanese A, Byrne J, Deuschl G, De Deyn P, Durif F (2004) Rivastigmine for dementia associated with Parkinson’s disease. New Engl J Med 351:2509–2518

    Article  CAS  PubMed  Google Scholar 

  13. Essau CA, Wittchen H-U (1993) An overview of the composite international diagnostic interview (CIDI). Int J Methods Psychiatr Res 3:79–85

    Google Scholar 

  14. Fahn S (1987) Unified Parkinson’s disease rating scale. In: Fahn S, Calne D (eds) Recent developments in Parkinson’s disease. MacMillan, Florham Park, pp 153–163

    Google Scholar 

  15. Folstein M, Folstein S, McHugh P (1975) Mini-mental state: a practical method for grading the mental state of patients by the clinician. J Psychiatr Res 12:189–198

    Article  CAS  PubMed  Google Scholar 

  16. Gelb D, Oliver E, Gilman S (1999) Diagnostic criteria for Parkinson’s disease. Arch Neurol 56:33–39

    Article  CAS  PubMed  Google Scholar 

  17. Herrmann N, Lanctot K, Sambrook R, Lesnikova N, Hebert R, McCracken P, Robillard A, Nguyen E, The COSID Investigators (2006) The contribution of neuropsychiatric symptoms to the cost of dementia care. Int J Geriatr Psych 21:972–976

    Article  Google Scholar 

  18. Hoehn M, Yahr M (1967) Parkinsonism: onset, progression and mortality. Neurology 17:427–442

    CAS  PubMed  Google Scholar 

  19. Hofman A, Breteler M, van Dujin C, Krestin G, Pols H, Stricker B, Tiemeier H, Uitterlinden A, Vingerling J, Witteman J (2007) The Rotterdam study: objectives and design update. Eur J Epidemiol 22:819–829

    Article  PubMed  Google Scholar 

  20. Hughes A, Daniel S, Kilford L, Lees A (1992) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinicopathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184

    Article  CAS  PubMed  Google Scholar 

  21. Jungwirth S, Weissgram S, Zehetmayer S, Tragl KH, Fischer P (2005) VITA: subtypes of mild cognitive impairment in a community-based cohort at the age of 75 years. Int J Geriatr Psych 20:452–458

    Article  CAS  Google Scholar 

  22. Kalbe E, Calabrese P, Kohn N, Hilker R, Riedel O, Wittchen HU, Dodel R, Otto J, Ebersbach G, Kessler J (2008) Screening for cognitive deficits in Parkinson’s disease with the Parkinson neuropsychometric dementia assessment (PANDA) instrument. Parkinsonism Relat Disord 14:93–101

    Article  PubMed  Google Scholar 

  23. Kulisevsky J, Pagonabarraga J, Pascual-Sedano B, Garcia-Sanchez C, Gironell A (2008) Prevalence and correlates of neuropsychiatric symptoms in Parkinson’s disease without dementia. Mov Disord 23:1889–1896

    Article  PubMed  Google Scholar 

  24. Leentjens A, Verhey F, Lousberg R, Spitsbergen H, Wilmink F (2000) The validity of the Hamilton and Montgomery-Asberg depression rating scales as screening and diagnostic tools for depression in Parkinson’s disease. Int J Geriatr Psychiatry 15:644–649

    Article  CAS  PubMed  Google Scholar 

  25. Li X, Sundquist J, Hwang H, Sundquist K (2008) Impact of psychiatric disorders on Parkinson’s disease. J Neurol. doi:10.1007/s00415-007-0655-z

  26. Lieberman A (2006) Depression in Parkinson’s disease: a review. Acta Neurol Scand 113:1–8

    Article  CAS  PubMed  Google Scholar 

  27. Marion M-H, Qurashi M, Marshall G, Foster O (2008) Is REM sleep behaviour disorder (RBD) a risk factor of dementia in idiopathic Parkinson’s disease? J Neurol 255:192–196

    Article  PubMed  Google Scholar 

  28. Martinez-Martin P, Schapira A, Stocchi F, Sethi K, Odin P, MacPhee G, Brown R, Naidu Y, Clayton L, Abe K, Tsuboi Y, MacMahon D, Barone P, Rabey JM, Bonuccelli U, Forbes A, Breen K, Tluk S, Olanow W, Thomas S, Rye D, Hand A, Williams A, Ondo W, Chaudhuri K (2007) Prevalence of nonmotor symptoms in Parkinson’s disease in an international setting: study using nonmotor symptoms questionnaire in 545 patients. Mov Disord 22:1623–1629

    Article  PubMed  Google Scholar 

  29. Miyasaki J, Shannon K, Voon V, Ravina B, Kleiner-Fisman G, Anderson K, Shulman L, Gronseth G, Weiner WJ (2006) Practice parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review). Neurology 66:996–1002

    Article  CAS  PubMed  Google Scholar 

  30. Montgomery S, Asberg M (1979) A new depression scale, designed to be sensitive to change. Br J Psychiatr 134:382–389

    Article  CAS  Google Scholar 

  31. Nuti A, Ceravolo R, Piccinni A (2004) Psychiatric comorbidity in a population of Parkinson’s disease patients. Eur J Neurol 11:315–320

    Article  CAS  PubMed  Google Scholar 

  32. Pacchetti C, Manni R, Zangaglia R, Mancini F, Marchioni E, Tassorelli C, Terzaghi M, Ossola M, Martignoni E, Moglia A, Nappi G (2005) Relationship between hallucinations, delusions and rapid eye movement sleep behaviour disorder in Parkinson’s disease. Mov Disord 20:1439–1448

    Article  PubMed  Google Scholar 

  33. Reijnders J, Ehrt U, Weber W, Aarsland D, Leentjens A (2008) A systematic review of prevalence studies of depression in Parkinson’s disease. Mov Disord 23:183–189

    Article  PubMed  Google Scholar 

  34. Remy P, Doder M, Lees A, Turjanski N, Brook D (2005) Depression in Parkinson’s disease: loss of dopamine and noradrenaline innervation in the limbic system. Brain 128:1314–1322

    Article  PubMed  Google Scholar 

  35. Riedel-Heller S, Busse A, Angermeyer M (2006) The state of mental health in old-age across the ‘old’ European Union: a systematic review. Acta Psychiatr Scand 113:388–401

    Article  CAS  PubMed  Google Scholar 

  36. Riedel O, Klotsche J, Spottke A, Deuschl G, Foerstl H, Henn F, Heuser I, Oertel W, Reichmann H, Riederer P, Trenkwalder C, Dodel R, Wittchen HU (2008) Cognitive impairment in 873 patients with idiopathic Parkinson’s disease: results from the German study on epidemiology of Parkinson’s disease with dementia (GEPAD). J Neurol 255:255–264

    Article  PubMed  Google Scholar 

  37. Royall RM (1986) Model robust confidence intervals using maximum likelihood estimators. Int Stat Rev 54:221–226

    Article  Google Scholar 

  38. Wittchen H-U, Jacobi F (2005) Size and burden of mental disorders in Europe: a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol 15:357–376

    Article  CAS  PubMed  Google Scholar 

  39. Zaudig M, Hiller W, Geiselmann B, Hansert E, Linder G, Mombour W, Reischies F, Thora C (1996) SIDAM: strukturiertes interview für die diagnose einer demenz vom Alzheimer typ, der multiinfarkt- (oder vaskulären) demenz und demenzen anderer ätiologien nach DSM-III-R, DSM-IV und ICD-10. Hogrefe, Göttingen

    Google Scholar 

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Acknowledgments

The GEPAD study was supported by an unrestricted educational grant of Novartis Pharma GmbH (Nürnberg, Germany) and received support from the German Ministry of Education and Research through award number BMBF No. 01GI9901/1 (R.D., W.O., H.R., C.T.). We wish to thank all cooperating physicians and patients for their participation in this study.

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Correspondence to Hans-Ulrich Wittchen.

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Riedel, O., Klotsche, J., Spottke, A. et al. Frequency of dementia, depression, and other neuropsychiatric symptoms in 1,449 outpatients with Parkinson’s disease. J Neurol 257, 1073–1082 (2010). https://doi.org/10.1007/s00415-010-5465-z

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  • DOI: https://doi.org/10.1007/s00415-010-5465-z

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