JPD: Parkinson's patients, depressive state predicts future neurological disorders

Parkinson's disease (PD) is defined by specific motor symptoms, including stiffness, bradykinesia, and tremor
.

Depression and autonomic dysfunction (AuD) are common and often debilitating non-motor symptoms (NMS) of Parkinson's disease that affect more than 50% of Parkinson's patients and portend a poor prognosis

 

Although the incidence and severity of all PD symptoms increased with disease course, studies investigating the relationship between AuD and other motor and non-motor symptoms have shown conflicting results
.

This may indicate the presence of symptom clusters in PD rather than a common pathophysiological basis for all symptoms of the disease

Available evidence suggests a clear overlap between AuD in PD and depression, both pathologically and co-involvement of norepinephrine neurotransmission, but these symptoms are currently treated in isolation
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Previous studies have attempted to delineate clinical associations between various PD NMSs, but have struggled to distinguish the effects of disease duration and age, at least in part due to sample heterogeneity in PD studies, recruitment bias, and/or lack of longitudinal data

A clearer understanding of the overlap of these two influential NMSs could lead to a synergistic approach to treatment
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This in turn may improve the diagnostic rate of these symptoms, enhance the planning of treatment options, and advance the development of effective therapeutic targets for NMS in PD

diagnosis

Hereby, Miriam Sklerova et al.

, from the University of North Carolina at Chapel Hill, investigated the longitudinal association between depressive symptoms and AuD in a large prospective cohort of patients with early PD and controls

They included baseline data from 421 PD patients, 360 from visit 6, 300 from visit 12, and 193 controls
.

When controlling for age, depression, and antihypertensive medication, depression predicted autonomic symptoms in all groups

hypertension

When the groups were compared, the effect of depression on autonomic symptoms was stronger in all Parkinson's disease groups than in the control group, and was strongest at Visit 12 for Parkinson's disease
.

Depression predicted autonomic symptoms of PD only at visit 12

The effect of depression on autonomic symptoms was stronger in all Parkinson's disease groups compared to controls

The significance of this study lies in the discovery of an important effect of depression on autonomic symptoms in the early and middle stages of PD, independent of motor symptoms
.

Although the physiological basis of these two Parkinson's disease symptoms is not fully understood, our findings add to the pathological evidence for a common mechanistic substrate, separate from the one responsible for Parkinson's motor symptoms
.
These findings could impact clinical management and the development of new treatments
.

Important effect of depression on autonomic symptoms in early and mid-stage PD independent of motor symptom management

 

Original source:
Sklerov M, Browner N, Dayan E, Rubinow D, Frohlich F.
Autonomic and Depression Symptoms in 3 Parkinson's Disease: Clinical Evidence for Overlapping Physiology.

Autonomic and Depression Symptoms in 3 Parkinson's Disease: Clinical Evidence for Overlapping Physiology.
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