Depression is the biggest threat to the welfare of Parkinson’s patients

12/14/2012

Read this Examiner.com article about early findings from the National Parkinson Foundation's Parkinson's Outcomes Project, the largest clinical study of Parkinson's disease ever conducted, showing that depression is the most important factor influencing the health status of Parkinson's patients.


Doctors need to reassess how they treat people with Parkinson’s disease, experts say, because while Parkinson’s is primarily viewed as a physically disabling disease, new research shows depression is the biggest threat to the health status of people with this crippling neurological disorder, but this serious condition is often overlooked or not treated effectively.

“Depression is a huge issue in Parkinson’s disease, but even at different expert clinics, there is no consensus yet on the best approach to treatment,” said Peter Schmidt, Ph.D., chief information officer and vice president of programs for the National Parkinson Foundation (NPF).

Early findings from the NPF’s Parkinson's Outcomes Project, the largest clinical study of Parkinson's disease ever conducted, show that mood and depression are the primary factors affecting the overall health of people with Parkinson’s followed by diminished mobility.

“At least 50 percent of people with Parkinson’s experience depression, and anxiety is also frequently reported,” the study revealed. “Yet, physicians often have trouble recognizing anxiety and depression, or their roles in hampering efforts to treat Parkinson’s.”

The international study, which began in 2009, includes more than 5,500 people from the United States, Canada, Israel and the Netherlands who are at different stages of the disease and who suffer from a variety of symptoms, as Parkinson’s affects everyone differently and the reaction to treatment varies. Participants range in age from 25 to 95 years old.

“Parkinson’s is the second most common neurodegenerative disease after Alzheimer’s,” said Dr. Schmidt, a biomedical engineer who oversees NPF's research, education and outreach initiatives.

“We estimate that approximately one million people in the United States have Parkinson’s, and it is more prevalent at all ages than all other neurological disorders except migraines, epilepsy, stroke and Alzheimer’s.”

Neurodegenerative diseases are incurable, debilitating neurological disorders that occur when nerve cells in the brain that affect movement and/or mental functioning deteriorate or die, causing a person's health to progressively decline.

The goal of this study is to determine the best treatment options and develop a standardized method of care for certain symptoms of Parkinson’s that will slow down the impact of the disease and help people live longer, better, more active lives, Dr. Schmidt said. To this end, researchers are following 529 people who have lived with Parkinson’s for more than 20 years with the hope of uncovering the secrets of their longevity.

Researchers say bradykinesia, the medical term for slowness of movement, is still the defining element of Parkinson’s, as it is present in all cases and it can have a detrimental impact on patients. Bradykinesia can affect a person’s balance, and ability to walk and perform everyday tasks that most people take for granted like feeding and bathing oneself. It can also result in falls, injury and even death.

Despite the devastating effects of impaired mobility, Dr. Schmidt stressed that, “you can’t address Parkinson’s by just focusing on physical disability.” The preliminary results of this study clearly show that Parkinson’s can cause both physically and mentally disabling conditions which are “closely tied together,” he said.

The study found that “better mobility reduces depression.” Likewise, a better state of mind can improve mobility. Therefore, a holistic approach to treatment is necessary, because depression can increase the physical effects of Parkinson's and the progression of the disease.

The NPF recommends that physicians screen patients for depression at least once a year. They cannot just depend on their observations though.

“It is hard to diagnose depression in Parkinson’s disease by just observation, because some of the symptoms can mask the usual cues for depression,” Dr. Schmidt said. He suggests that physicians ask their patients how they feel emotionally, or have them or their caretakers fill out a form that asks simple questions like whether they feel depressed, isolated, lonely, weepy, angry or worried about the future.

Impaired mobility can lead to depression. However, Dr. Schmidt said, “depression in Parkinson’s is most often caused by a chemical imbalance in the brain rather than sadness about the disease, so treatment can also be challenging.”

Although depression in Parkinson’s rarely reaches the severest levels of hopelessness found in major depressive disorders, Dr. Schmidt said depression can be very dangerous for someone with Parkinson’s, because research shows that exercise is the most important part of a Parkinson’s treatment plan, and people who are depressed tend not to exercise and are more likely to neglect their self-care. “Once you lose ground in Parkinson’s, it is much more difficult to gain it back,” Dr. Schmidt added.

“A well-designed exercise plan can significantly improve almost everything about your health, including stabilizing your walking, calming tremor, improving mood, and possibly even slowing progression of the disease. Regular exercise is typically associated with a lower care burden as well,” according to the study.

To help Parkinson’s patients improve the quality of their lives, researchers say physicians need to identify symptoms of depression early and develop an aggressive treatment plan that includes antidepressant medication, exercise and counseling.

—Shirley L. Smith

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