Carer burden in apathy and impulse control disorders in Parkinson's disease

Leroi, Iracema; Harbishettar, Vijay; Andrews, Michelle; McDonald, Kathryn; Byrne, E. Jane; Burns, Alistair

doi:10.1002/gps.2704

Cited by 143 publications

(141 citation statements)

References 39 publications

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“…This confirms our fourth hypothesis that NPS are main determinants of caregiver burden, particularly mood/apathy and psychosis, while ICDs may play a lesser role. This is consistent with a recent study reporting that although caregivers of patients with ICD displayed more burden than caregivers of patients without ICD, the association between ICD symptoms and caregiver burden was low [25]. In another study, cognitive behavioral therapy for patient's ICD did not alleviate caregiver burden [26].…”

Section: Discussionsupporting

confidence: 90%

“…Previous studies have documented the significant impact of the patient's mood/apathy [25], psychotic symptoms [4], disability [9,22] and disease duration [27] on caregiver burden [28]. Screening for these factors, and specifically patient's NPS and dementia, may help identify caregivers who could benefit from intervention strategies such as group support or respite care [29].…”

Section: Discussionmentioning

confidence: 99%

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Neuropsychiatric symptoms and caregiver's burden in Parkinson's disease

Martinez‐Martín

Rodríguez‐Blázquez

Forjaz

et al. 2015

Parkinsonism & Related Disorders

184

166

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Introduction: In Parkinson's disease (PD), neuropsychiatric symptoms (NPS) can be particularly burdensome for caregivers. The main goal of this study was to assess the impact of NPS, assessed by means of a new specific scale, on caregiver burden.Methods: A sample of 584 pairs of PD patients and their primary caregivers was studied. Patients' NPS were measured with the Scale for Evaluation of Neuropsychiatric Disorders in PD (SEND-PD), and the Zarit Caregiver Burden Inventory was used to quantify caregiver burden. Three linear regression models were built to check factors associated with caregiver burden, one for the total sample and two for subgroups stratified by the presence of dementia. Results: The most prevalent SEND-PD dimensions were mood/apathy (87.4%), followed by psychotic symptoms (48.5%) and impulse control disorders (26.5%). Patients with dementia (n=94; 16.15% of sample) consistently presented more NPS than patients without dementia (p<0.001). On linear regression models, the main determinants of caregiver burden (for the total sample and the sample of patients without dementia) were SEND-PD dimensions mood/apathy and psychosis, PD-related disability and disease duration. For patients with dementia, the only significant caregiver burden determinants were SEND-PD psychosis and mood/apathy subscale scores.Conclusions: NPS in PD are highly associated with and are determinants of caregiver burden, and are more prevalent and burdensome in patients with dementia. Detailed assessment and specific interventions aimed at NPS could alleviate caregiver burden. Author DeclarationParkinsonism & Related Disorders is committed to proper scientific conduct and the protection of animal and human research subjects. Submission of this manuscript implies compliance with the following ethical requirements. Please affirm that you are representing all of the authors in stating compliance with these policies by checking the box at the end of this section.1. Studies with human subjects must have been conducted in accordance with the Declaration of Helsinki. All persons must have provided informed consent prior to being included in the study.2. Studies with animal subjects must have been conducted in accordance with the Guide for the Care and Use of Laboratory Subjects as adopted by the US National Institutes of Health and/or according to the requirements of all applicable local, national and international standards.3. Protocols with animal or human subjects must have been approved by the relevant local committee(s) charged with ensuring subject protection. Studies that entail pain or distress will be assessed in terms of the balance between the distress inflicted and the likelihood of benefit.4. The authors declare that the manuscript is original, that it is not being considered for publication elsewhere, and that it will not be submitted elsewhere while still under consideration for Parkinsonism & Related Disorders or after it has been accepted by Parkinsonism & Related Disorders.5. All authors have seen and app...

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Neuropsychiatric symptoms and caregiver's burden in Parkinson's disease

Martinez‐Martín

Rodríguez‐Blázquez

Forjaz

et al. 2015

Parkinsonism & Related Disorders

184

166

View full text Add to dashboard Cite

show abstract

“…Twenty-two were taking anti-depressants and the frequency of use was disproportionate among groups (p=.049; 35.3% of ICD group; 24.0% of apathy group; 10.8% of PD controls). 4 Barrett Impulsiveness Scale-II; 5 Apathy Evaluation Scale, Clinician version Post-hoc Scheffe or Mann Whitney U for two-group comparison: # ICD versus control at p<0.05, ## at p<0.01, and ### at p<0.001; ‡ ICD versus apathy at p<0.05, ‡ ‡ at p<0.01, and ‡ ‡ ‡ at p<0.001; † Apathy versus control at p<0.05, † † at p<0.01, and † † † at p<0.001…”

Section: Demographic Psychiatric and Motor Variables Of Pd Participantsmentioning

confidence: 99%

“…Apathy and impulse control disorders (ICDs) are examples of nonmotor behavioural changes that may complicate idiopathic Parkinson's disease (PD) [1,2], negatively impacting on quality of life [3] and caregiver burden [4]. Apathy, which has been defined as "a lack of interest, emotion and motivation", can occur in about 50% those with PD [1,5].…”

Section: Introductionmentioning

confidence: 99%

Personality Style in Behavioural Disturbances in Parkinson?s Disease

McDonald¹

2014

J Neurol Neurophysiol

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Objective: Non-motor changes in Parkinson's disease (PD) can include behavioural disturbances, such as apathy and impulse control disorders (ICDs). These behavioural problems impact on quality of life and caregiver burden. In the case of impulsivity, there is some association with specific personality styles at the time of assessment. This study compares current and pre-morbid personality attributes among people with PD who experience a clinically significant ICD, apathy, or no behavioural disturbance.Methods: 94 PD participants without dementia (ICD, n=34; apathy, n=24; control, n=36) were examined for current and pre-morbid (10 years before PD onset) personality style using self-and informant-versions of the NEO FiveFactor Inventory. All informants were knowledgeable about participants' midlife personalities and provided both current and pre-morbid ratings.Results: When key co-variates (depression, anxiety, age and dopamine load) were controlled for, a difference in self-reported current personality style was found among the three PD groups, with the ICD group rating themselves as less agreeable compared to those with apathy or no behavioural disorder. Informant-rated current and pre-morbid measurements of personality style did not differ. Conclusion:While people with PD and clinically significant ICDs currently report themselves as being less agreeable, their informants did not support this finding and reported no change from pre-morbid personality. Differences in personality style with impulsive-compulsive behaviours in PD may not be discernable to others and may be related to transient 'state' factors (i.e. influenced by the disease process or response to treatment), rather than the more enduring trait characteristics exhibited prior to the onset of PD. Until longitudinal investigation of personality determinants has been conducted, there should be a cautious approach in screening for at-risk individuals using specific personality attributes, to avoid overlooking persons with PD who may be vulnerable to developing behavioural complications.

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“…Hypersexuality can be clinically defined as "a preoccupation with sexual gratification outside the accepted social and personal bounds, despite the harm that may be incurred" [11]. It is often an underreported issue and has been demonstrated to be potentially problematic from both social and medico-legal perspectives for patients with PD and their families [12].…”

Section: Introductionmentioning

confidence: 99%

The prevalence and clinical characteristics of hypersexuality in patients with Parkinson's disease following dopaminergic therapy: A systematic literature review

Nakum

Cavanna

2016

Parkinsonism & Related Disorders

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Introduction: A range of impulse control disorders have been identified as possible behavioural effects of brain dopamine replacement therapy (DRT) in patients with Parkinson's disease (PD). Among the behavioural problems associated with dysregulation of dopaminergic pathways underlying reward processing, hypersexuality carries significant social and legal repercussions, in addition to embarrassment for the patient with PD and his/her family. The present article evaluates the prevalence and characteristics of hypersexuality in the context of PD, focusing on the best available evidence. Methods: We conducted a systematic literature review according to the Prisma guidelines on largescale epidemiological studies (n>250) assessing hypersexuality in patients with PD treated with DRT. Results: Our systematic literature review identified 10 relevant studies characterised by medium-tolarge sample sizes (n=268-3,090). Average lifetime prevalence of hypersexuality in patients with PD on DRT was found to be 2.7% (7.4% in patients on dopamine agonists). In general, hypersexuality was associated with male gender and higher doses of dopamine agonists. Other clinically relevant associations included younger age, earlier PD onset and history of behavioural symptoms prior to dopamine agonist use. Conclusion: Hypersexuality is not rare in patients with PD treated with DRT, particularly in those on dopamine agonists. These findings indicate that PD specialists should regularly screen and monitor for hypersexuality, paying particular attention to younger male patients, with an early PD onset and previous history of behavioural problems.

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Carer burden in apathy and impulse control disorders in Parkinson's disease

Abstract: PD-related behaviour disturbances, such as apathy and ICDs, as well as psychiatric complications, have significant negative implications for burden of care.

Cited by 143 publications

References 39 publications

Neuropsychiatric symptoms and caregiver's burden in Parkinson's disease

Neuropsychiatric symptoms and caregiver's burden in Parkinson's disease

Personality Style in Behavioural Disturbances in Parkinson?s Disease

The prevalence and clinical characteristics of hypersexuality in patients with Parkinson's disease following dopaminergic therapy: A systematic literature review

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