Symptom Dimensions of Depression and Apathy and Their Relationship With Cognition in Parkinson’s Disease

Szymkowicz, Sarah M.; Dotson, Vonetta M.; Jones, Jacob D.; Okun, Michael S.; Bowers, Dawn

doi:10.1017/s1355617717001011

Cited by 17 publications

(20 citation statements)

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“…We excluded participants under 50 years of age ( N = 53) and non-PD controls. We excluded participants under 50 years of age because the relationship between mood symptoms and cognitive functioning is hypothesized to be driven by similar mechanisms (i.e., disruption of similar neural circuits; Butterfield et al, 2010; Jones et al, 2016; Pirogovsky-Turk et al, 2017; Szymkowicz et al, 2018; Varanese et al, 2011); however there is evidence that young onset-PD patients (before the age of 50) experience greater psychosocial stressors (loss of employment, perceived stigma, family disruptions), which may contribute to depressive symptoms (Schrag, Hovris, Morley, Quinn, & Jahanshahi, 2003). Therefore, we excluded participants under 50 to remove the possible confound that depression is differentially driven by separate mechanisms (i.e., psychosocial contributors vs. neurobiological contributors).…”

Section: Methodsmentioning

confidence: 99%

“…Regarding apathy and depression, at least five past studies have examined the relationship−intersectionality between apathy, depression, and cognition in PD (Butterfield, Cimino, Oelke, Hauser, & Sanchez-Ramos, 2010; Jones et al, 2016; Pirogovsky-Turk et al, 2017; Szymkowicz, Dotson, Jones, Okun, & Bowers, 2018; Varanese, Perfetti, Ghilardi, & Di Rocco, 2011). However, findings concerning whether cognition has a stronger relationship with apathy or depression have generally been inconsistent.…”

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confidence: 99%

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Depressive symptoms precede cognitive impairment in de novo Parkinson’s disease patients: Analysis of the PPMI cohort.

Jones¹,

N²,

Kuhn³

et al. 2019

Neuropsychology

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Introduction: Nonmotor symptoms, including depression, anxiety, apathy, and cognitive dysfunction, are common in Parkinson’s disease (PD). Although a link between mood symptoms and cognitive impairment in PD has been theorized vis-à-vis striatal dopamine depletion, studies have been inconsistent regarding the relationship between mood symptoms and cognitive function. Inconsistencies may reflect the cross-sectional nature of previous studies. The current study examined the bidirectional longitudinal relationship between mood and cognition. Method: Data were obtained from 310 individuals newly diagnosed with PD, who were followed up to 4 years (baseline, 1st, 2nd, 3rd, and 4th annual follow-ups). Apathy, anxiety, depressive symptoms, motor severity, and neurocognitive functioning were assessed at each annual assessment. The longitudinal relationship between apathy, anxiety, depressive symptoms, and cognition was analyzed with multilevel models. Results: Over the 4-year period, more severe depressive symptoms were related to worse performance on tasks of processing speed, verbal learning, and verbal delayed recall. Additionally, there was a significant Depression × Time interaction, suggesting that individuals with more severe depressive symptoms experience more rapid declines in global cognitive functioning and verbal learning. Apathy and anxiety were not significantly related to performance in any cognitive test. Lagged models revealed that changes in depression precede declines in working memory, verbal learning, delayed verbal recall, and global cognition. Conclusion: Findings suggest depressive symptoms may be a harbinger for future cognitive decline among individuals with PD.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Depressive symptoms precede cognitive impairment in de novo Parkinson’s disease patients: Analysis of the PPMI cohort.

Jones¹,

N²,

Kuhn³

et al. 2019

Neuropsychology

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“…A previous study reported that, while depressed patients showed significantly worse health status, low health literacy itself did not predict depressive symptomology [42]. Thus, it is crucial to disentangle the exact aspects of depression and its related factors that influence HRQoL, especially with regard to different subfactors such as loss of interest, apathy/lack of motivation, and somatic symptoms [43,44]. As it was the primary aim of the present analysis to understand how medication knowledge is related to HRQoL and which overall factors influence this relationship, the available data cannot provide information on the exact parameters of depressive mood that drive this influence.…”

Section: Discussionmentioning

confidence: 99%

“…The issue is further complicated by the fact that some overlap exists between depression and cognitive impairment [44,45]. Depression, a common nonmotor symptom observed in patients with PD, can cause reversible cognitive impairment, particularly poorer concentration, impaired memory, and impaired problem solving, without the additional presence of dementia [46].…”

Section: Discussionmentioning

confidence: 99%

The impact of poor medication knowledge on health-related quality of life in people with Parkinson’s disease: a mediation analysis

et al. 2021

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Purpose This study aimed to determine how limited medication knowledge as one aspect of health literacy contributes to poorer health-related quality of life (HRQoL) in people with Parkinson’s disease (PD). Methods Demographical data, PD-specific data (MDS-Unified Parkinson’s Disease-Rating Scale, Nonmotor symptom scale), and data about depressive symptoms (Beck’s depression inventory), cognition (Montreal cognitive assessment), HRQoL (Short-Form Health Questionnaire-36, SF-36), and medication knowledge (names, time of taking, indication, dosage) were assessed in 193 patients with PD. Multivariate analysis of variance (MANOVA), multivariate analysis of covariance, and mediation analyses were used to study the relationship between medication knowledge and HRQoL in combination with different mediators and covariates. Results Overall, 43.5% patients showed deficits in at least one of the 4 knowledge items, which was associated with higher age, number of medications per day and depression level, and poorer cognitive function, motor function, and lower education level. Using one-way MANOVA, we identified that medication knowledge significantly impacts physical functioning, social functioning, role limitations due to physical problems, and role limitations due to emotional problems. Mediation models using age, education level, and gender as covariates showed that the relationship between knowledge and SF-36 domains was fully mediated by Beck’s Depression Inventory but not by Montreal Cognitive Assessment. Conclusions Patients who expressed unawareness of their medication did not necessarily have cognitive deficits; however, depressive symptoms may instead be present. This concomitant depressive symptomatology is crucial in explaining the contribution of nonadherence and decreased medication knowledge to poor quality of life.

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“…However, more recent studies have suggested that the presence of Lewy body and/or Alzheimer's pathology in these patients may lead to errors in memory encoding and retrieval [38]. Additional research is needed to definitively establish the relationship between apathy, depression, and cognitive impairment [40].…”

Section: Discussionmentioning

confidence: 99%

Psychometric Properties of the Apathy Scale in Advanced Parkinson’s Disease

Wetmore

Arbelo

Catalán

et al. 2019

Parkinson's Disease

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Objectives. To assess the psychometric attributes of the Apathy Scale- (AS-) Spanish version in patients with advanced Parkinson’s disease (APD). Materials and Methods. Over 6 months, 61 patients participated in a clinical study of levodopa-carbidopa intestinal gel (LCIG) and were evaluated using the AS and other clinical tools. Various psychometric attributes of the AS were assessed. Results. Patients (60.7% men) were aged 68.02 ± 7.43 years, with 12.57 ± 5.97 years from PD diagnosis. Median HY of patients in “on state” was 2 (range, 1–4), and mean levodopa equivalent daily dose was 1455.98 ± 456.00 mg. Overall, the parameters of feasibility/acceptability were satisfactory, except for a moderate-to-high floor effect in AS items but not in its total score (both 3.3%). Cronbach’s alpha was 0.78, while item homogeneity coefficient was 0.21. Almost all items (11/14) reached acceptable item-total corrected correlations (rS = 0.16–0.50). AS total score was moderately correlated with Beck Depression Inventory (0.34) and with Non-Motor Symptoms Scale domains 2 (sleep/fatigue, 0.35), 3 (mood/apathy, 0.56), and 5 (attention/memory, 0.41). There were no significant differences between AS total scores by established groups of sex, time from diagnosis, HY, and Clinical Global Impression-Severity Scale. Following LCIG treatment, there was no significant change in the AS total score. The relative change was 5.56%, the standard error of the difference was 4.17, and Cohen’s d effect was 0.10. Conclusions. The AS showed satisfactory feasibility, acceptability, scaling assumptions, internal consistency, and convergent validity. Responsiveness parameters were poor, probably due to the characteristics of the clinical study from which these data came. This trial is registered with NCT02289729.

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Symptom Dimensions of Depression and Apathy and Their Relationship With Cognition in Parkinson’s Disease

Cited by 17 publications

References 96 publications

Depressive symptoms precede cognitive impairment in de novo Parkinson’s disease patients: Analysis of the PPMI cohort.

Depressive symptoms precede cognitive impairment in de novo Parkinson’s disease patients: Analysis of the PPMI cohort.

The impact of poor medication knowledge on health-related quality of life in people with Parkinson’s disease: a mediation analysis

Psychometric Properties of the Apathy Scale in Advanced Parkinson’s Disease

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