A profile of neuropsychiatric problems and their relationship to quality of life for Parkinson's disease patients without dementia

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Abstract

Neuropsychiatric problems are common in Parkinson's disease (PD) but there is little information regarding how they impact on quality of life. PD patients without dementia (49) were assessed for low mood/depression, fatigue, apathy, sleep problems and hallucinations. Measures of quality of life and motor function were also obtained. Over 77% of the patients reported symptoms consistent with one or more neuropsychiatric problems. Low mood/depression, anxiety and the presence of hallucinations predicted poorer quality of life after controlling for motor symptoms. Additional to the motor symptoms, we found that specific neuropsychiatric problems may impact on quality of life for PD patients.

Introduction

A range of neuropsychiatric problems have been associated with Parkinson's disease (PD) in the absence of dementia. Individual symptoms, such as depression, are linked to reduced independence and quality of life for PD patients [1], [2], and are important predictors of caregiver distress which may result in early rest home placement [3]. However, these symptoms are often not recognized by treating physicians [4]. Varying prevalence rates have been reported for neuropsychiatric symptoms in PD patients depending on methodology, with up to 70% reporting symptoms consistent with depression [5], 40% for anxiety [6], 30% hallucinations [7], 43% apathy [6], [8], 40% fatigue [9] and 80% for sleep problems [10], [11].

Although the presence of individual neuropsychiatric symptoms has been well documented, relatively little is known regarding a typical profile associated with PD without dementia. Aarsland and Karlsen [12] examined the frequency of neuropsychiatric symptoms in a group of 139 PD patients (Hoehn & Yahr, (H&Y) stages I–IV) with the Neuropsychiatric Inventory [13], and found depression (38%) and hallucinations (27%) to be the most common disorders, with 61% of the sample reporting at least one symptom. Psychiatric symptoms were more common among patients in rest homes and those with cognitive impairment. However, 42% of their sample either met the criteria for or had questionable dementia and more recent studies indicate that PD patients with dementia have a greater number of neuropsychiatric problems [14]. Shulman et al. [9] reported sleep disturbance (47%) and sensory symptoms (63%) as being the most common neuropsychiatric problems in a group of 99 PD patients (H&Y I–IV) without dementia. High rates of fatigue (40%), depression (36%) and anxiety (33%) were also reported. Shulman et al. [9] also found comorbidity to be high, with 59% of the patients having two or more symptoms and 25% having four or more.

Neuropsychiatric problems have been found to contribute to the reduction in quality of life in PD patients, in addition to the motor symptoms associated with the disease [1], [15]. However, no prior study has used a single group of subjects to examine the effect that different neuropsychiatric problems have on quality of life for PD patients.

Thus, the major goal of the present research was to examine the relationship between different neuropsychiatric problems and quality of life. A related aim was to determine the profile of neuropsychiatric symptoms in this group. Because many problems such as apathy, fatigue, depression and sleep disturbance have a considerable degree of symptom overlap, we also examined the relationships among the different neuropsychiatric measures.

Section snippets

Methods

Approval for the study was granted by the Upper South B Regional Ethics Committee and informed consent was obtained from patients with a diagnosis of idiopathic PD confirmed by a specialist neurologist. Inclusion criteria were as follows: no evidence of another major medical illness, no evidence of dementia (MMSE⩾25) [16], and less than 80 years of age. Of the 115 letters that were mailed, 11/115 (9.6%) could not participate due to illness or dementia, 8/115 (6.9%) were deceased, 8/115 (6.9%)

Results

Table 2 displays the mean and standard deviation for the entire sample and also percentage of patients who exceeded the cut-offs for each of the seven neuropsychiatric outcomes. Overall, neuropsychiatric problems were extremely common with over 77% of the sample reaching the cut-off for one or more problems (11/49=0; 6/49=1; 9/49=2; 14/49=3; 2/49=4 and 4/49=5). Physical fatigue, mental fatigue, low mood/depression and apathy were the most frequent neuropsychiatric problems, and were each

Discussion

Our data suggest that neuropsychiatric problems are common for patients with PD. Over 77% of the patients reported symptoms consistent with at least one problem and more than 46% with three or more problems. Symptoms consistent with low mood/depression, physical fatigue, mental fatigue, apathy, and sleep problems were each reported by over 30% of the patients. Anxiety and hallucinations were relatively less common. Given the overlap between symptoms for these disorders we also examined the

Acknowledgments

This project has been supported by grant from the Canterbury Medical Research Foundation. Audrey McKinlay was sponsored by a scholarship from the Foundation for Science Research and Technology and by a Claude McCarthy Fellowship.

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