Abdul Rehman M. Qureshi

Association of restless legs syndrome, pain, and mood disorders in parkinson's disease

Purpose/Aims: The objectives of the study were to analyze the association between Parkinsons disease and restless legs syndrome, and to explore the relationship between mood disorder comorbidity (anxiety and depression), pain, and restless legs syndrome. Methods: This study included 123 Parkinsons disease patients and 123 non-Parkinsons disease patients matched for age and gender, and evaluated for anxiety severity, depression severity, pain severity, pain interference, pain disability, and restless legs syndrome prevalence. This was performed using semi-structured interviews and a neurological examination through the restless legs syndrome diagnostic criteria and the following inventories; Hospital Anxiety and Depression Scale, Brief Pain Inventory, and Pain Disability Index. Results: Parkinsons disease patients had significantly greater anxiety severity, depression severity, pain severity, pain interference, pain disability, and restless legs syndrome prevalence in comparison to controls. In addition, Parkinsons disease patients’ comorbid for anxiety and depression had significantly greater pain severity, pain interference, and pain disability, but not RLS prevalence, in comparison to Parkinsons disease only, Parkinsons disease anxiety, and Parkinsons disease depression patients. Conclusions: Pain interference, pain severity, and pain disability is greater among Parkinsons disease patients with anxiety and depression, in comparison to Parkinsons disease patients without anxiety and depression. On the contrary, the prevalence of restless legs syndrome was not found to be relevant.

Restless leg syndrome: a risk factor of higher prevalence of anxiety and depression in Parkinson’s disease patients

Background: Many studies have assessed the relationship of depression and anxiety with Parkinson’s disease (PD), as well as examining restless leg syndrome (RLS) with depression and anxiety. Nonetheless, there has not been an extensive effort to show how the prevalence of RLS affects both depression and anxiety in PD patients. The objective of this study was to examine how the prevalence of RLS in PD patients affects the prevalence and severity of depression and anxiety and how they compare with each other. This study is the first of its kind that examines the effects of the combination of the two neurological conditions with depression and anxiety as well as comparing their prevalence and severity to each other. Methods: The study included 27 PD patients who also suffered from RLS, 27 PD patients not suffering from RLS, and 27 gender-matched healthy individuals. All were evaluated for caseness and severity of both anxiety and depression using the Hospital Anxiety and Depression Scale (HADS); HADS-A and HADS-D, respectively. Results: PD patients with RLS reported having the highest prevalence of both anxiety and depression. The least reported cases for both anxiety and depression were in the control group. In comparison, the results for severity of anxiety and depression within the three groups showed that PD patients with and without RLS had significantly higher severity scores for both anxiety and depression than the control group, but the scores did not significantly differ between the two PD patient groups. Conclusion: The presence of RLS in PD patients may increase the occurrence of both anxiety and depression, but the severity of the symptoms is not significant in the two groups of the PD patients.

Disability from pain directly correlated with depression in Parkinson’s disease

OBJECTIVE Parkinsons disease (PD) is a progressively debilitating disorder resulting in reduced quality of life (QoL). Along with the motor symptoms of PD, non-motor symptoms of PD such as pain, restless leg syndrome (RLS) depression also occur. These exacerbate the worsening QoL and must be promptly diagnosed and treated. The objective of this study was to determine the relationship between pain severity, walking, general activity and work (WAW) and rapid eye movements (REM) dimensions of pain interference, and disability with depression and RLS in PD. PATIENTS & METHODS 120 patients with PD and 120 controls were evaluated for depression using the Hospital Anxiety and Depression Scale (HADS-D). Pain severity and interference was measured using Brief Pain Inventory (BPI). REM and WAW dimensions of pain were also measured. The Pain Disability Index (PDI) was used to assess the disabling effects from chronic pain. RESULTS The study found a statistically significant direct correlation between the BPI, PDI and PD. A significant direct correlation was also found for depression and pain in PD. No association as found between RLS and PD; RLS was not a confounding factor. CONCLUSIONS Based on these findings, we conclude that pain interference, severity of pain and disability from pain is directly correlated with depression in PD. We also discern that these symptoms of PD are not independent of each other. We cannot establish a causal relationship between any of these variables. Prompt recognition and treatment of pain and depression is valuable in preserving the quality of life in PD.

Giant cell arteritis or tension-type headache?: A differential diagnostic dilemma

Giant cell arteritis (GCA) or Temporal arteritis (TA) is an autoimmune disease and the most common type of vasculitis in the elderly. It causes inflammation of the medium and large arteries in the upper part of the body. GCA is an under-recognized cause of  head aches in the elderly, especially when it presents itself with atypical features, resulting in delayed or incorrect diagnosis. Since GCA is a treatable condition, an accurate diagnosis is crucial to prevent the most serious complication of CGA, permanent vision loss. The diagnosis can be further complicated as GCA may present with features of other painful neurological conditions. The present case is an 81-year-old woman diagnosed with GCA, who initially presented with features similar to tension-type headache. Due to overlapping features of these conditions, the diagnosis of GCA was delayed, resulting in irreversible vision loss. Although previous research highlights diagnostic dilemmas featuring GCA and other disease states, this case is exclusive in describing a unique dilemma where tension-type headache mimics GCA.

Decreased sleep quality in Parkinson’s patients is associated with higher anxiety and depression prevalence and severity, and correlates with pain intensity and quality

Abstract Objective: Pain, poor sleep quality, restless legs syndrome (RLS), and other symptoms are frequently reported by patients with Parkinson’s disease (PD). However, the impact that pain severity and interference has on non-motor symptoms (NMS) has not been extensively studied. The objective of the present study is to explore the relationship between sleep quality in PD to pain and other NMS that affect quality of life.Methods: The study included 100 PD patients and 100 age and gender-matched controls assessed for pain severity and pain interference using the Brief Pain Inventory and sleep quality using the Pittsburgh Sleep Quality Index. Participants were also evaluated for their subjective levels of anxiety and depression using the Hospital Anxiety and Depression Scale.Results: PD patients with poor sleep quality had greater pain severity and pain interference than controls and PD patients with good or borderline sleep quality. PD patients with poor sleep quality also had the greatest case-ness and severity for depression and anxiety. However, RLS was not significantly correlated with depression, anxiety or pain.Discussion: Poor sleep quality in PD patients is related to greater pain severity, pain interference, and more radiating and paresthestic pain that is independent of RLS. There is a higher prevalence of depression and anxiety in PD patients compared to controls, especially in PD patients with poor sleep quality. Our findings suggest a relationship between poor sleep quality in PD with pain, anxiety and depression. Prospective studies are warranted to investigate the causal relationship.

Increased likelihood of anxiety and poor sleep quality in Parkinson's disease patients with pain

BACKGROUND Pain is a bothersome non-motor symptom in patients with Parkinsons disease (PD), but the relationships between PD, presence of pain, different pain characteristics, and other non-motor symptoms such as mood and sleep disturbances are unclear. OBJECTIVE To investigate the relationship between PD and pain as well as specific subtypes of pain with anxiety, depression and sleep quality. METHODS This cross-sectional case-control study included two groups of PD patients; one with (n=37) and one without pain (n=37). Healthy controls with (n=37) and without pain (n=37) were recruited and matched to the PD groups for age and gender. All participants completed questionnaires regarding pain, mood and sleep. RESULTS PD patients with pain showed significantly higher anxiety severity and poorer sleep quality than PD patients without pain. Compared to controls with pain, PD patients with pain had more anxiety, depression and worsened sleep quality. PD patients with pain were more likely to report akathisic, tension and sharp pain compared to controls with pain, but these three pain characteristics did not correlate with each other. There were no differences in depression, anxiety, or sleep between PD patients with akathisic, tension and sharp pain and those without. CONCLUSION Pain in PD seems to be linked with specific pain characteristics (akathisic, tension and sharp pain) as well as heightened anxiety and worsened sleep quality. Integrative approach treatments which address pain in PD may also improve anxiety and sleep quality.

Impact of ethnicity on mood disorders in Parkinson's disease

Anxiety and depression are common in Parkinsons disease (PD) patients, yet their prevalence and severity compared to individuals without PD requires more research. Moreover, it has never been compared across different ethnic groups. The objective of this study was to close that gap in the literature by exploring the caseness and severity of anxiety and depression in PD patients of different ethnicities compared to controls without PD. It was found that caseness and severity of anxiety and depression are higher in individuals with PD compared to controls. Furthermore, the caseness and severity of anxiety and depression do not vary significantly among ethnic groups. Finally, depression caseness was not predicted by age, gender, disease duration, restless legs syndrome prevalence, Hoehn and Yahr (H&Y) score nor Unified Parkinsons disease rating scale part III (UPDRS-III) score. Anxiety caseness was predicted by gender, with females 2.7 times more likely to have anxiety caseness than males. Overall, our study suggests that treatment plans should be individualized based on prevalence and severity of the two conditions in individuals with PD rather than generalize treatment for specific ethnic groups.

Negative impact of severity of pain on mood, social life and general activity in Parkinson’s disease

ABSTRACT OBJECTIVE: Pain is an important non-motor symptom of Parkinson’s disease (PD); however, it remains understudied. The purpose of previous studies on the relationship between PD and pain, has been to explore the cause, origin and types of pain. This case control study is designed for clinicians and rehabilitation specialists to effectively identify pain from the patient’s point of view. Pain present in PD patients correlates with significant disruption to their daily lives, which was seen by analysing characteristics, frequency, severity and interference of pain. METHOD: A total of 100 PD patients and 100 control healthy individuals, consisting of 66 males and 34 females were evaluated during routine clinical assessment followed by a neurological exam. The Brief Pain Inventory (BPI) was used to measure chronic pain in terms of pain severity, pain interference and pain frequency between the two groups. RESULTS: It was determined that PD patients had significantly higher pain severity scores compared to controls (p < 0.05). PD patients with depressive symptoms had significantly higher pain severity and pain interference scores than controls without depressive symptoms. PD patients reported greater scores on Global BPI pain interference and all components of the pain interference subscale. DISCUSSION: PD and depression seem to be correlated with higher perceived pain, severity and interference. These findings have not been reported by other case control studies, and warrant further causal research into pain, depression and PD.

Comprehensive Examination of Therapies for Pain in Parkinson’s Disease: A Systematic Review and Meta-Analysis

Pain in Parkinson’s disease (PD) is a debilitating symptom with a prevalence of 68%, yet is untreated 50% of the time. What is unclear, however, is which treatment is optimal for minimizing pain severity in PD. Thus, the objective of this systematic review and meta-analysis was to investigate the efficacy of a variety of novel, complimentary, and conventional treatments for pain in PD and elucidate which therapy is the most effective. A systematic search was performed using MEDLINE, PsycINFO, Embase, CINAHL, and CENTRAL databases. To identify additional articles, manual searches of reference lists of included trials were also searched. Major neurology conference proceedings occurring between January 2014 and February 2018 were also searched to identify unpublished studies that may be potentially eligible. Twenty-five randomized controlled trials that encompassed medical, surgical, and complementary therapies met our inclusion criteria and exhibited moderate quality evidence. Two reviewers conducted assessments for study eligibility, risk of bias, data extraction, and quality of evidence rating. A conservative random-effects model was used to pool effect estimates of pain severity. The greatest reductions in pain were found with safinamide (Standardized mean difference = –4.83, 95% CI [–5.07 to –4.59], p < 0.0001), followed by cannabinoids and opioids, multidisciplinary team care, catechol-O-methyltransferase inhibitors, and electrical and Chinese therapies. Moderate effects in reducing pain were in pardoprunox and surgery, while the weakest effects were in dopaminergic agonists and miscellaneous therapies. Safinamide is an important adjunct to standard parkinsonian medication for alleviating pain in PD.

Impact of progression of parkinson's disease and various other factors on generalized anxiety disorder

Objective: While much research has been conducted toward understanding the relationship between prevalence of Parkinsons disease (PD) and generalized anxiety, little has been done considering additional influential factors in the relationship by means of a large ethnically diverse sample. Our study strives to fulfill these deficits in the literature as we set out to determine the impact of progression of PD, age, gender, and Hoehn and Yahr (H and Y) staging of PD on generalized anxiety. Methods: A retrospective chart review analysis was performed on PD patients who were regularly examined in a community-based PD and movement disorders center from 2005 to 2010. Results: This study consisted of 310 patients with PD among whom 12% had generalized anxiety. Neither age nor gender was significant onset predictors at P = 0.05. The impact of progression of H and Y Stages 2–3 and 2–4 increased the odds of generalized anxiety disorder (GAD) prevalence though it was statistically insignificant at P = 0.05. Conclusions: Clinicians should not expect the risk of developing anxiety to depend on gender nor change as a function of age though it may increase with symptomatic progression of PD as outlined by H and Y. To the best of our knowledge, this is the largest and most ethnically diverse prevalence study with a focus on generalized anxiety and PD. Significant Outcomes and Limitations: The symptomatic progression of PD, but not age or gender, may be associated with an increased risk for GAD. This study lacked adjustment for potential confounders such as depression and PD medications.