Daniel Weintraub

Effect of psychiatric and other nonmotor symptoms on disability in Parkinson's disease.

Objectives: To examine the effect of depression and other nonmotor symptoms on functional ability in Parkinsons disease (PD).

Recognition and Treatment of Depression in Parkinson's Disease

Depression in Parkinsons disease (PD) is common, but little is known about its recognition and treatment. The authors report the antidepressant experience (N = 100) and outcome of depression assessment (n = 77) of a convenience sample of patients at a PD center. Subjects were assessed with a psychiatric and neurological battery, and information was gathered on depression treatment. One third (34%) of subjects met criteria for a depressive disorder, and two thirds (65%) of them were not currently receiving antidepressant treatment. Approximately one quarter (23%) of subjects were taking an antidepressant, but almost half (47%) of them still met criteria for a depressive disorder. Few antidepressant users with persistent depression had received either antidepressant treatment at dosages within the highest recommended range (11%) or more than 1 antidepressant trial (33%). Most depressed patients are untreated, and half of antidepressant users remain depressed, suggesting that even when delivered, treatment is often inadequate or ineffective. (J Geriatr Psychiatry Neurol 2003; 16:178-183).

Assessing the Executive Function Deficits of Patients with Parkinson’s Disease: Utility of the Tower of London-Drexel

The aim of the study was to investigate the utility of the Tower of London-Drexel (TOL DX ) in assessing the executive deficits associated with Parkinson’s disease (PD). We sought to determine whether the TOL DX would differentiate between (a) patients with PD and healthy control participants (HCP), (b) demented and nondemented patients, and (c) depressed and nondepressed patients. A new TOL DX score, stimulus bound, was introduced to assess utilization behaviors. Furthermore, the convergent and divergent validity of the TOL DX was examined. The TOL DX total move, rule and time violation, and stimulus-bound scores of patients with PD significantly differed from the HCP. Demented and nondemented patients also differed significantly in their TO DX performance, with the stimulus-bound score being the most significantly differentiating score. However, the depressed and nondepressed patients did not differ in their TOL DX performance. Support was found for the convergent and divergent validity of the TOL DX. The clinical and theoretical implications of the findings are discussed.

Prevalence of Impulsive-Compulsive Symptoms in Elderly Parkinson’s Disease Patients: A Case-Control Study

BACKGROUND Impulse-control disorders (ICDs) are frequently described in patients with Parkinsons disease (PD), particularly among those treated with dopaminergic medications, but data on the prevalence of ICDs in elderly populations are lacking. OBJECTIVE The aim of this study was to estimate the prevalence of ICDs by using an Italian validation of the Questionnaire for Impulsive-Compulsive Disorders in Parkinsons Disease (QUIP) and to identify associated sociodemographic and clinical factors in a sample of elderly PD patients and in a control group of similarly aged healthy volunteers. METHODS Using the United Kingdom Parkinsons Disease Society Brain Bank diagnostic criteria, we included 115 consecutive PD and 105 healthy controls. They were recruited from June 2014 to December 2015. All participants completed the self-administered QUIP-Anytime for assessment of ICDs occurring any time during the course of PD. RESULTS Mean ± SD age was 75.7 ± 7.0 years in the PD patients and 76.1 ± 7.0 years in the control group. The mean disease duration was 6.8 years (range, 1-26 years). Among the PD patients, 44.7% (n = 51) had at least 1 ICD or related disorder compared to 25.2% (n = 26) in the control group (between-group difference: P = .003). Hypersexuality and compulsive shopping were significantly more common in the PD group than in the control group (P < .05). The prevalence of other compulsive behaviors was 42.5% in the PD group and 38.9% in the control group (P = NS). The Italian version of the QUIP-Anytime showed high test-retest reliability (κ > 0.70 for all items). CONCLUSIONS Our data confirm a high prevalence of ICD symptoms in elderly PD patients, approximately twice that seen in the general population.