Bta Improved Mmse Score
The MMSE scores did not differ between the two groups before and after treatment , and the MMSE scores were increased significantly in both groups after treatment .
Comparison of cognitive function. There was no significant difference in cognitive function scores between the control group and the observation group before treatment, after 1, 2 and 3 months of treatment, and 2 months after completion of treatment . Compared with before treatment, both the observation group and the control group exhibited higher cognitive function scores after 1, 2 and 3 months of treatment and 2 months after completion of treatment . * indicates comparisons within the observation group, P< 0.05, # indicates comparisons within the control group, P< 0.05.
Effectiveness On Motor Symptoms
Considering Bupropions pro-dopaminergic effect, its potential parallel role in ameliorating motor symptoms in PD is the second issue that can be discussed in light of the results of the present review. Among selected articles that measured motor outcomes, the two RCTs , one original article and two case reports showed an improvement in motor symptoms following treatment with Bupropion. Additionally, using a meta-analytic approach, Paumier reported that, in subjects with early PD, antidepressant therapy reduced the probability of requiring dopaminergic therapy compared with subjects not taking antidepressants . However, these investigations adopted questionnaires that measured generic changes in motor symptoms, so the effect of Bupropion on a specific PD-related motor symptom cannot be surveyed. Only the investigation from Kim and colleagues specifically showed a reduction of gait freezing in PD patients treated with Bupropion, although this difference was not significant when compared with baseline. In this respect, although the exact mechanism of action of Bupropion is not fully understood, this improvement in motor symptoms is likely associated with increased dopaminergic levels in the dopaminergic pathways involved in PD .
Depression In Genetic Pd
Whether genetic forms of PD predispose to depression remains an open question, although monogenic forms of PD resembling idiopathic PD with Lewy-body synucleinopathy represent critical etiopathogenic models.
Depression is frequent in patients with genetic PD , although depression was not related to mutations of parkin, leucine-rich repeat kinase 2 and apolipoprotein E status in a large study gathering 632 families . In addition, a recent study showed that depression severity was similar to healthy controls in both LRRK2 and glucocerebrosidase mutation carriers at risk of PD as well as RBD and impulse control disorders . Nevertheless, prevalence of depression is close to 30% in LRRK2 patients with manifest PD and may predate motor symptoms, similar to patients with idiopathic PD , whereas prevalence of dementia might be lower . Moreover, depression severity increased over 2 years in heterozygous carriers of GBA mutations, who are at high risk of PD, also associated with greater olfactory and cognitive impairment , and depending on the alleles .
Overall, these robust statistical associations and temporal precedence suggest that depression and PD may share common pathophysiological mechanisms , and that association with specific comorbidities and risks factors may reflect different pathological routes .
Table 1 Summary of epidemiological findings for depression in patients with Parkinsons disease
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Diagnosis Of Depression In Parkinsons Disease
Diagnosing depression in PD can be particularly difficult because of the clinical overlap between the two syndromes.
Symptoms that are common to both depression and idiopathic Parkinsons disease include motor slowing, bradyphrenia, sleep and appetite disturbance, weight loss, loss of interest and concentration, and reduced libido. The body language of depression looks similar to that of PD at first glance. The patient often appears hunched with a lack of an obvious affective response and spontaneity .
Symptoms that may help in the diagnosis of depression in people with PD include
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pervasive low mood with diurnal variation
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early morning wakening
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pessimistic thoughts about the world, themselves, and the future
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suicidal ideation.
Table 1 lists the Diagnostic and statistical manual, 4th revision criteria for major depressive episode.
Table 1
DSM-IV criteria for major depressive episode
Depression should be considered in any patient whose function deteriorates notably over a few days or weeks.
Table 2
Differential diagnosis of depression in Parkinsons disease
A variety of mood disorders have been described in the setting of neurosurgery for PD. These include transient dysphoria during surgery . More chronic changes in mood have also been described following pallidotomy and deep brain stimulation although definitive studies have not been performed in this area.
Restoration Of Dopaminergic Deficits
Treatment of many of the motor symptoms of PD can be achieved through restoration of striatal dopaminergic tone. This may be accomplished through targeted delivery of dopamine-producing cells, or the use of viruses to deliver genes encoding the enzymes required for dopamine biosynthesis into the striatum. Targeting these regenerative treatments to the striatum, the site of greatest dopamine loss in PD, would minimize the off-target effects seen with oral dopamine-replacement.
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Traditional Chinese Medicine In Depression In Parkinsons Disease Treatment
Traditional single-target antidepressants have unsatisfactory therapeutic effects on DPD and may aggravate MS in PD patients . TCM has a long history of treating depression, especially in Asia, where it is most common in China, Japan, and South Korea . With deepening of the understanding of TCM in the treatment of depression, TCM is gradually being used in the treatment of other neurological diseases with depressive symptoms, including post-stroke depression, depression in Alzheimers disease, depression in epilepsy, and DPD .
TCM has a unique medical theory. As a holistic medicine, TCM emphasizes the integrity of the body and the influence of the environment on homeostasis. In TCM theory, depression is caused by qi deficiency, which is caused by dysfunction of multiple physiological systems in the body, such as qi stasis,blood stagnation, and phlegm obstruction. Restoration of vital energy is the principle in healing depression, but disorders of other physiological systems also need to be corrected by promoting blood circulation and removing stasis, as well as regulating the liver.
TABLE 1. Characteristics of studies on TCM prescriptions in depressed PD.
FIGURE 2. The proportion of single herbal medicines included in Traditional Chinese Medicine prescriptions confirmed clinically in the treatment of depression in Parkinsons disease .
TABLE 2. Effect of antidepressant ingredient in single herbal.
How Is Depression Treated
It often is difficult to know how to effectively help a loved one with depression. It is important to have realistic expectations and to give unconditional love. Communication should take place in a positive and honest way. Your loved one may reject attempts to help at first this is part of the illness. Fortunately, treatments are available and are successful in 90 percent of patients with depression.
Depression may be treated with psychological therapy, as well as with medications. Studies show each treatment is effective by itself, but they are much more effective when used together.
There are many antidepressant medications available, each with its own advantages and disadvantages. The choice of antidepressant for patients with Parkinsons disease depends on their overall condition and specific needs. Most antidepressants used for treatment in general are effective in those with Parkinsons disease, although there are some antidepressants that have shown promise in recent studies specifically for Parkinsons disease.
Psychological therapy can help a patient with Parkinsons disease regain a sense of self worth while his or her physical and functional abilities are declining. It also can help the person maintain good relationships with caregivers and family members, even while he or she may have to depend on them even more. It also can help the patient focus on more positive approaches to problem-solving.
References
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Diagnosis Of Parkinsons Disease
There are currently no blood or laboratory tests to diagnose non-genetic cases of Parkinsons. Doctors usually diagnose the disease by taking a persons medical history and performing a neurological examination. If symptoms improve after starting to take medication, its another indicator that the person has Parkinsons.
A number of disorders can cause symptoms similar to those of Parkinsons disease. People with Parkinsons-like symptoms that result from other causes, such as multiple system atrophy and dementia with Lewy bodies, are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinsons, certain medical tests, as well as response to drug treatment, may help to better evaluate the cause. Many other diseases have similar features but require different treatments, so it is important to get an accurate diagnosis as soon as possible.
Q: What Would Be The Value Of Knowing That Someone Who Has Depression When Theyre In Their 30s Or 40s Might Be At Risk Of Parkinsons Disease Later In Life
A: There are a couple of scenarios that can play out. If we knew that depression was linked to the future occurrence of Parkinsons, we might find a way to mitigate the risk by treating the depression or by some other means. Or, we may be able to use some disease-modifying therapies for Parkinsons earlier. It could redefine how we diagnose and treat Parkinsons. On the other side of things, if Parkinsons disease is affecting the same brain circuitry that causes depression, it may help us learn more about depression. Right now, were still all guessing as to what the broken part is in depression.
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Managing Depression In Parkinsons Disease
People with Parkinsons, family members and caregivers may not always recognize the signs of depression and anxiety. If you are experiencing depression as a symptom of Parkinsons, it is important to know it can be treated.
Here are some suggestions:
- For information and support on living well with Parkinsons disease, contact our Information and Referral line.
- As much as possible, remain socially engaged and physically active. Resist the urge to isolate yourself.
- You may want to consult a psychologist and there are medications that help relieve depression in people with Parkinsons, including nortriptyline and citalopram .
What Anxiety Looks Like
Anxiety often feels like extreme worry or fear. Itâs more than everyday worries or nerves. It can get in the way of your daily life. You might have trouble sleeping or sudden waves of fear. You could have physical symptoms too, like nausea, a racing heartbeat, shortness of breath, sweating, or dizziness.
Anxiety can also lead to avoiding thigs you used to enjoy. You may stay away from social situations because you worry about your symptoms and feel embarrassed around others. Or you might fear being left alone or not being able to function on your own.
Symptoms of anxiety often include:
- Extra worry or fear
- Worry about upcoming events
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Parkinsons Disease Alternative Medicine
Hope is a powerful thing. Without hope for a better future, the will to live is lost and recovery, no matter what the affliction, is impossible.
Imagine then, being told by your doctor that you have a progressive and degenerative disease that robs you of the ability to control your own body. A disease for which there is no cure.
This is the reality for those diagnosed with Parkinsons disease.
Hope is offered in the form of medication such as Levodopa. Levodopa acts to restore levels of dopamine in the brain. The lack of dopamine is the primary reason for the symptoms associated with the condition. Since it first began being administered in the 1960s, it has lessened much of the suffering experienced by millions of people throughout the world, and is recognised as the gold standard in medical treatment of the disease. However, it can not completely reverse the symptoms, and like all drugs, is more effective in some than others.
Consequently many have sought hope in alternative treatments. Parkinsons disease has been a recognised ailment in virtually all cultures since ancient times. Many of these ancient treatments are becoming popular in the west and are increasingly validated by western medicine.
Broad beans Australian researchers discovered that broad beans are also an extremely effective natural source of L-dopa. The highest concentration of L-dopa is found in the pod so they are most effective when consumed whole.
2002-2012©Parkinsons Disease Information.
Can Eating Well Alter The Course Of Pd
Scientists know a lot about the molecular changes that underlie Parkinsons. You may have heard of alpha-synuclein, the protein that forms clumps in brain cells, oxidative stress, mitochondrial dysfunction, and inflammation. The search is intense for therapies that can stop or reverse these processes. Can nutrition or dietary choices do anything to change them or alter the course of PD?
Some laboratory and animal research suggest that diet could have an effect, especially plant-based foods like fruits, vegetables, legumes, nuts and seeds. Every plant-based food contains hundreds of chemicals called phytochemicals. These are not nutrients, but substances that may, alone or in combination, affect many of the processes thought to be involved in PD including oxidation, chronic inflammation, protein aggregation and mitochondrial dysfunction.
Phytochemicals have not been proven to change disease progression in people with PD, but neither is there typically any harm in eating a diet that includes whole, unprocessed plants. This diet has proven benefits for preventing heart and vascular disease and can reduce PD symptoms, like constipation and risk of cognitive change.
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Ask The Md: Depression And Anxiety In Parkinsons Disease
This 4-minute video is a summary of depression and anxiety symptoms in Parkinsons disease by Dr. Rachel Dolhun. She packs a lot of information into such a short time, explaining precisely how both can be managed with medication, talk therapy and/or behavioral strategies, such as regular exercise and social activities.
Symptoms Of Parkinsons Disease
Parkinsons has four main symptoms:
- Tremor in hands, arms, legs, jaw, or head
- Muscle stiffness, where muscle remains contracted for a long time
- Slowness of movement
- Impaired balance and coordination, sometimes leading to falls
Other symptoms may include:
The symptoms of Parkinsons and the rate of progression differ among individuals. Early symptoms of this disease are subtle and occur gradually. For example, people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinsons. They may see that the persons face lacks expression and animation, or that the person does not move an arm or leg normally.
People with Parkinson’s disease often develop a parkinsonian gait that includes a tendency to lean forward take small, quick steps and reduce swinging their arms. They also may have trouble initiating or continuing movement.
Symptoms often begin on one side of the body or even in one limb on one side of the body. As the disease progresses, it eventually affects both sides. However, the symptoms may still be more severe on one side than on the other.
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Original Articles Observational Studies
Considering safety concerns of monoamine oxidase type B inhibitors in PD, Ritter and colleagues retrospectively reviewed the clinical charts of 28 patients with PD, who were prescribed Selegiline in association with antidepressants , with the aim to investigate the safety of different combinations. Among the investigated combinations , only one interaction emerged . With respect to Bupropion, authors considered the medication an appropriate first choice in subjects prescribed Selegiline, whereas tricyclic antidepressants and Trazodone may be reserved as second-line treatments .
A cross-sectional prospective study collected data from a national database of veterans who attended clinical visits for depression, followed up for the following 12months to compare different antidepressants in patients with versus without PD . Results showed interesting data on antidepressant approaches in the two subgroups . Bupropions prescription accounted for 6.8% of patients with PD, a percentage similar to Venlafaxine but lower compared to other classic serotonergic antidepressants .
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Management Of Depression In Parkinsons Disease
Although traditionally considered a purely motor disorder, Parkinsons disease is increasingly recognized as a complex disease process with diverse neuropsychiatric complications in addition to its motor symptomatology. The range of neuropsychiatric complications associated with Parkinsons disease is broad and includes depression, anxiety, apathy, psychosis, cognitive impairment, impulse control disorders, and sleep disturbances. These neuropsychiatric complications become increasingly prevalent over the course of the disease and are often associated with poorer quality of life, increased disability, worse outcomes, and greater caregiver burden . As mental health providers commonly encounter depression in the Parkinsons disease population, it is important to be familiar with available, validated treatment options for this illness.