Affective disturbance in parkinson's disease

✍ Scribed by H. A. Ring; M. R. Trimble

• Publisher: John Wiley and Sons
• Year: 1991
• Tongue: English
• Weight: 844 KB
• Volume: 6
• Category: Article
• ISSN: 0885-6230
• DOI: 10.1002/gps.930060609

✦ Synopsis

KEY woms-Affective disorder, old age, Parkinson's disease. Some or all of the central clinical features of Parkinsonism, bradykinesia, muscular rigidity, rest tremor and postural instability, may result from a number of different conditions including idiopathic Parkinson's disease (PD), other basal ganglia degenerations, Alzheimer's disease and neuroleptic treatment. While all these conditions may be associated with psychiatric symptoms, this review will concentrate on affective disturbance in PD.

Parkinson's disease generally begins between the ages of 40 and 70 with peak onset in the sixth decade of life. It is a common condition. In the United States 1% of the population over 50 years of age are known to be affected (Adams and Victor, 1989). In addition, Marsden (1990) points out that estimates of incidence and prevalence are generally based on hospital referrals. He suggests that as many as 40% of cases may not reach hospital services but may be living in the community undiagnosed, with their symptoms dismissed as 'old age'.

Many authors have noted that patients with PD are more commonly depressed than might be expected. However, published estimates of the frequency of depression in PD (see Table ) have varied from less than 20% to more than 90% . Methodological differences account for some of the variation in these studies. Recruitment of patients has been from general neurological clinics, specialist PD clinics and psychiatric hospitals. Depression is at times defined using recognized diagnostic criteria, eg DSM or ICD, but sometimes rating scales or symptom checklists are employed and these differ in the sensitivity and range with which they pick up depressive symptoms (Levin etal., 1988). Rating scale based studies may put too much weight on somatic symptoms that are common to PD and depression (Klawans, 1982). In addition, these dif-