Parkinson's disease results when nerve cells in a certain part of the brain die or stop working properly. These cells stop producing an important brain chemical called dopamine. Dopamine normally transmits signals to another part of the brain that allows controlled muscle movement. Without enough dopamine, the cells in this part of the brain fire out of control. As a result, you are unable to control your movements normally.
People who have Parkinson's disease experience tremors or shaking as a result of the damage to their nerve cells. Tremors caused by Parkinson's get worse when the person is at rest and better when the person moves. The tremor may affect one side of the body more than the other, and can affect the lower jaw, arms and legs. Handwriting may also look "shaky" and smaller than usual. Other symptoms of Parkinson's disease include nightmares, depression, excess saliva, difficulty walking or buttoning clothes, or cutting food.
As many as half the people with Parkinson's disease develop depression. In some cases, depression may occur months or even years before Parkinson's disease is diagnosed. Although physical limitations resulting from Parkinson's disease can be frustrating and stressful, depression in someone with Parkinson's isn't usually a reaction to physical disability. Instead, it more likely arises from underlying brain changes associated with the disease itself.
In addition, some people with Parkinson's disease eventually develop dementia, a condition that can include memory loss, impaired judgment and personality changes.70% of individuals with Parkinson's disease diagnosed with pre-existing depression go on to develop anxiety. 90% of Parkinson's disease patients with pre-existing anxiety subsequently develop depression; apathy or abulia.
A high rate of depression has been observed in patients with Parkinson's disease [PD]. PD involves a loss of central monoamines, and a decrease of monoamines has been implicated in depression; therefore, it is possible that depression in PD results from the loss of endogenous neurotransmitters. however, it is equally possible that depression represents a reaction to the chronic disabling course of PD.
Study reveals that a significant number of patients of Parkinson's disease suffer from Anxiety Depression and Cognitive impairments. These manifestations cannot be the out come of chronic disabling disease alone but has a distinctive psychological pattern which needs further investigation with methodologically sound studies.
Although some people in the later stages may become mentally confused or demented, most retain their intellectual facilities while living in a body which is becoming increasingly disabled. This, in itself, can contribute to the boredom, social isolation and depression commonly experienced by sufferers.
Evidence from a variety of sources integrates the clinical features of Parkinson's disease and depression with neuroanatomical and pathophysiologic findings. This evidence comes from the correlation of clinical symptoms with structural lesions and focal neuropathology; results of brain-imaging studies of patients with Parkinson's disease or depression; the use of pharmacologic interventions that improve both disorders (including the use of levodopa, monoamine oxidase inhibitors, and catechol O-methyltransferase inhibitors); the use of neurosurgical procedures that treat Parkinson's disease (including pallidotomy, thalamotomy, and transplantation of fetal mesencephalic tissue); the use of electrical-stimulation techniques, including electroconvulsive therapy, that ameliorate the symptoms of both Parkinson's disease and depression; the use of transcranial magnetic stimulation, reported to be effective in both depression and Parkinson's disease9; and the use of high-frequency deep-brain stimulation, a new treatment for Parkinson's disease.
Depression plays an important role in non-adherence to medical treatment. Depressed patients are three times more likely not to comply with medical regimens than non-depressed patients.
Like many other neurological illnesses, Parkinson's disease is chronic, progressive and, at the moment, incurable. The main treatment for it is drug therapy, although surgical techniques are also used. Research is continuing into the use of foetal brain tissue implants, but as yet the results are inconclusive.
In this issue of the Journal, Bejjani and colleagues report the case of a patient who received high-frequency deep-brain stimulation to treat her intractable Parkinson's disease. Although stimulation of the left subthalamic nucleus of her brain through an electrode improved the symptoms of Parkinson's disease, electrical stimulation delivered through a second electrode positioned in the central region of the left substantia nigra evoked, during the course of the stimulation, unequivocal symptoms and signs of depression.
Many people believe that depression and memory loss are just a normal part of Parkinson’s, but there are effective treatments available that can have a tremendous effect on the quality of life for these people and their families.”
In some cases, depression can be an early manifestation of Parkinson's disease, new research suggests.
Researchers at the Harvard School of Public Health compared antidepressant use among more than 1,000 individuals with Parkinson's disease to more than 6,600 age- and gender-matched individuals without the degenerative neurological illness.
They found that people currently on antidepressants had an 80 percent higher risk of developing Parkinson's disease than those who had never taken antidepressants. This was true for both men and women, regardless of age or the class of antidepressant used.
"We think this is not actually the medication that is causing Parkinson's disease. Instead, we think people who are going to get Parkinson's disease get depression first," said study co-author Dr. Alvaro Alonso, a research associate at Harvard. "It's very important not to say that people taking antidepressants have a higher risk of developing Parkinson's disease," he said.
That's because the effect was only apparent in the year prior to disease diagnosis, and because it was true for two different types of medications, tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), which work via wholly different mechanisms, Alonso explained.
He noted that additional data, not included in the published study, indicated that newer users of antidepressants -- those who had been on the drugs for less than one year -- had a threefold higher risk of developing Parkinson's than people who had never used antidepressants.
Alonso's interpretation: Depressive symptoms could be one of the first manifestations of Parkinson's disease.
The research is scheduled to be presented May 1 at the annual meeting of the American Academy of Neurology, in Boston.
Dr. Rajesh Pahwa, director of the Parkinson Disease and Movement Disorder Center at the University of Kansas Medical Center, in Kansas City, called the observation "interesting."
At the same time, he said, the depression-Parkinson's link is "common knowledge" among neurologists, who have long recognized that depression often occurs alongside Parkinson's disease.
However, primary care physicians and psychiatrists, who may not be aware of the link, "need to pay more attention to this issue," Pahwa said. At-risk individuals who suddenly develop depressive symptoms could in fact be showing the first signs of Parkinson's.Neurologists could also benefit from these findings, Pahwa added.
"For us, the biggest issue is that we need to pay more attention to depression in Parkinson's disease," Pahwa said. Too often, physicians may view depression as a natural psychological reaction to a Parkinson's diagnosis. However, that may not sometimes be the case, "and we need to treat it more aggressively," he said.
According to Pahwa, Parkinson's disease is a progressive neurodegenerative disorder marked by the loss of dopamine-producing neurons in the brain. Though most commonly associated with motor deficits such as tremors and stiffness, there also are non-motor features, including urinary problems, constipation, insomnia, depression, anxiety, and dementia. There is no laboratory test for Parkinson's, so it must be diagnosed clinically. Nor is there yet any cure for this degenerative disease.
According to the National Parkinson Foundation, 1.5 million Americans currently have the illness, which strikes men and women in roughly equal numbers, usually after the age of 65.
Dr. Giselle Petzinger, a movement disorder specialist at the University of Southern California, said this study is the first to "really suggest" that non-motor features could be early indicators of Parkinson's disease.
"This is pretty convincing data," she said. "Mood probably could be an early manifestation. That's never been shown before."
Petzinger said such early symptoms could enable eventual earlier -- and thus, more effective -- use of neuroprotective medicines, though she noted that no such drug currently exists.
"You want to catch them before they develop motor symptoms," Petzinger said. "That might be a point of no return. Early recognition, that's when you want to capture people."
Because of the ageing of the world population, the importance of Parkinson's disease as a public health issue is expected to increase. The emphasis in WHO's efforts is placed on the promotion of epidemiological studies and health statistics; assessment of cost benefits and health needs; the organization of services; and on raising public and professional awareness of Parkinson's disease.
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