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Parkinson's, Alzheimer's, News
Parkinson Studies Find More Apathy than Depression,
Experience Needed for Brain Stimulation
Parkinson disease
affects 1 of every 100 people over the age of 60
July 11, 2006 – Two studies in current scientific
journals look at Parkinson disease, which affects about one of every 100
people over the age of 60, and is the most common neurodegenerative
disease after Alzheimer's disease. One study found Parkinson patients –
often considered to be at high risk of depression – can be apathetic
without being depressed and says apathy my be a core feature of the
disease. The second study says patients undergoing the treatment known
as deep brain stimulation may benefit from the direct involvement of a
neurologist with expertise both in movement disorders and in deep brain
stimulation.
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The average age of those diagnosed with Parkinson's
is age 60, according to the National Parkinson Foundation.
Apathy is a mental state characterized by a loss of
motivation, loss of interest, and loss of effortful behavior. In apathy,
the mood is neutral and there is a sense of indifference. In depression,
the mood is negative and there is emotional suffering. Because apathy
and depression share some of the same symptoms, the disorders can be
misdiagnosed.
“This study shows that it’s important to screen for
both apathy and depression so patients can be treated appropriately,”
said study author Lindsey Kirsch-Darrow, MS, of the University of
Florida in Gainesville.
“It will also be important to educate family
members and caregivers about apathy to help them understand that it is a
characteristic of Parkinson disease. Apathetic behavior is not something
the patient can voluntarily control, and it is not laziness or the
patient trying to be difficult – it is a symptom of Parkinson disease.”
The study compared 80 people with Parkinson disease
to 20 people with dystonia, another movement disorder. The researchers
hypothesized that apathy would occur more often in people with Parkinson
disease, because the disease affects areas of the brain in the frontal
cortex that are involved in non-motor activities, whereas dystonia
affects areas mainly involved with movement.
Of those with Parkinson disease, 51 percent had
apathy, compared to 20 percent of those with dystonia. Apathy with no
depression occurred in 29 percent of those with Parkinson disease and
none of those with dystonia. The rate of depression was the same in both
groups.
Treatments for depression and apathy in people with
Parkinson disease are still being evaluated.
The current criteria for diagnosing depression may
not be appropriate for people with Parkinson disease, according to
neurologist Irene Richard, MD, of the University of Rochester in New
York, who wrote an editorial accompanying the study.
“A person with Parkinson disease might be diagnosed
with minor depression based solely on the presence of apathy,” she said.
“The recognition that apathy can be present without depression is
important so that we do not inappropriately diagnose and treat a
depressive disorder that is not present.”
Note: The report is published in the July 11,
2006, issue of Neurology, the scientific journal of the American Academy
of Neurology. The study is consistent with guidelines issued recently by
the American Academy of Neurology recommending that all people with
Parkinson disease be screened for and treated for depression, which can
affect their quality of life and how well they function.
Experienced
Neurologist Needed for Deep Brain Stimulation Treatment
Patients with Parkinson’s disease who are
undergoing a treatment known as deep brain stimulation may benefit from
the direct involvement of a neurologist with expertise both in movement
disorders and in deep brain stimulation, according to an article posted
online that will appear in the September 2006 print issue of Archives of
Neurology, one of the JAMA/Archives journals.
Deep brain stimulation is a surgical procedure that
involves implanting electrodes into the brain to electronically
stimulate areas that control movement, treating Parkinson’s disease
symptoms such as tremor, stiffness and problems walking. It is the most
effective surgical treatment for advanced cases of Parkinson’s disease.
Deep brain stimulation involves intensive patient
management, including adjustments of electrical currents and medication
dosages as a patient’s condition changes. Many medical centers in North
America delegate these responsibilities to personnel who do not have
extensive experience in Parkinson’s disease care, such as surgical
nurses, fellows or neurophysiologists, according to information in the
article.
Elena Moro, M.D., Ph.D., and colleagues at
University Health Network, University of Toronto, Ontario, studied
whether the outcomes resulting from deep brain stimulation could be
improved with the direct involvement of a neurologist with specific
expertise both in the treatment of movement disorders in general and in
deep brain stimulation in particular.
Forty-four consecutive patients at the hospital who
had already been receiving regular deep brain stimulation treatments for
an average of 3.5 years underwent evaluation by such a neurologist—in
other words, the neurologist changed the electric stimulation settings
during the procedure and also adjusted the medications that patients
received afterward. The patients underwent assessments for Parkinson’s
disease symptoms before and after their reprogrammed treatment, with
following assessments at an average of 5 months (range 1 hour to 14
months) after the reprogramming.
Of the 44 patients, 24 (54.6 percent) showed
additional improvement in their Parkinson’s disease symptoms; 16 (36.4
percent) were unchanged; and four (9.1 percent) worsened. The patients
who did improve experienced fewer tremors and less rigidity and
bradykinesia (slowness of movement) and also had reductions in their
medication dosages. The four patients who worsened had more speech and
gait problems and were returned to their original settings.
“Further improvement of parkinsonian signs can be
achieved in the majority of patients even after long-term stable
stimulation,” the authors conclude. “Improved patient outcomes from
subthalamic nucleus deep brain stimulation are obtained when
postoperative care is personally managed by a neurologist expert in
movement disorders and deep brain stimulation who is directly
responsible for stimulation programming and simultaneous drug
adjustments based on observed clinical responses to changing stimulation
parameters.”
Editor’s Note: This study was partially funded
through a Center of Excellence grant from the National Parkinson
Foundation and a grant from Medtronic in support of fellow and nurse
salaries.
About American Academy of Neurology
The American Academy of Neurology, an association
of more than 19,000 neurologists and neuroscience professionals, is
dedicated to improving patient care through education and research. A
neurologist is a doctor with specialized training in diagnosing,
treating, and managing disorders of the brain and nervous system such as
Alzheimer’s disease, epilepsy, Parkinson disease, multiple sclerosis,
and stroke. For more information about the American Academy of
Neurology, visit
http://www.aan.com.
>> More information from the
National Parkinson Foundation.
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