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Neurodegenerative Diseases Parkinson’s Disease
Independent risk factors for PDD found in population-based studies Apathy
include advanced age,
29
neuropsychological deficits and MCI
30,31
and As yet there are no longitudinal studies of apathy in PD, and thus it is
severity of parkinsonism,
32
particularly axial symptoms such as uncertain whether and how characteristics of apathy may change
postural instability and speech problems.
11
During an eight-year over time. In addition, currently there is a lack of generally accepted
prospective follow-up study of a community-based sample of diagnostic criteria for apathy. In population-based studies of apathy in
non-demented patients with PD, development of PIGD parkinsonism PD, prevalence estimates range from 16.5%, as measured by the
was associated with accelerated cognitive decline and an Neuropsychiatric Inventory, to 38% using the motivation/initiative
approximate 50% risk of dementia within the following four years.
11
item of the UPDRS.
43
These figures are lower than some of those
Interestingly, none with tremor-dominant parkinsonism at study end observed in clinic-based studies, where prevalence rates of up to 70%
had developed dementia, in line with another clinic-based study.
33
were reported.
44
In community-based studies,
43
similar to clinic-based
studies, apathy relates to higher depression scores, cognitive
Depression impairment and more severe motor symptoms. Hence, prevalence
Depression is an important predictor of reduced quality of life in rates of apathy are anticipated to increase with advance in PD,
PD.
34,35
In a recent systematic review of prevalence studies of particularly in the context of progressive cognitive decline.
depression in PD, frequency rates ranged from 2.7 to 35% in
population-based studies fulfilling quality criteria for inclusion, Fatigue
compared with 12.7 to ~90% in clinic-based studies.
36
In studies from Fatigue in PD may occur as a physical or mental problem, and both
the general PD population, the mean prevalence of major depression dimensions of fatigue are more prominent in PD than in the general
population. Population-based data demonstrate that fatigue has a
substantial negative impact on quality of life in patients with PD.
45
Recent
Fatigue in Parkinson’s disease may occur
clinic-based data suggest that fatigue may precede the onset of the
disease and is frequent in newly diagnosed subjects not on
as a physical or mental problem, and
dopaminergic treatment.
46
However, population-based data from early
both dimensions of fatigue are more
PD cohorts are not yet available to support this. In the only
population-based longitudinal study to date, fatigue prevalence
prominent in Parkinson’s disease than in
increased from 36 to 56% during eight years of follow-up.
47
This increase
the general population.
was related to disease severity, depression and excessive daytime
sleepiness (EDS). However, even in patients without depression and EDS
more than one-third of subjects complained about fatigue, suggesting
was 8.1%, and the mean prevalence of clinically relevant depressive that fatigue in PD may develop independently of other non-motor
symptoms (major depression, minor depression or dysthymia) was problems with possible overlapping symptomatology. In more than half
10.8%.
36
A four-year longitudinal community-based study reported an of patients, fatigue was a persistent feature once experienced.
47
increase in the proportion of patients with self-reported depression
from 27 to 56%.
9
The profile of depressive symptoms in non- Sleep Disorders
demented PD is different from that in non-PD subjects, with more Insomnia is the most common sleeping problem in PD, and a major
concentration difficulties but significantly less sadness, anhedonia contributor to reduced quality of life.
34,48
After an average nine years of
and feelings of guilt.
37
This pattern may explain why suicide, despite disease duration, 60% of a population-based sample reported nocturnal
the higher prevalence of depression in the disease, is not more sleeping problems,
49
with sleep fragmentation and early awakening
common in PD than in the general population.
38,39
being the main complaints.
49
Longitudinal follow-up of this cohort
revealed similar prevalence rates of insomnia over eight years, but
Psychosis considerable variation of sleeping problems in individual patients over
Psychotic symptoms in PD include minor phenomena such as illusions time.
50
The presence of insomnia over time was associated with disease
and senses of presence or passage, simple and complex hallucinations, duration, depressive symptoms and female sex.
50
with and without insight, and delusions. Visual hallucinations are found
to be the most common form in PD. While provisional diagnostic criteria EDS is also common in PD,
51
and not a consequence of nocturnal
for psychosis associated with PD have been proposed recently,
40
they sleeping problems.
52,53
Clinical EDS has been found in 15% of PD
have not yet been taken into account in most published studies. Few patients in a population-based cohort with mean disease duration of
population-based studies of psychosis have been conducted in PD. In a nine years, compared with only 1% of EDS in healthy elderly control
cross-sectional population-based prevalent sample of patients with subjects.
52
Two longitudinal studies in this population observed an
a mean disease duration of 12 years, 10% had hallucinations increase of EDS prevalence to 29 and 41% of surviving patients after
with insight retained and 6% had more severe hallucinations or four and eight years of follow-up, respectively.
52,53
EDS was found to be
delusions.
41
However, among patients who lived in nursing homes, the a persistent complaint in most patients and was associated with age,
corresponding figures were significantly higher, at 23 and 19%, gender, use of dopamine agonists and disease severity, suggesting
respectively.
41
In another community-based study of patients with six multifactorial underlying pathophysiology.
52,53
years of disease duration at study start, the proportion of patients
reporting hallucinations increased from 23 to 56% during four years of REM sleep behaviour disorder (RBD) is a parasomnia characterised by
follow-up.
9,10
However, these figures are likely to be underestimates as prominent motor activity due to loss of the normal skeletal muscle
none of these studies captured the whole spectrum of psychosis in PD. atonia during REM sleep. Typical clinical features of RBD include
Population-based data suggest that hallucinations are one of the main vocalisations and movements of limbs and body, often associated
risk factors for hospitalisation and nursing home placement in PD.
42
with dreams. Patients with idiopathic RBD are at high risk of
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