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Depression et Maladie de Parkinson: étude d’une série de 135 parkinsoniens

Published online by Cambridge University Press:  14 September 2018

A. Anguenot ,
P.Y. Loll ,
J.P. Neau ,
P. Ingrand  and
R. Gil
A. Anguenot
Affiliation:
Service de Neurologie, Unité de Neuropsychologie, CHU de la Milétrie, 86021 Poitiers cedex
P.Y. Loll
Affiliation:
Service de Neurologie, Unité de Neuropsychologie, CHU de la Milétrie, 86021 Poitiers cedex
J.P. Neau
Affiliation:
Service de Neurologie, Unité de Neuropsychologie, CHU de la Milétrie, 86021 Poitiers cedex
P. Ingrand
Affiliation:
Département de Pédagogie et de Biostatistiques, Faculté de Médecine et de Pharmacie, 86005 Poitiers, France
R. Gil*
Affiliation:
Service de Neurologie, Unité de Neuropsychologie, CHU de la Milétrie, 86021 Poitiers cedex
*
Roger Gil, Service de Neurologie, CHU de la Milétrie, 86021 Poitiers, France
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Résumé:

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Objective:

La fréquence de la dépression au cours de la maladie de Parkinson (MP) conduit à s’interroger sur les difficultés du diagnostic et sur les liens entre la dépression et l’histoire naturelle de la maladie.

Méthodes:

Une série consécutive de 135 sujets atteints d’une MPidiopathique a été examinée sur le plan psychiatrique (DSM-III-R, échelle de dépression de Goldberg), neurologique (en distinguant les signes “axiaux” des autres signes parkinsoniens), neuropsychologique ( et en particulier tests frontaux).

Résultats:

Plus de la moitié des sujets ont une dépression qui apparaît plus fréquente dans les formes akinétiques et les formes fluctuantes de la maladie. Les sujets déprimés n’ont pas de déficit cognitif plus marqué mais leurs scores aux tests frontaux sont plus élevés. En outre les signes axiaux de la maladie (instabilité posturale, rigidité axiale) sont plus marqués chez les parkinsoniens déprimés, suggérant un lien entre la dépression et les lésions non dopaminergiques de la maladie. Alors que le ralentissement, les troubles de l’appétit et du sommeil, la fatigue peuvent être observés même chez des parkinsoniens non dépressifs, la séparation de la population parkinsonienne en plusieurs groupes montre que certains symptômes ne sont jamais rencontrés chez les parkinsoniens non dépressifs: il en est ainsi apparu que “l’impression que la vie ne vaut pas la peine d’être vécue”, “la perte d’espoir pour l’avenir”, “l’impression de ne pas être à la hauteur, de ne rien faire de bien”, “la baisse d’énergie”, “la tristesse matinale” caractérisent la dépression parkinsonienne. La dépression parkinsonienne revêt deux grandes formes cliniques. La première est la plus riche en manifestations somatiques: troubles du sommeil, fatigue matinale; elle correspond aux dépressions les plus sévères avec une absence d’espoir pour l’avenir , une perte de confiance en soi. La seconde est pauvre en manifestations somatiques alors que l’apathie y est très fréquente ainsi que le ralentissement.

Conclusions:

Cette étude permet ainsi de préciser les symptômes de la dépression parkinsonienne qui doit être mieux reconnue pour être plus souvent traitée. Les liens entre la dépression et les signes axiaux de la maladie expliquent sans doute pourquoi la L-dopa et les agonistes dopaminergiques améliorent les signes moteurs de la dépression sans agir le plus souvent sur les manifestations dépressives.

Abstract:

Abstract:Objectif:

The prevalence of depression in Parkinson’s disease (PD) raises the issues of the difficulties of diagnosing the condition and of the relationships between depression and the natural history of the disease.

Methods:

Acohort of 135 consecutive patients with idiopathic PD underwent psychiatric (DSM-III-R, Goldberg depression scale), neurological (distinguishing “axial” signs from other signs of parkinsonism), and neuropsychological (particularly frontal tests) evaluations.

Results:

Depression is present in more than half of the patients and it seems to be more frequent in patients with the akinetic and fluctuating forms of the disease. The subjects who are depressed do not have a greater degree of cognitive impairment, but their scores on frontal tests are higher. Moreover, the axial signs of the disease (postural instability, axial rigidity) are more severe in depressed parkinsonians suggesting a link between depression and the non-dopaminergic lesions of the disease. Even though slowness, appetite and sleep disturbances, and fatigue may be encountered in non-depressed parkinsonian patients, separation of the parkinsonian population into subgroups shows that certain symptoms are never seen in parkinsonians who are not depressed: it is thus evident that “the impression that life is not worth living”, “the hopelessness”, “the impression of being worthless and incompetent”, “the low level of energy”, “the morning sadness” are characteristic of parkinsonian depression. Parkinsonian depression has two major clinical forms. The first one is associated with a greater number of somatic manifestations: sleep disturbances, morning fatigue, corresponding to more severe depression with hopelessness and loss of self confidence. The second exhibits few somatic manifestations with apathy and slowness as frequent complaints.

Conclusions:

This study defines the symptoms of parkinsonian depression which should be better recognised in order to be treated. The link between depression and axial signs of the disease may explain why L-dopa and dopaminergic agonists improve the motor signs of depression without influencing depressive manifestations in most cases.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 29 , Issue 2 , May 2002 , pp. 139 - 146
Copyright
Copyright © Canadian Neurological Sciences Federation 2002

References

1. Cumings, JL. Depression and Parkinson’s disease: a review. Am J Psychiatr 1992;149:443-445.Google Scholar
2. American Psychiatric Association. DSM-III-R. Manuel diagnostique et statistique des troubles mentaux. Paris: Masson éditeurs, 1989.Google Scholar
3. Menza, MA, Sage, J, Marshall, E, Cody, R, Duvoisin, R. Mood changes and “on-off” phenomena in Parkinson’s disease. Mov Disord 1990;5:148-151.Google Scholar
4. Bielauskas, LA, Glantz, RH. Depression type in Parkinson’s disease. J Clin Exp Neuropsychol 1989;11:597-604.Google Scholar
5. Ehmann, TS, Beringer, RJ, Gawel, MJ, Riopelle, RJ. Depressive symptoms in Parkinson’s disease: a comparison with disabled control subjects. J Geriatr Psychiatr Neurol 1990;2:3–9.Google Scholar
6. Mayeux, R, Stern, Y, Rosen, J. Depression, intellectual impairment, and Parkinson’s disease. Neurology 1981; 31: 645-650.CrossRefGoogle Scholar
7. Celesia, GG, Wanamaker, WM. Psychiatric disturbances in Parkinson’s disease. Dis Nerv Syst 1972;33:577-583.Google Scholar
8. Brown, RG, MacCarthy, B, Gotham, AM, Der, GJ, Marsden, CD. Depression and disability in Parkinson’s disease: a follow-up study of 132 cases. Psychol Med 1988;18:49-55.Google Scholar
9. Starkstein, SE, Mayberg, HS, Leiguarda, R, Preziosi, TJ, Robinson, RG. A prospective longitudinal study of depression, cognitive decline, and physical impairments in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 1992;55:377-382.Google Scholar
10. Wertman, E, Speedie, L, Shemesh, Z, et al. Cognitive disturbances in parkinsonian patients with depression. Neuropsychiatr Neuropsychol Behav Neurol 1993;6:31-37.Google Scholar
11. Santamaria, J, Tolosa, E, Valles, A. Parkinson’s disease with depression: a possible subgroup of idiopathic parkinsonism. Neurology 1986;36:1130-1133.Google Scholar
12. Taylor, AE, Saint-Cyr, JA, Lang, AE, Kenny, FT. Parkinson’s disease and depression: a critical re-evaluation. Brain 1986;109:279-292.Google Scholar
13. Huber, SJ, Paulson, GW, Shuttleworth, EC. Relationship of motor symptoms, intellectual impairment, and depression in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1988;51:855-858.Google Scholar
14. Fahn, S, Elton, RL and Members of the UPDRS development committee. Unified parkinson’s disease rating scale In: Fahn, S, Marsden, CD, Goldstein, M, Calne, DB. (eds.) Recent Developments in Parkinson’s Disease. New York: Macmillan 1987;2:153-163.Google Scholar
15. Webster, DD. Critical analysis of the disability in Parkinson’s disease. Modern Treatment 1968;5:257-282.Google Scholar
16. Hoehn, MM, Yahr, MD. Parkinsonism: onset, progression and mortality. Neurology 1967;17:427-442.Google Scholar
17. Goldberg, D, Bridges, K, Duncaan-Jones, P, Grayson, D. Detecting anxiety and depression in general medical settings. Br Med J 1988;297:897 – 899.Google Scholar
18. Gil, R, Toullat, G, Pluchon, C, et al. Une méthode d’évaluation rapide des fonctions cognitives (ERFC), son application à la démence sénile de type Alzheimer. Sem Hôp Paris 1986;62(27):2127–2133.Google Scholar
19. Reitan, RM. Validity of the trail making test as an indicator of organic brain damage. Percept Mot Skills 1958;8:271-276.Google Scholar
20. Malloy, PF, Webster, JS, Russel, W. Tests of Luria’s frontal lobe syndromes. Int J Neuropsychol 1985;7:88-95.Google Scholar
21. SAS / STAT User’s Guide. Version 6, Fourth edition, Volume 1. Cary, NC: SAS Institute Inc., 1989.Google Scholar
22. Symons, MJ. Clustering criteria and multivariate normal mixtures. Biometrics 1981;37:35-43.Google Scholar
23. Poewe, W, Luginger, MD. Depression in Parkinson’s disease. Neurology 1992;52(Suppl 3):S2-S6.Google Scholar
24. Mayeux, R. The mental state in Parkinson’s disease. In: Koller, WC (ed). Handbook of Parkinson’s disease. 2nd ed. New York: Marcel Dekker, 1992, 159-184.Google Scholar
25. Gotham, A, Brown, RG, Marsden, CD. Depression in Parkinson’s disease: a quantitative and qualitative analysis. J Neurol Neurosurg Psychiatry 1986;49:381-389.CrossRefGoogle Scholar
26. Brown, RG, MacCarthy, B. Psychiatric morbidity in patients with Parkinson’s disease. Psychol Med 1990;20:77-87.Google Scholar
27. Warburton, JW. Depressive symptoms in Parkinson patients referred for thalamotomy. J Neurol Neurosurg Psychiatry 1967;30:368-370.Google Scholar
28. Starkstein, SE, Preziosi, TJ, Forrester, AW, Robinson, RG. Specificity of affective and autonomic symptoms of depression in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1990;53:869-873.Google Scholar
29. Costic, VS, Djururicic, BM. Depression and Parkinson’s disease: Possible rôle of serotoninergic mechanisms. J Neurol, 1987;12:94-96.Google Scholar
30. Davous, P. A french prospective study of depression in Parkinson’s disease. European Congress on Mental Dysfunction in Parkinson’s Disease. Amsterdam, Oct 1993.Google Scholar
31. Brown, GL, Wilson, WP. Parkinsonism and depression. South Med J 1972;65:540-545.Google Scholar
32. Mindham, RHS, Marsden, CD, Parkes, JD. Psychiatric symptoms during L-dopa therapy for Parkinson’s disease and their relationship to physical disability. Psychol Med 1976;6:23-33.CrossRefGoogle Scholar
33. Martilla, RJ, Rinne, VK. Dementia in Parkinson’s disease. Acta Neurol Scand 1976;54:431-441.Google Scholar
34. Starkstein, SE, Preziosi, TJ, Bolduc, PJ, Robinson, RG. Depression in Parkinson’s disease. J Nerv Ment Dis 1990;178:27-31.Google Scholar
35. Troster, AI, Paolo, AM, Lyons, KE, et al. The influence of depression on cognition in Parkinson’s disease: a pattern of impairment distinguishable from Alzheimer’s disease. Neurology 1995;45:672-676.CrossRefGoogle Scholar
36. Tandberg, E, Larsen, JP, Aarsland, D, Laake, K, Cummings, JL. Risk factors for depression in Parkinson disease. Arch Neurol 1997;54:625-630.Google Scholar
37. Pillon, B, Dubois, B, Cusimano, G, et al. Does cognitive impairment in Parkinson’s disease result from non-dopaminergic lesions? J Neurol Neurosurg Psychiatry 1989;52:201-206.CrossRefGoogle Scholar
38. Friedman, J, Friedman, H. Fatigue in Parkinson’s disease. Neurology, 1993;43:2016-2018.CrossRefGoogle Scholar
39. Allain, H, Schuck, S, Mauduit, N. Depression in Parkinson’s disease. Br Med J 2000;320:1287-1288.Google Scholar