Depressive symptoms impacting on health-related quality of life in early Parkinson's disease: Results from Chinese l-dopa exposed cohort☆

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Abstract

Objective

To investigate the impact of depressive symptoms on health-related quality of life (HR-QOL) in a group of patients with early Parkinson's disease (PD).

Methods

A 20-item scale, the Center for Epidemiologic Studies Depression Scale (CESD) and a 36-item questionnaire, the medical outcomes study short form (SF-36) were administered as part of baseline assessment of a clinical trial in PD, enrolling 391 early-stage, l-dopa exposed PD patients in China. We used multiple regression models to examine the relationship of depressive symptoms, measured by the CESD with HR-QOL, as measured by the SF-36. The SF-36 score of the depressed patients was compared with those non-depressed, as well.

Results

A total of 146 (37.3%) patients screened positive for depression. Compared with those non-depressed, depressed patients had lower scores in all dimensions of SF-36 profile (p < 0.001). Multiple regression analysis revealed that depressive symptoms, measured by CESD, increased our ability to explain the variance of SF-36 total score by 34.5%. Additionally, depressive symptom is the only variable which has the predictive value not only for total SF-36 total score, but also for each subdimension score of SF-36 profile.

Conclusion

Depressive symptoms are common early in the disease, having a substantial impact on patients’ HR-QOL, affecting many areas other than the obvious mental health dimension of the HR-QOL profile. Our results highlight the broad importance of treating depression in this population.

Section snippets

Patients

Patients included in our study were diagnosed according to CAPIT criteria [12]. Besides, all enrolled individuals were (1) older than 30 years at the time of diagnosis; (2) early in the disease with Hoehn–Yahr stage 3 or less, and disease duration less than 5 years; (3) receiving stable l-dopa therapy no less than 2 months, while no restriction was administered on other PD medications. 391 of 599 patients with idiopathic PD were included. 182 patients were excluded, and 26 patients refused to

Descriptive data

Baseline characteristics of 391 patients are shown in Table 1. The percentage of patients with depressive symptoms was 37.3% (146 patients) (Table 1), the mean CESD score of these depressed was 25.38 ± 7.90.

Comparison of SF-36 submersion between the patients with depressive symptom and those without

Patients with depressive symptoms had lower mean scores on all dimensions of the SF-36 compared with those without this feature (Fig. 2). The greatest difference between two groups was in the role limitation-emotional dimension, where the depressed PD patients scored substantially worse than

Discussion

By using SF-36 than PDQ-39 in this study, the patient's HR-QOL is measured by a generic rating scale instead of a PD-specific tool. The large floor effects of PDQ-39 occurred in evaluating patients with mildly perceived PD [24], had risen our concerns that this instrument might not be considered as suitable for valid use in this early PD population. Moreover, PDQ-39 was not available in China at the time this study was planned. The results from this and previous studies [2], [25] show, however,

Conclusions

Results from this large cohort of patients with early PD suggest that depressive symptoms are common early in the disease and have a substantial impact on patients’ HR-QOL, not only strongly correlating with overall HR-QOL, but also affecting many areas other than the obvious mental health dimension of the HR-QOL profile. Further investigation of the effect of depressive symptoms on HR-QOL in well-defined samples of patients in different disease stages would provide more cues to develop better

Acknowledgments

We thank all the Neurologists who participated (Beisha Tang, Shenggang Sun, Shendi Chen, Haibo Chen, Rong Peng, Xinhua Wan, Luning Wang, Xiangru Sun, Baocheng Yu, Xiaoting Guan, Xiaoying Zhang, Weiqin Zhao, Guoping Zhang, Zhongxin Zhao, Benshu Zhang, Zhenguo Liu, Shuwen Xu, Ming Shao, Weizhi Wang, Guohua Hu, Xinxiang Yan, Xian Qiao, Ying Wang, Zhenfu Wang, Xiaohong Zhang, Yaming Zhao, Liuqing Huang, Linping Dou, Limei Zhang, Qiuhui Chen, Anmu Xie.Lijie Zhao, Tao Wu, Hui Ding, Zhuqin Gu, Jing

References (27)

  • D. Aarsland et al.

    Range of neuropsychiatric disturbances in patients with Parkinson's disease

    J Neurol Neurosurg Psychiatry

    (1999)
  • B. Ravina et al.

    The impact of depressive symptoms in early Parkinson disease

    Neurology

    (2007)
  • D. Weintraub et al.

    Recognition and treatment of depression in Parkinson's disease

    J Geriatr Psychiatry Neurol

    (2003)

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    ☆

    Funding for this study was provided by tenth-five key technologies Research & Development program of the ministry of science and technology of P.R. China (2004BA702B02), partial funding was also provide by 863 Hi-tech Research & Development program of China (2006AA02A408).

    1

    See acknowledgements for a full list of participating neurologists.

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    Published by Elsevier B.V.