Depression in alpha-synucleinopathies: prevalence, pathophysiology and treatment
Parkinson’s disease (PD), dementia with Lewy bodies (DLB) and multiple system atrophy (MSA) are increasingly recognized as alphasynucleinopathies, i.e. neurodegenerative disorders that share a common sub-cellular pathology characterized by alpha-synuclein
- PDF / 1,326,835 Bytes
- 9 Pages / 595 x 791 pts Page_size
- 21 Downloads / 136 Views
Summary. Parkinson's disease (PD) , dementia with Lewy bodies (DLB) and multiple system atrophy (MSA) are increasingly recognized as alphasynucleinopathies, i.e. neurodegenerative disorders that share a common subcellular pathology characterized by alpha-synuclein abnormal aggregation. In the present review we focus on depression in alpha-synucleinopathies, discussing epidemiological, pathophysiological and treatment aspects of this frequently disabling clinical feature which may occur in PD , DLB and MSA alike. Introduction The term alpha-synucleinopathies has been proposed to combine a group of neurodegenerative disorders including Parkinson's disease (PD), dementia with Lewy bodies (DLB) and multiple system atrophy (MSA) whose cytopathological hallmark is the formation of intracellular inclusions containing alpha-synuclein. In PD and DLB abnormal alpha-synuclein aggregation is present in neuronal Lewy bodies whereas in MSA oligodendroglial cytoplasmic inclusions have been shown to be immunoreactive for alpha-synuclein (Spillantini et al., 1998; Wakabayashi et al., 1998). The motor disorder of the alpha synucleinopathies has been well characterized, however non-motor features have received less attention. In the present review we focus on various aspects of depression in PD compared to DLB and MSA . Prevalence of depression in alpha-synucleinopathies Affective disorders frequently occur in PD, DLB and MSA. It has been demonstrated that depression is present in about 40% (Table 1) of PD patients ranging between 4 and 70% (Cummings, 1992). Studies on risk factors (Table 2) and prevalence of depression in relation to age and gender suggest that it is more frequent in younger patients and affects mostly women with PD (Gotham et al., 1986; Starkstein et al., 1989). Two peaks in the frequency of
P. Riederer et al. (eds.), Advances in Research on Neurodegeneration © Springer-Verlag Wien 2000
336
N. Stefanova et al. Table 1. Studies on prevalence of depression in PO
Study Santamaria et al., 1986; Mayeux et aI., 1986; Huber et aI., 1988; Sano et aI., 1989; Retrospective Prospective Starkstein et al., 1990
Number of subjects
% depressed (OSM-III)
34 49
43
32
60
32
339
56 30
110 105
40
Table 2. Risk factors for depression in PO Female gender Family history of PO ~ Greater functional disability (impaired AOL) ~ Prominent gait and postural changes ~ Prominent rigidity s- Prominent motor asymmetry (left > right) ~ ~
depression have been identified during the course of PD, one at disease onset, the second during late stages associated with increasing motor disability and handicap (Poewe and Luginger, 1999). Major and minor depression are found to be equally common in hospitalised patients (Cummings, 1992). More recent community surveys demonstrate that major depression occurs in up to 4 % of non-demented patients and in 26% of demented PD patients (Tandberg et aI., 1996). DLB is recognized as a distinctive neurodegenerative disorder with clinical features that overlap with both Alzheimer's disease and PD (Litv
Data Loading...
