Neurology Research Centre, Royal Brisbane & Women's Hospital, Australia.
J Neurol Sci. 2011 Nov 15;310(1-2):208-10. doi: 10.1016/j.jns.2011.06.031. Epub 2011 Jul 20.
Depression is a common problem experienced by patients with Parkinson's disease (PD). Identifying depression in PD is difficult and the determinants of depression in PD are complex and debatable. Here we review our recent studies which have (i) examined the validity of current depression rating scales in PD, (ii) introduced a self-reported and validated strategy to identify a lifetime history of depression in PD, and (iii) investigated genetic and non-genetic factors associated with depression in the context of PD. Our research showed PD-specific cut-off values suitable to use for the Hamilton Depression Scales (HAMD and HDI) and the Geriatric Depression Scale (GDS-15) when dichotomising patients with and without a current depression. Using the GDS-15 specific cut-off scores and a number of self-reported questions that screen for a lifetime history of depression, we developed a novel method to dichotomise PD patients according to current depression or a past history of depression. This method was applied in a large-scale study examining the factors associated with depression in PD. We clarified that the severity of PD is positively related to depression. We also showed that a number of other clinical factors including a longer duration of PD, a younger PD onset age, frequent falls, a history of anxiety disorder and memory problems were associated with depression in PD. In addition to these clinical factors, we observed associations between depression, and lower education levels, a history of smoking and a regular use of non-aspirin bases NSAIDs or analgesics. No associations were found between depression in PD and common genetic variations examined across the serotonin and dopamine transporter genes. Our studies provide a focus for future intervention strategies.
抑郁症是帕金森病（PD）患者常见的问题。识别 PD 中的抑郁症很困难，而 PD 中抑郁症的决定因素复杂且存在争议。在这里，我们回顾了我们最近的研究，这些研究（i）检验了 PD 中当前抑郁评定量表的有效性，（ii）引入了一种自我报告和验证的策略来识别 PD 中的终生抑郁史，以及（iii）研究了与 PD 相关的遗传和非遗传因素与抑郁的关系。我们的研究表明，在将有和没有当前抑郁症的患者进行二分时，PD 特有的 Hamilton 抑郁量表（HAMD 和 HDI）和老年抑郁量表（GDS-15）的截断值适合使用。使用 GDS-15 的特定截断分数和一些筛查终生抑郁史的自我报告问题，我们开发了一种新的方法，根据当前抑郁或过去的抑郁史将 PD 患者分为两类。这种方法在一项大规模研究中得到了应用，该研究检查了与 PD 中抑郁相关的因素。我们明确指出，PD 的严重程度与抑郁呈正相关。我们还表明，许多其他临床因素，包括 PD 的持续时间更长、PD 发病年龄更年轻、频繁跌倒、焦虑障碍史和记忆问题，与 PD 中的抑郁有关。除了这些临床因素外，我们还观察到抑郁与较低的教育水平、吸烟史以及经常使用非阿司匹林类 NSAIDs 或镇痛药之间存在关联。PD 中的抑郁与我们在 5-羟色胺和多巴胺转运体基因中检测到的常见遗传变异之间没有关联。我们的研究为未来的干预策略提供了重点。
