Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Psychiatry, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Mov Disord Clin Pract. 2024 Sep;11(9):1103-1112. doi: 10.1002/mdc3.14145. Epub 2024 Jun 22.
Anxiety and depression are common non-motor symptoms in Parkinson's disease (PD) but remain under-recognized and under-treated.
To evaluate functional outcomes associated with baseline anxiety or depression and effects related to the initiation of new psychiatric treatment.
We analyzed 7 years of data from patients with de novo PD enrolled in the Parkinson's Progression Markers Initiative. Longitudinal regression models evaluated the association between baseline anxiety and depression with Schwab and England (SE) and MDS-UPDRS total scores over time. Cox proportional hazard models assessed effects of baseline anxiety and depression on time to initiation of dopaminergic therapy. Piecewise linear regression models examined the association of treatment initiation for anxiety and depression with SE and MDS-UPDRS.
490 participants with baseline depression and anxiety data were included. Anxiety and depression were associated with lower SE (anxiety: β = -1.31, P = 0.038, depression: β = -1.96, P = 0.012, co-morbid: β = -2.70, P = 0.003) and higher MDS-UPDRS scores (anxiety: β = 5.37, P < 0.001, depression: β = 9.17, P < 0.001, co-morbid: β = 10.50, P < 0.001) longitudinally. Anxiety was associated with faster time to dopamine replacement therapy initiation (HR 1.30, 95% CI 1.03-1.66, P = 0.03). 16 participants with anxiety initiated treatment for anxiety, which was associated with subsequent lower levodopa daily dose (slope change = -218.49, P = 0.018). 10 participants with depression initiated treatment of depression, which was associated with reduced MDS-UPDRS total scores (slope change = -8.3, P < 0.001) and higher SE scores (slope change = 5.99, P = 0.004).
Anxiety and depression at PD onset are associated with multiple negative longitudinal trajectories. However, preliminary findings suggest that anxiety and depression treatment may be linked with improved motor and non-motor outcomes.
焦虑和抑郁是帕金森病（PD）常见的非运动症状，但仍未得到充分认识和治疗。
评估基线时焦虑或抑郁与功能结果的关系，以及与开始新的精神科治疗相关的效果。
我们分析了帕金森进展标志物倡议中纳入的新发 PD 患者 7 年的数据。纵向回归模型评估了基线时焦虑和抑郁与 Schwab 和 England（SE）以及 MDS-UPDRS 总分随时间的关系。Cox 比例风险模型评估了基线时焦虑和抑郁对开始多巴胺能治疗时间的影响。分段线性回归模型检查了焦虑和抑郁治疗开始与 SE 和 MDS-UPDRS 的关联。
纳入了 490 名基线时有抑郁和焦虑数据的参与者。焦虑和抑郁与 SE 评分较低相关（焦虑：β=−1.31，P=0.038；抑郁：β=−1.96，P=0.012；共病：β=−2.70，P=0.003）和 MDS-UPDRS 评分较高相关（焦虑：β=5.37，P<0.001；抑郁：β=9.17，P<0.001；共病：β=10.50，P<0.001）。焦虑与更快开始多巴胺替代治疗相关（HR 1.30，95%CI 1.03-1.66，P=0.03）。16 名焦虑患者开始接受焦虑治疗，这与随后左旋多巴每日剂量降低相关（斜率变化=−218.49，P=0.018）。10 名抑郁患者开始接受抑郁治疗，与 MDS-UPDRS 总分降低相关（斜率变化=−8.3，P<0.001）和 SE 评分升高相关（斜率变化=5.99，P=0.004）。
PD 发病时的焦虑和抑郁与多种负面纵向轨迹相关。然而，初步研究结果表明，焦虑和抑郁的治疗可能与改善运动和非运动结局有关。
