LETTERS TO THE EDITORS
Quality of life and depressive symptoms in Parkinson's disease
Qualidade de vida e sintomas depressivos na doença de Parkinson
Dear Editor,
Depression is the most common psychiatric comorbidity in Parkinson's disease (PD) and can affect up to 68.1% of patients with this movement disorder.1 It is well-known that depression directly affects the quality of life and psychosocial functioning of PD patients. Thus, we have read with great interest the article by Margis et al. in which the authors assessed the influence of depressive symptoms on the quality of life of PD patients.2 The authors observed that the Geriatric Depression Scale (GDS) score was positively associated with the total score in the World Health Organization Quality of Life Assessment for older adults and five of its six domains.
To the same end as Margis et al.,2 we have recently used the 39-item Parkinson's Disease Questionnaire (PDQ-39) and its eight dimensions and the 15-item GDS (GDS-15) to assess quality of life and depressive symptoms in PD patients, respectively. We divided the patients into two groups (PD without depression and PD with depression) according to the GDS-15 cutoff score of eight proposed for the screening of depression in PD.3
The study was approved by the local ethics committee and the patients gave their informed consent to participate (HCRP nº 10078/2009).
A total of 114 patients (50.9% male) with a mean age of 64.7 years (SD = ±12.6) were enrolled. Most participants (n = 92; 80.7%) had little education (less than 8 years), were not working (n = 109; 95.6%), and were married (n = 65; 57%). One limitation of this study is the absence of further clinical data. In addition, structured clinical interviews (e.g.: SCID-CV) were not applied for the diagnosis of depression. This is also a limitation of the study by Margis et al.2
The total score in the PDQ-39 and its subscales/dimensions strongly correlated with the total score in the GDS-15. The group of patients with current depression (GDS-15 > 8) had higher scores (p < 0.0001) in the PDQ-39 and its dimensions (Table 1). Therefore, our findings confirm and expand the results found by Margis et al.2
Nowadays, special attention has been given to the non-motor symptoms of PD in clinical and research settings. In particular, depressive symptoms have been consistently associated with poor quality of life, and, in some studies, this correlation is stronger than that found for motor symptoms.4
The mobility dimension was strongly correlated with depressive symptoms (rho = 0.654) in our study. This is in line with the findings of Margis et al.,2 in which depression presented the strongest correlation with the autonomy domain (rho = 0.61).2 It is interesting to note that this domain was not associated with the Hoehn and Yahr stage or correlated with the motor subscale of the UPDRS. This finding suggests that depressive symptoms in PD could be more related to autonomy than to motor disability.
This is also consistent with the results of another Brazilian study, in which depression was found to be the most consistent determinant of quality of life and was an independent predictor of quality of life.5
In conclusion, these data highlight the importance of the recognition and diagnosis of depression in PD in order to implement the appropriate treatment and consequently to improve the quality of life of these patients.
Marcos Hortes N. Chagas, Rafael Faria Sanches,
Vitor Tumas
Department of Neuroscience and Behavior,
Faculdade de Medicina de Ribeirão Preto (FMRP),
Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
National Institute of Translational Medicine (CNPq), Brazil
Kátia Colombo Marchi, Carlos Renato Tirapelli
Escola de Enfermagem de Ribeirão Preto (EERP),
Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
WHO Collaborating Centre for Nursing Research
Development
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- 1. Nakabayashi TI, Chagas MH, Côrrea AC, Tumas V, Loureiro SR, Crippa JA. Prevalence of depression in Parkinson's disease. Rev Psiq Clin 2008;35(6):219-27.
- 2. Margis R, Donis KC, Schonwald SV, Rieder CR. WHOQOL-OLD assessment of quality of life in elderly patients with Parkinson's disease: influence of sleep and depressive symptoms. Rev Bras Psiquiatr. 2010;32(2):125-31.
- 3. Chagas MH, Tumas V, Loureiro SR, Hallak JE, Trzesniak C, de Sousa JP, Rodrigues GG, Santos Filho A, Crippa JA. Validity of a Brazilian version of the Zung self-rating depression scale for screening of depression in patients with Parkinson's disease. Parkinsonism Relat Disord. 2010;16(1):42-5.
- 4. Gallagher DA, Lees AJ, Schrag A. What are the most important nonmotor symptoms in patients with Parkinson's disease and are we missing them? Mov Disord 2010;25(15):2493-500.
- 5. Carod-Artal FJ, Ziomkowski S, Mourao Mesquita H, Martinez-Martin P. Anxiety and depression: main determinants of health-related quality of life in Brazilian. Parkinsonism Relat Disord 2008;14(2):102-8.
Publication Dates
-
Publication in this collection
26 Apr 2011 -
Date of issue
Mar 2011
