Depression is biggest hurdle for Parkinson's patients

11/28/2012

Read this USA Today article about early findings from the National Parkinson Foundation's Parkinson's Outcomes Project, the largest clinical study of Parkinson's disease ever conducted, showing that depression is the most important factor influencing the health status of Parkinson's patients.


A new study shows depression is a bigger challenge than the physical obstacles that patients face.

November 28, 2012 — Depression takes a bigger toll on Parkinson's patients than the physical problems linked to the neurological disease and often goes undiagnosed, according to early findings out today from an international study.

"Nearly everyone thinks of the disease as a mobility disorder but the No. 1 problem turns out to be depression,'' says Joyce Oberdorf, president of the National Parkinson's Foundation. The advocacy group's long-term study is the largest ever undertaken on the degenerative disease, she says. It affects about 1 million people in the USA and 5 million worldwide, and is characterized by tremors, stiffness, slowness of movement and speech difficulties.

Trying to pinpoint which treatments enable some Parkinson's patients to thrive while others decline led the foundation to launch the research three years ago. There is no cure.

"Some patients stay active and can live at home rather than go to a nursing home,''says physician Michael Okun, co-director of the Center for Movement Disorders and Neurorestoration at the University of Florida. "There's a wide disparity of treatments. We wanted to know what treatments were improving quality of life and to set guidelines for good outcomes."

The project involves 20 research centers and 5,557 patients. Each year, patients fill out a health survey and the information is entered into a database. The early findings on depression show the "magnitude of the problem," says physician Laura Marsh. Among the 61% who reported depression in the survey, 1,192 (21%) had minor symptoms, 1,248 (22%) had mild depression, and 1,021 (18%) reported severe, major depressive disorders.

"It's not because they're sad they have the disease, which they may very well be, but this depression is related to underlying changes in the brain and for many it will occur before diagnosis of Parkinson's," says Marsh, director of mental health care service at Michael E. DeBakey Veterans Affairs Medical Center in Houston.

"The more aggressively it is treated the better the disease outcome,'' she says. "There's a real problem with under-recognition and under-treatment."

Oberdorf says the database analysis is showing "divergence in outcomes. We're finding the jewels of treatment."

Patients who receive a combination of treatments for depression — medication and supportive therapy — do the best, according to Marsh. Another problem associated with not treating depression: Until it is addressed, she says, patients might not want to take part in exercise programs, an important therapy for the disease.

"The more exercise you get the more it helps with stiffness, and it can also help prevent falls as the disease progresses,'' says Okun. "Exercise might actually modify the disease."

Okun says therapies involving training on a treadmill and spinning on an exercise cycle also elevate mood.

"We're much more likely now to recommend to patients every day to break a sweat, get your heart rate up,'' he says.

The early findings about effective treatments are "just the tip of the iceberg," says Oberdorf. "We're committed to following this for a very long time."

—Janice Lloyd

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