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BRIEF COMMUNICATIONS: Suzanne Holroyd, Lillian J. Currie, and G. Frederick Wooten Depression is associated with impairment of ADL, not motor function in Parkinson disease Neurology 2005; 64: 2134-2135 [Abstract] [Full text] [PDF]

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Depression is associated with impairment of ADL, not motor function in Parkinson disease

Yasuo Iwasaki, Ken Ikeda,Osamu Igarashi,Shigeji Baba   (27 October 2005)

Reply to Iwasaki et al

Suzanne Holroyd, Lillian J. Currie, G. Frederick Wooten   (27 October 2005)

Depression is associated with impairment of ADL, not motor function in Parkinson disease 27 October 2005
Yasuo Iwasaki, Toho University Omori Hospital 6-11-1,Omorinishi,Ota-ku,Tokyo, Japan, Ken Ikeda,Osamu Igarashi,Shigeji Baba Send Correspondence to journal: Re: Depression is associated with impairment of ADL, not motor function in Parkinson disease yaso{at}med.toho-u.ac.jp Yasuo Iwasaki, et al.	We read the Holroyd et al article with great interest. [1] We evaluated 50 patients with Parkinson's Disease (PD). All patients had idiopathic PD, none had a previous history of stroke and all met DSM-III criteria for dementia. We evaluated depressive state using Zung self- rating depression scale.[2] Motor disability(tremor,rigidity,bradykinesia)Hoehn & Yahr stage, age at onset, levodopa dosage, duration of illness, history of depression and score of Mini-mental examination [3] did not correlate with the SDS score. Our reslts indicated that no factor correlated with the SDS score, and we would argue with Holroyd et al's conclusion. [1]. They reported that depression was associated with lower cognition, history of depression and a high Unified Parkinson's Disease Rating Scale score. We would like to know whether there is any difference between early-onset and late-onset PD in relation to their results. A variety of elements may contribute to depression. Dopaminergic in addition to serotonergic pathways are related to depression. We suggest that cognitive examination,including depressive state, should be performed as a part of evaluation of PD and relationship between depressive state and neurochemical study also be examined. References 1.Holroyd S,Currie LJ,Wooten GF. Depression is associated with impairment of ADL, not motor function in Parkinson disease. Neurology 2005;64:2134-2135. 2.Zung WWK.A self-rating depression scale.Arch Gen Psychiatry 1965;12:63-70. 3.Folstein MF,Folstein SE, McHugh PR.Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; Nov 12:189-198. Disclosure: The authors report no conflicts of interest.
Reply to Iwasaki et al 27 October 2005
Suzanne Holroyd, University of Virginia Dept. of Psychiatric Medicine UVA HS Box 800623, Charlottesville VA 22908, Lillian J. Currie, G. Frederick Wooten Send Correspondence to journal: Re: Reply to Iwasaki et al sh4s{at}virginia.edu Suzanne Holroyd, et al.	We thank Iwasaki et al for their interest in PD and depression. In their experience, they found no association between depression and any other clinical measure. However,there are many differences between our study and their report. First, the Zung self-rating scale for depression is not well validated in medically ill patients, as is the scale we utilized, the Geriatric Depression Scale. Second, the UPDRS is a more thorough rating of PD symptomology than the Hoehn and Yahr scale that they used. Importantly, as noted as a key point of our study (and in fact the title), although the UPDRS score was higher in those with depression, closer examination revealed it was the ADL subscale score that was associated with depression rather than the motor score, suggesting it is not the motor symptoms causing the depression (because if so, then worse motor scores would be associated with higher depression scores). The results suggest that depression may worsen ADL function. We also noted the role of dopaminergic and serotonergic abnormalities in the development of depression in our paper. Finally, the authors recommend cognitive exam of PD patients, but they should have noted we did a cognitive exam in our patients, the TICS, which we feel is superior to the Folstein MMSE,for reasons noted in our paper, for patients with PD. We suggest further research regarding the relationship of depression and function in PD. Disclosure: The authors report no conflicts of interest.