Factors associated with depression in patients with Parkinson’s disease A multicenter study in Lima, Peru

Abstract The diagnosis and treatment of depression in patients with Parkinson’s disease (PD) is inadequate, often contributing to a reduced quality of life, rapid disease progression, higher cognitive impairment, and an increased burden of care for family members of patients with PD. Objective: To determine the factors associated with depression in PD and to examine the frequency of depressive symptoms among patients with PD. Methods: This study was an observational, analytical, multicenter study of a cross-sectional cohort, conducted between July 2016 and May 2017. PD patients were recruited from neurology clinics in Lima, Peru. All statistical analyses were performed using descriptive statistics. Bivariate and multivariate logistic regression analyses were calculated using STATA. Results: Out of 124 patients (average age: 68.7 years; 58% males) included in the study 60.5% (75/124) presented with symptoms of depression; only 20% (25/124) received antidepressants. Factors associated with depression in PD included: unemployment, falls, freezing of gait, involuntary movements micrographia, stooped posture, hyposmia, movement disorders in sleep, rapid disease progression, and the use of MAOIs. Furthermore, statistically significant differences were found in disease duration, UPDRS and MMSE scores, Hoehn and Yahr (HY) stage, and length of time taking L-dopa between PD patients with and without depressive symptoms. Conclusion: Factors associated with depressive symptoms in patients with PD were hyposmia, rapid progression of the disease, the use of L-dopa, and use of MAOIs. The frequency of depressive symptoms in patients with PD is high; early diagnosis and prompt treatment are needed to improve their quality of life and the family environment.摘要 帕金森病（Parkinson’s Disease, PD）患者的抑郁诊断与治疗存在不足，往往会导致患者生活质量下降、疾病进展加速、认知障碍程度加重，同时增加帕金森病患者家属的照护负担。 目的：明确帕金森病患者抑郁的相关影响因素，并调查其抑郁症状的发生频率。 方法：本研究为一项观察性、分析性多中心横断面队列研究，于2016年7月至2017年5月间开展。研究对象招募自秘鲁利马的神经内科门诊。所有统计分析均采用描述性统计方法；二元及多元逻辑回归分析采用STATA软件完成。 结果：本研究共纳入124例患者（平均年龄68.7岁；男性占比58%），其中60.5%（75/124）的患者存在抑郁症状；仅20%（25/124）的患者接受了抗抑郁药物治疗。与帕金森病患者抑郁相关的因素包括：失业、跌倒、步态冻结（freezing of gait）、不自主运动、小写征（micrographia）、姿势异常、嗅觉减退（hyposmia）、睡眠期运动障碍、疾病快速进展以及单胺氧化酶抑制剂（Monoamine Oxidase Inhibitors, MAOIs）的使用。此外，伴与不伴抑郁症状的帕金森病患者在病程时长、统一帕金森病评定量表（Unified Parkinson’s Disease Rating Scale, UPDRS）评分、简易精神状态检查（Mini-Mental State Examination, MMSE）评分、Hoehn-Yahr（HY）分期以及左旋多巴（Levodopa, L-dopa）服用时长方面均存在统计学差异。 结论：帕金森病患者抑郁症状的相关影响因素包括嗅觉减退、疾病快速进展、左旋多巴使用以及单胺氧化酶抑制剂的使用。帕金森病患者的抑郁症状发生频率较高，需及早开展诊断与治疗，以改善患者的生活质量及家庭照护环境。