A Systematic Review of Apathy and Depression in Progressive Supranuclear Palsy

Abstract

Depression and apathy can be significant problems in progressive supranuclear palsy (PSP). Using PRISMA guidelines, this systematic review examined prevalence estimates for depression and apathy in PSP, and, how different methods of definition may influence results. 29 studies meeting inclusion/exclusion criteria were identified: 12 on depression, 9 on apathy, and 8 on both. Studies were stratified according to whether a diagnostic criteria, rating scale or screening question methodology was employed. The weighted mean prevalence was 59.7% for depression (sample size = 473) and 58.3% for apathy (sample size = 858). Results for depression using diagnostic criteria or rating scales were similar whereas screening questions were associated with considerable inconsistency. Depression prevalence appeared to be influenced by apathy but not somatic symptoms. Most apathy studies relied only on a screening question method. Depression and apathy are common in PSP but there is a need for consensus on how they are defined (both tools and cut-off scores). In particular, more studies probing apathy in greater detail than a simple screening question are required.

Depression and Apathy across Different Variants of Progressive Supranuclear Palsy

“…Across the entire cohort we found 56% of our patients met criteria for depression which is similar to the frequency of depression reported in a recent large systematic study 13 and other studies. 8,20,21 Our frequency was, however, lower than that reported in another study (77%) that assessed depression across PSP variants using the MDS-PSP criteria.…”

“…21 We did not find apathy to be more frequent in our cohort, or in any one variant, compared to depression as reported 14 and our frequency was lower than what was found in one systematic study (12% vs. 58%). 13 There are, however, similarly reported low frequencies of apathy in the literature. For example, apathy was reported in 21% of PSP-RS patients in one study.…”

“…A recent systematic review found a mean prevalence of 59.7% for depression and 58.3% for apathy in patients with PSP. 13 There has only been one study that compared depression and apathy among MDS-PSP defined variants. 14 Forty-nine patients in that study were diagnosed retrospectively using the MDS-PSP criteria.…”

A case presenting with a major depressive episode with palilalia and difficulty opening eyes as prodromal symptoms of progressive supranuclear palsy

“…Patients with PSP frequently experience depression [3][4][5][6]14,15 and are commonly prescribed antidepressants. 14,15 In this case, depres- PSP and corticobasal syndrome, selective serotonin reuptake inhibitors may be used; however, tricyclic antidepressants should be avoided.…”

“…Progressive supranuclear palsy (PSP) is a neurodegenerative disease characterized by ocular motor dysfunction, postural instability, akinesia, and cognitive dysfunction 1,2 . Few studies have assessed the prevalence of depression in patients with PSP using the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria 3–7 . It is common for patients with PSP to have broadly defined depressive disorders, including major depressive disorder, dysthymic disorder, adjustment disorder and depressive disorder due to PSP 3–6 .…”