Affective symptoms in multiple system atrophy and Parkinson's disease: response to levodopa therapy

Abstract

The objective was to determine the extent to which psychiatric disturbances (especially mood disorders) generally considered poor prognostic factors, are present in patients with striatonigral (SND) type multiple system atrophy (MSA) compared with patients with idiopathic Parkinson's disease (IPD). The Hamilton depression scale (HAM-D), brief psychiatric rating scale (BPRS), and Unified Parkinson's disease rating scale (UPDRS) were administered to clinically probable non-demented patients with SND-type MSA and patients with IPD matched for age and motor disability, at baseline and after receiving levodopa. At baseline total HAM-D score was greater in patients with IPD. Overall, BPRS score did not diVer between the two groups; however, patients with IPD scored higher on anxiety items of the BPRS, and patients with MSA had higher scores on the item indicating blunted aVect. After levodopa, both groups improved significantly in UPDRS and HAM-D total scores (just significant for patients with MSA). Patients with IPD improved significantly in total BPRS score but patients with MSA did not. At baseline patients with IPD were more depressed and anxious than patients with MSA who, by contrast, showed blunted aVect. After levodopa, depression and anxiety of patients with IPD improved significantly whereas the aVective detachment of patients with MSA did not change. Major neuronal loss in the caudate and ventral striatum, which are part of the lateral orbitofrontal and limbic circuits, may be responsible for the blunted aVect not responsive to levodopa therapy found in patients with MSA. (J Neurol Neurosurg Psychiatry 1999;66:541-544)

Progression of parkinsonism in multiple system atrophy

“…Fourth, a larger cohort of patients followed-up for extended time periods will be required to substantiate the nonlinear progression of parkinsonism observed in our study. Fifth, although the UPDRS has been the instrument of choice to measure motor disability in MSA so far [1,3,17,21], it does not accurately reflect the complex motor picture of MSA owing to the mixed cerebellar and parkinsonian motor impairment that occurs in most MSA patients [16]. However, the UPDRS-III has been shown to provide a useful severity measure of parkinsonism in MSA [21].…”

Neuropsychiatric aspects of parkinson’s disease

“…Dopaminergic antiparkinsonian drug therapy may therefore have antidepressant effects. Studies of PD patients with advanced disease and motor fluctuations with [30] and without [31] baseline depression have shown improvement of depression and mood after receiving levodopa. In another study, only minor beneficial effects of levodopa on mood in nondepressed, mildly affected, and drug-naive patients were reported [32•].…”

Cognitive Impairment in Spinocerebellar Degeneration

“…MSA-P patients showed significant deficits in the tests previously shown to be sensitive to frontal lobe dysfunction [83, 85, 86, 88]. There are several studies demonstrating that MSA-P patients have apraxias [91,92,93] or depressive state [94,95,96]. In comparisons among PD and MSA-P and progressive supranuclear palsy, although results were not consistent, all studies showed patients with progressive supranuclear palsy were most severely impaired in cognitive function.…”