Mood changes and “on‐off” phenomena in Parkinson's disease

Abstract

Ten patients with idiopathic Parkinson's disease and motor fluctuations were rated for mood changes during discrete "off," "on," and "on with dyskinesia" periods. The Profile of Mood States and visual analogue scales were used. Significant changes in mood and anxiety were found to parallel changes in motor fluctuations. One patient rated his moods as consistently improving from the "off" state to the "on" state and finally to the "on with dyskinesia" state, a finding that is consistent with concomitant central dopaminergic changes. All other patients showed moods that improved significantly from the "off" state to the "on" state but then worsened significantly in the "on with dyskinesia" state, a finding that is consistent with the fact that patients feel worse when impaired by dyskinesias. It is suggested that these results argue for multiple etiologies of depression in Parkinson's disease. The literature on dopamine and depression in Parkinson's disease is briefly reviewed and the opportunity provided by "on-off" phenomena to study the effect of dopamine on mood changes is discussed.

CBT for the treatment of depression in Parkinson’s disease: a promising nonpharmacological approach

“…In addition, depression may co-occur with the motor "on-and-off" fluctuations frequently observed during dopaminergic treatment in PD patients. For example, some patients may experience mood fluctuations (i.e., brief periods of dysphoria or anxiety) in conjunction with motor fluctuations or "off time" (i.e., intermittent periods throughout the day when their motor symptoms are not well controlled by the antiparkinson's medications-usually resulting from long term use of levodopa) [20,21,22].…”

Alterations of the sense of self and personality in Parkinson's disease

“…Studies of the sense of Self and personality in PD suggest that PD patients are less talkative, less flexible, suspicious and cautious compared with age-matched healthy controls as well as controls with other chronic diseases (Poewe et al, 1983;Eatough et al, 1990;Menza et al, 1990;Glosser et al, 1995;Hubble and Koller, 1995;McNamara et al, 2003). In studies using the Cloninger 'tridimensional personality questionnaire', or its more recent variant, the Temperament and Character Inventory (TCI; Cloninger et al, 1993), patients with Parkinson's disease show less 'novelty seeking' activity, greater 'harm-avoidance' behavior, and less consistency in performance on ''reward dependence'' tasks than controls (Menza et al, 1990;Menza et al, 1993;Fujii et al, 2000).…”

Levodopa Challenge Neuroimaging of Levodopa-Related Mood Fluctuations in Parkinson's Disease

“…Some sadness with increased disability is not surprising, and mild mood fluctuations occur in almost all PD patients with motor fluctuations (Nissenbaum et al, 1987;Hardie et al, 1984;Menza et al, 1990;Maricle et al, 1995a, b). These fluctuations are not always tightly correlated to levodopa dosing (Menza et al, 1990;Richard et al, 2001).…”

“…Some sadness with increased disability is not surprising, and mild mood fluctuations occur in almost all PD patients with motor fluctuations (Nissenbaum et al, 1987;Hardie et al, 1984;Menza et al, 1990;Maricle et al, 1995a, b). These fluctuations are not always tightly correlated to levodopa dosing (Menza et al, 1990;Richard et al, 2001). However, a minority of patients develop severe depression, anxiety, or mania, usually with a more predictable relationship to levodopa dosing (Damásio et al, 1971;Hardie et al, 1984;Keshavan et al, 1986;Nissenbaum et al, 1987;Lees, 1989;Friedenberg and Cummings, 1989;Menza et al, 1990;Goodwin, 1990;Riley and Lang, 1993;Vázquez et al, 1993;Siemers et al, 1993;Maricle et al, 1995a, b).…”

“…These fluctuations are not always tightly correlated to levodopa dosing (Menza et al, 1990;Richard et al, 2001). However, a minority of patients develop severe depression, anxiety, or mania, usually with a more predictable relationship to levodopa dosing (Damásio et al, 1971;Hardie et al, 1984;Keshavan et al, 1986;Nissenbaum et al, 1987;Lees, 1989;Friedenberg and Cummings, 1989;Menza et al, 1990;Goodwin, 1990;Riley and Lang, 1993;Vázquez et al, 1993;Siemers et al, 1993;Maricle et al, 1995a, b). The focus of this report is on these more clinically significant symptoms, usually called 'mood fluctuations' in the PD literature.…”