The prevalence, course and clinical correlates of migraine in Parkinson's disease: A multicentre case-controlled study.

Background Previous studies have reported a lower migraine prevalence in Parkinson's disease (PD) patients and improvements in migraine headaches after PD onset, but the clinical association of migraines with PD is unclear. Methods We analysed headache and migraine prevalence and clinical correlates in 436 PD patients (mean age, 69.3 ± 7.8 years) and 401 age- and sex-matched controls (mean age, 69.2 ± 8.6 years) in a case-controlled, multicentre study. Migraines were diagnosed by a questionnaire developed according to the International Classification of Headache Disorders, second edition. We evaluated changes in headache intensity, frequency and severity over several years around the onset of PD among PD patients with headaches or migraines, and over the past several years among control subjects with headaches or migraines. Results PD patients had lower lifetime (9.6% vs. 18.0%) and 1-year (6.7% vs. 11.0%) migraine prevalences than controls. However, lifetime (38.5% vs. 38.9%) and 1-year (26.1% vs. 26.2%) headache prevalence did not differ between PD patients and controls. After adjusting for gender, timing of the evaluation of headache changes, and recall period, PD patients with headaches or migraines exhibited a pronounced reduction in the intensity, frequency and overall severity of their headaches and migraines after the onset of PD compared with controls with headaches or migraines. PD patients with migraines exhibited a higher rate of depression and higher Pittsburgh Sleep Quality Index and PD sleep scale-2 scores than those without headaches. Conclusion While overall headache and migraine severity reduced after PD onset, the presence of migraines was associated with sleep disturbances and depression in PD patients.

Impact of sleep-related symptoms on clinical motor subtypes and disability in Parkinson's disease: a multicentre cross-sectional study.

OBJECTIVES: To investigate the impact of sleep disturbances on Parkinson's disease (PD) clinical motor subtypes and disease-related disability in a multicentre setting. METHODS: We report a cross-sectional relationship between sleep-related symptoms and clinical motor subtypes (tremor dominant (TD); intermediate; postural instability and gait disturbances (PIGDs)) identified in a multicentre study, including 436 patients with PD and 401 age-matched controls. PD-related sleep problems (PD-SP), excessive daytime sleepiness (EDS) and probable REM sleep behaviour disorder (pRBD) were evaluated using the PD sleep scale (PDSS)-2, Epworth Sleepiness Scale (ESS) and RBD screening questionnaire-Japanese version (RBDSQ-J), respectively. RESULTS: PD-SP (PDSS-2 ≥18; 35.1% vs 7.0%), EDS (ESS ≥10; 37.8% vs 15.5%) and pRBD (RBDSQ-J ≥5; 35.1% vs 7.7%) were more common in patients with PD than in controls. The prevalence of restless legs syndrome did not differ between patients with PD and controls (3.4% vs 2.7%). After adjusting for age, sex, disease duration and Movement Disorder Society-Unified PD Rating Scale (MDS-UPDRS) part III score, the PIGD group had higher PDSS-2 and ESS scores than the TD group. The RBDSQ-J scores did not differ among the TD, intermediate and PIGD groups. A stepwise regression model predicting the MDS-UPDRS part II score identified the Hoehn and Yahr stage, followed by the number of sleep-related symptoms (PD-SP, EDS and pRBD), disease duration, MDS-UPDRS part III score, PIGD subtype, depression and MDS-UPDRS part IV score as significant predictors. CONCLUSION: Our study found a significant relationship between sleep disturbances and clinical motor subtypes. An increased number of sleep-related symptoms had an impact on disease-related disability.

Determinants of Low Body Mass Index in Patients with Parkinson's Disease: A Multicenter Case-Control Study.

BACKGROUND: In Parkinson's disease (PD) patients, the factors related to weight loss remain unclear. OBJECTIVE: To investigate determinants of low body mass index (BMI) in PD patients. METHODS: We identified factors associated with low BMI in PD patients in a multicenter case-control study. A total of 435 PD patients and 401 controls were included. RESULTS: The mean BMI was significantly lower in PD patients than in controls (22.0±3.4 kg/m2 vs. 25.4±4.3 kg/m2), with an adjusted odds ratio (AOR) of 3.072 (95% CI, 2.103-4.488; p < 0.001) for low BMI (<22 kg/m2) in PD. Compared to the high-BMI PD group (>22 kg/m2), the low-BMI PD group (<22 kg/m2) had more women; a longer disease duration; higher revised Movement Disorder Society Unified PD Rating Scale (MDS-UPDRS) II and IV scores; an increased levodopa equivalent dose (LED); and increased constipation, visual hallucination, dysphagia, dyskinesia and wearing off rates. There were no between-group differences in depression, anhedonia, apathy, sleep problems and daytime sleepiness. Multivariable analysis showed that visual hallucination (AOR, 2.408; 95% CI, 1.074-5.399; p = 0.033) and the MDS-UPDRS IV (AOR, 1.155; 95% CI, 1.058-1.260; p = 0.001) contributed to low BMI after controlling for clinical factors. In a second model, visual hallucination (AOR, 2.481; 95% CI, 1.104-5.576; p = 0.028) and dyskinesia (sum of the MDS-UPDRS 4.3-4.6) (AOR, 1.319; 95% CI, 1.043-1.668; p = 0.021) significantly contributed to low BMI. CONCLUSION: PD patients were 3 times more likely than healthy controls to have a low BMI. Motor complications, particularly dyskinesia, and visual hallucination were significantly associated with low BMI in PD patients.

Circadian variation of core body temperature in Parkinson disease patients with depression: a potential biological marker for depression in Parkinson disease.

BACKGROUND: The biological rhythm in comorbidity of depression and Parkinson disease (PD) is still unclear. For early diagnosis or clarification of the pathologic condition of comorbidity of depression and PD, the present study investigated the presence of circadian rhythm abnormalities in patients with depression. METHODS: We measured the rectal temperature (RT) in 30 PD patients with or without depression during 48 consecutive hours using the maximum entropy method (MEM) and least-squares method (COSINOR). The presence of major or minor depression was evaluated by the Mini International Neuropsychiatric Interview based on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders, and the Hamilton Depression Scale. RESULTS: The RT rhythms of patients without depression predominately showed a circadian rhythm. However, 2 of 6 patients with depression showed an infradian rhythm using MEM. COSINOR revealed that PD patients with depression showed lower amplitudes of core body temperature (p = 0.012) and higher minimum RT (p = 0.031) relative to those of patients without depression. CONCLUSION: PD patients with depression show an altered RT circadian rhythm. The results suggest that the characteristics of core body temperature could be potentially used as a biological marker for depression in PD.

Characterizing restless legs syndrome and leg motor restlessness in patients with Parkinson's disease: A multicenter case-controlled study.

BACKGROUND: We investigated the prevalence and impact of restless legs syndrome (RLS) and leg motor restlessness (LMR) in patients with Parkinson's disease (PD) in a multicenter study. METHODS: A total of 436 PD patients and 401 age- and sex-matched controls were included in this study. RLS was diagnosed based on four essential features. LMR was diagnosed when a participant exhibited the urge to move his or her legs but did not meet the four essential features of RLS. RESULTS: The RLS prevalence did not differ between PD patients and controls (3.4% vs. 2.7%), while LMR prevalence was significantly higher in PD patients than in controls (12.8% vs. 4.5%). PD patients with RLS or LMR had a higher prevalence of excessive daytime sleepiness (EDS) (50.7%, vs. 6.9%), probable REM sleep behavior disorder (38.0% vs. 3.4%) and PD-related sleep problems (49.3% vs. 20.7%) than controls with RLS or LMR. RLS/LMR preceding PD onset was related to an older age of PD onset. CONCLUSION: Our study revealed an increased prevalence of LMR but not RLS in PD patients. LMR could be an early manifestation of PD; however, whether LMR is within the range of RLS or whether LMR and RLS constitute different entities in PD requires further studies.

[Depression and anxiety in Parkinson's disease].

Parkinson's disease (PD) is accompanied by nonmotor symptoms (NMS) such as mood disorders. Among them, depression and anxiety complicate PD and are present at high rates in PD patients. Organic depression is generally known to affect a patient's recovery from the sequelae of the primary disease; thus early detection and appropriate treatment are essential. Depression in PD is thought to result from different factors such as disappearance of neurons in the dopamine, noradrenaline, and serotonin as well as from psychogenic reactions associated with the onset of the disease. Moreover, anxiety may also be a side effect of PD treatment. As morbid states of depression and anxiety are complicated, these symptoms are often difficult to diagnose. Moreover, the validity of these diagnostic methods has not been established. Therefore, accurate diagnoses of morbid states in the early stage of the disease and corresponding appropriate treatments are vital.

Apathy and anhedonia in Parkinson's disease.

Depression, apathy, and anhedonia are often comorbid in patients with Parkinson's disease. Since the morbid states of apathy and anhedonia are complicated, these symptoms are often difficult to diagnose. Several therapeutic methods for apathy and anhedonia are considered effective. However, the validity of these methods has not been established. Similar to depression, apathy and anhedonia clearly affect the quality of life of patients and their families. Therefore, accurate diagnoses of morbid states in the early stage of the disease and corresponding appropriate treatments should be given high priority.

Characteristics of mood disorders in Japanese patients with medication-overuse headache.

OBJECTIVE: The importance of psychiatric comorbidity in migraine has long been recognized. There is a growing body of evidence that these psychiatric comorbidities share diverse epidemiological properties, pathophysiological mechanisms, and treatment response. The prevalence of psychiatric comorbidities is high in patients with medication-overuse headache (MOH). METHODS: To understand the characteristics of mood disorders in MOH in Japanese patients, we studied and evaluated the characteristics of psychiatric comorbidities in MOH. RESULTS: The results suggested that mood disorders in MOH are similar to those in endogenous depression but different from those of secondary mood disorders associated with other diseases. Suspicion of depression and intervention are essential for providing medical care for patients with MOH. CONCLUSION: Affective disorders diagnosed in migraine patients might later progress to MOH. In contrast, migraine patients without MOH and healthy subjects had a similar prevalence of mood disorders.

Usefulness of the Japan Stroke Scale-Depression Scale-(JSS-D) for the diagnosis of post-stroke depression.

BACKGROUND: Post-stroke depression (PSD) has a great impact on the quality of life of patients with stroke. The Mini International Neuropsychiatric Interview (MINI) and the Hamilton Depression Scale (HAM-D(17)) are considered the most reliable diagnostic tests for depression. However, both are difficult to conduct in a clinical setting since they require completion of a questionnaire in a limited time period. The Japan Stroke Scale -Depression Scale- (JSS-D) was established by the Japan Stroke Society to evaluate mood disorders following stroke, including PSD. Here, we correlated the results of HAM-D(17), MINI and JSS-D scores. METHODS: We studied 100 stroke patients (mean age: 64.6+/-11.6 [+/-SD], range: 32-85 years) in the subacute phase (2-5 weeks after onset). We determined the correlations between HAM-D(17) and JSS-D scores. We used MINI to diagnose PSD, which represented major and minor depression, and compared the results with those of JSS-D. RESULTS: JSS-D scores correlated with those of HAM-D(17) (r=0.847, p <0.0001). The cutoff value of JSS-D score for PSD was 2.40. The sensitivity and specificity were 0.950 and 0.988, respectively. CONCLUSION: JSS-D is the most valuable diagnostic test for PSD based on its ease of use and reliability for estimating PSD in Japan.

Characteristics of post-stroke depression in Japanese patients.

Post-stroke depression (PSD) has an important impact on the quality of life of patients with stroke. We studied 100 stroke patients (mean age+/-SD: 64.6+/-11.6, range: 32-85 years) in the subacute phase (2-5 weeks after onset) and investigated the prevalence and clinical correlates of PSD in the subacute phase. The prevalences of PSD and major depression in the subacute phase evaluated by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, were 20.0 and 5.0%, respectively. These values were lower than those reported in Caucasian studies. The Zung Self-Rating Depression Scale (SDS) did not underestimate the presence of PSD and was thus considered valuable for the initial screening of PSD. However, SDS may overestimate PSD especially in patients with anxiety disorders or somatoform disorders and vice versa. Apathy was observed in 40.2% of patients; however, it was widely distributed and observed even in patients without serious depression.