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Vol. 282 No. 12, JAMA September 22/29, 1999 Keeping Depression at Bay Helps Patients With Parkinson Disease Vancouver, BC — The first major international study to assess factors that influence quality of life in patients with Parkinson disease (PD) has found that the most powerful impact comes from depression rather than from the severity of the disorder or adverse effects of medication. "The key finding of the Global Parkinson Disease Survey (GPDS) is that depression has an overwhelming impact on quality of life, as measured by Beck's Depression Inventory [BDI]," said Tobias E. Eichhorn, MD, of Philipps University, Marburg, Germany, who analyzed the clinical implications of the study results. "It is the first step that will form the basis of intervention studies to determine how to treat different degrees of depression in these patients." Later he added that, since there have been no trials specifically involving antidepressant treatment of patients with PD, various classes of drugs should be studied to determine which will be of most benefit. Speaking at a symposium held during the 13th International Conference on Parkinson Disease, Eichhorn urged physicians to "expand over the routine management approach to identify and treat depression in Parkinson patients." He said, "Monitoring and treatment of depression should become routine in Parkinson patients." SIX COUNTRIES SURVEYED The GPDS is a multicenter, randomized survey conducted in Canada, Italy, Japan, Spain, the United Kingdom, and the United States. The study was designed to obtain the perceptions of a randomly selected group of patients, clinicians, and caregivers through face-to-face interviews and questionnaires to measure quality of life. Seven validated instruments, including the Parkinson's Disease Questionnaire-39 and Mini-Mental State Examination, were used to obtain a comprehensive evaluation of the health status and quality of life of patients, said the study's international clinical coordinator, Leslie J. Findley, MD, who directs the Essex Neurosciences Unit at Oldchurch Hospital in Essex, England. The GPDS involved more than 1000 patients, 200 clinicians, and 687 caregivers. The study was developed by the European Parkinson's Disease Association, the National Parkinson's Disease Foundation, and the World Health Organization. Recruitment and fieldwork began in 1998 following pilot studies in the United Kingdom and United States. Investigators first presented the initial results here at the Congress. OVERLOOKED BUT IMPORTANT "Depression is often overlooked in Parkinson disease," said Eichhorn, but the GPDS has confirmed that it is highly prevalent in patients with the disorder. The study found that 50% of the patients were depressed, as assessed using the BDI, he said, even though only 1% of patients and 2% of caregivers reported that depression affected the patient. "This discrepancy highlights the fact that depression is not easily recognized in Parkinson disease, even by the patient's caregiver," he noted, and reflects a disparity in perception between patients and caregivers. The study also examined other aspects of quality of life through rating scales that looked at such factors as physician delivery of information at the time of diagnosis, access to information, and attitude of patients, caregivers and physicians. One factor that appears to have an additional effect on quality of life is the patient's satisfaction with how the physician explains the disease when it is diagnosed, said Findley. Another is the patient's level of optimism. "Physicians need to be aware of the importance of the first consultation with the patient," said Eichhorn. "In addition, they need to support patient optimism throughout the course of treatment." It has long been hypothesized that severity of disease and type of medication have a major impact on the quality of life enjoyed by patients with Parkinson disease, Findley said, but this study demonstrates that other factors play an important role. Understanding the factors that influence quality of life, he said, will lead to the development of better treatment plans for patients. by Pat Phillips 1999 American Medical Association. All rightsreserved. <http://jama.ama-assn.org/issues/v282n12/full/jmn0922-2.html> janet paterson 52 now / 41 dx / 37 onset 613 256 8340 po box 171 almonte ontario canada K0A 1A0 a new voice: <http://www.geocities.com/SoHo/Village/6263/> <[log in to unmask]>