Lack of independent mood-enhancing effect for dopaminergic medications in early Parkinson's disease.
Affect
/ drug effects
Aged
Antidepressive Agents
/ pharmacology
Antiparkinson Agents
/ pharmacology
Cognition
/ drug effects
Depression
/ drug therapy
Disease Progression
Dopamine Agonists
/ pharmacology
Female
Humans
Levodopa
/ pharmacology
Male
Middle Aged
Parkinson Disease
/ drug therapy
Prospective Studies
Treatment Outcome
Depression
Dopamine agonists
Levodopa
MAO-B inhibitors
Mood
Parkinson's disease
Journal
Journal of the neurological sciences
ISSN: 1878-5883
Titre abrégé: J Neurol Sci
Pays: Netherlands
ID NLM: 0375403
Informations de publication
Date de publication:
15 Jul 2019
15 Jul 2019
Historique:
received:
04
02
2019
revised:
22
03
2019
accepted:
12
05
2019
pubmed:
28
5
2019
medline:
18
8
2020
entrez:
25
5
2019
Statut:
ppublish
Résumé
A direct antidepressant effect has been reported for certain dopaminergic medications used in the treatment of Parkinson's disease (PD). To examine whether dopaminergic medications may exert differential effects on mood in early PD. We analyzed prospectively-collected 5-year data on 405 early, drug-naïve (at baseline) PD patients enrolled in the Parkinson's Progression Markers Initiative (PPMI) cohort study, initiated on levodopa, dopamine agonists (DAs), or monoamine-oxidase type B inhibitors (iMAO-B) under naturalistic conditions. The outcome for depressive symptoms was the 15-item Geriatric Depression Scale (GDS-15) score. Potential motor and cognitive confounders were measured using the Unified Parkinson's disease Rating Scale (MDS-UPDRS-III) and the Montreal Cognitive Assessment (MoCA). Three statistical models were used to determine medication effects on GDS-15 scores: unadjusted, adjusted, and a marginal structural model. One-third of patients in this cohort met GDS-15 threshold for clinically-significant depressive symptoms (GDS-15 ≥ 5). There was a marginal positive effect on GDS-15 scores after iMAO-B treatment initiation (-0.35 95%; CI: -0.73, 0.04; p = 0.08). There were no significant interactions between any of the three medication groups, but robust interactions between MoCA scores and both DAs (p = 0.005) and iMAO-B (p = 0.03) use on GDS-15 scores. Specifically, as MoCA scores worsened, DAs yielded a steeper worsening of GDS-15 scores while iMAO-B a moderating effect on GDS-15. Dopaminergic medications have no direct effect on mood in early, unselected PD patients.
Sections du résumé
BACKGROUND
BACKGROUND
A direct antidepressant effect has been reported for certain dopaminergic medications used in the treatment of Parkinson's disease (PD).
OBJECTIVE
OBJECTIVE
To examine whether dopaminergic medications may exert differential effects on mood in early PD.
METHODS
METHODS
We analyzed prospectively-collected 5-year data on 405 early, drug-naïve (at baseline) PD patients enrolled in the Parkinson's Progression Markers Initiative (PPMI) cohort study, initiated on levodopa, dopamine agonists (DAs), or monoamine-oxidase type B inhibitors (iMAO-B) under naturalistic conditions. The outcome for depressive symptoms was the 15-item Geriatric Depression Scale (GDS-15) score. Potential motor and cognitive confounders were measured using the Unified Parkinson's disease Rating Scale (MDS-UPDRS-III) and the Montreal Cognitive Assessment (MoCA). Three statistical models were used to determine medication effects on GDS-15 scores: unadjusted, adjusted, and a marginal structural model.
RESULTS
RESULTS
One-third of patients in this cohort met GDS-15 threshold for clinically-significant depressive symptoms (GDS-15 ≥ 5). There was a marginal positive effect on GDS-15 scores after iMAO-B treatment initiation (-0.35 95%; CI: -0.73, 0.04; p = 0.08). There were no significant interactions between any of the three medication groups, but robust interactions between MoCA scores and both DAs (p = 0.005) and iMAO-B (p = 0.03) use on GDS-15 scores. Specifically, as MoCA scores worsened, DAs yielded a steeper worsening of GDS-15 scores while iMAO-B a moderating effect on GDS-15.
CONCLUSION
CONCLUSIONS
Dopaminergic medications have no direct effect on mood in early, unselected PD patients.
Identifiants
pubmed: 31125734
pii: S0022-510X(19)30225-4
doi: 10.1016/j.jns.2019.05.009
pii:
doi:
Substances chimiques
Antidepressive Agents
0
Antiparkinson Agents
0
Dopamine Agonists
0
Levodopa
46627O600J
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
81-85Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 Elsevier B.V. All rights reserved.