Journal article
Lack of independent mood-enhancing effect for dopaminergic medications in early Parkinson's disease
Journal of the neurological sciences, Vol.402, pp.81-85
07/15/2019
DOI: 10.1016/j.jns.2019.05.009
PMID: 31125734
Abstract
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.
•Mood effects by dopaminergic effects are confounded by cognitive and motor function.•There was no adjusted mood stabilizing or enhancing effect by any dopaminergic drug.•As cognition worsens, dopamine agonists are associated with worse depression scores.•MAO-B inhibitors may have a modest attenuating effect in the cognition-depression link.
Details
- Title: Subtitle
- Lack of independent mood-enhancing effect for dopaminergic medications in early Parkinson's disease
- Creators
- Alberto J Espay - James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USAEric D Foster - Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USAChristopher S Coffey - Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USALiz Uribe - Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USAChelsea J Caspell-Garcia - Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USADaniel Weintraub - Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USAParkinson's Progression Markers Initiative
- Resource Type
- Journal article
- Publication Details
- Journal of the neurological sciences, Vol.402, pp.81-85
- DOI
- 10.1016/j.jns.2019.05.009
- PMID
- 31125734
- NLM abbreviation
- J Neurol Sci
- ISSN
- 0022-510X
- eISSN
- 1878-5883
- Publisher
- Elsevier B.V
- Grant note
- DOI: 10.13039/100005339, name: American Academy of Neurology; DOI: 10.13039/100000864, name: Michael J. Fox Foundation
- Language
- English
- Date published
- 07/15/2019
- Academic Unit
- Biostatistics; College of Public Health
- Record Identifier
- 9984214697202771
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