Skip to main content

Depression and anxiety among patients with Parkinson’s disease: frequency, risk factors, and impact on quality of life

Abstract

Background

Depression and anxiety are non-motor symptoms of Parkinson’s disease (PD) that are often overlooked and underrated. This study aimed to highlight the frequency and risk factors of depression and anxiety among subjects with PD.

Methods

Sixty-four patients with PD who were diagnosed according to United Kingdom Parkinson’s Disease Society (UKPDS) Brain Bank Criteria and 50 sex- and age-matched healthy control subjects are evaluated for depression and anxiety. PD severity and staging were assessed using Unified Parkinson’s Disease Rating Scale (UPDRS) and Hoehn and Yahr scale. Depression and anxiety were diagnosed using DSM-IV TR criteria and scored using Hamilton Depression and Hamilton Anxiety Rating Scales (HAM-D and HAM-A). The World Health Organization Quality of Life (WHOQOL)-BREF was used to assess impact of depression and anxiety on quality of life.

Results

31.25% of patients with PD had depression while 40.6% of patients had anxiety disorder. Depression was higher in females and patients with history of depression and low socioeconomic status (SES). Anxiety was common in young patients and those who had history of anxiety. Overlap between depression and anxiety was recorded in 23.4%. Total UPDRS and Hoehn and Yahr scale accounted for 33.4% of variance for depression. Total UPDRS and earlier age of onset accounted for 39% of variance for anxiety. Advanced disease stage and severity were independent predictors for depression while disease severity and younger age of onset were the main predictors for anxiety. Depression and anxiety have a negative impact on the overall quality of life of PD patients especially on physical and psychosocial domains.

Conclusion

Depression and anxiety are relatively common in PD. Female gender, low SES, and history of depression were the main risk factors for developing depression. Young age and history of anxiety were risk factors for anxiety. Both had negative impact on quality of life.

Introduction

Parkinson’s disease (PD) is a neurodegenerative movement disorder in which bradykinesia in combination with rest tremors, rigidity, or both is the main motor symptoms of the disease [1]. Mood disorders are the most prevalent non-motor symptoms (96.4%) of studied Egyptian patients with PD [2]. Depression and anxiety are among the most distressing neuropsychiatric symptoms of PD [3]. These symptoms represent a further burden on the patients and their caregivers [4]. These non-motor symptoms are often overlooked and do not take an adequate concern or proper treatment plan [5]. Prevalence of depression in PD exceeds that in other disabilities of the same degree [6]. The symptom overlap between depressive disorders and PD increases the difficulty of detection of depression among such patients and necessitates a high index of suspicion [7]. Psychiatric disorders in PD are likely the result of complex interactions between genetic vulnerabilities, cognitive predisposition, age-associated changes in neurobiology, and stressful events. Deficiencies in dopaminergic, serotonergic, and cholinergic networks have all been suggested to play a role in pathobiology [8,9,10]. The disease’s multisystem nature makes it difficult to identify the specific causes of neuropsychiatric disorders mainly depression and anxiety. Estimating the frequency of depression and anxiety and understanding factors of their association in PD may facilitate early detection and add future treatment strategies. In this study, we are aiming at highlighting the frequency and predictors of depression and anxiety among PD patients.

Methods

In this cross-sectional study, we recruited 64 patients with Parkinson’s disease from the neurology outpatient clinic of our hospitals from September 2015 to August 2016; they were compared with a group of 50 age- and sex-matched control subjects. Inclusion criteria included patients diagnosed with PD according to the United Kingdom Parkinson’s Disease Society (UKPDS) Brain Bank Criteria [11, 12], non-demented, willing to participate in the study, and able to give informed consent. Exclusion criteria included moderate to severe dementia as measured by Mini-Mental State Examination (MMSE) test with a score of < 18 for literate patients and < 16 for illiterate patients [13, 14]. Severe hearing or visual impairment or severe general medical problems (renal or liver failure as these are confounding factors related to depression). Neither the patient nor controls have been treated with antidepressant nor anxiolytic drugs. All participants provided an informed written consent. The local Ethical Committee of Qena Faculty of Medicine approved the study.

Modified Hoehn and Yahr scale [15] and Unified Parkinson’s Disease Rating Scale (UPDRS) [16] were used for staging and detection of severity of PD, respectively. Socioeconomic scale for family was used for socioeconomic assessment [17].

Structured Clinical Interview for DSM-IV-Clinician Version (SCID-CV) [18] the Arabic form [19] was used to diagnose depression and anxiety, as well as to eliminate any clinical comorbidity in patients and controls. It has seven diagnostic modules for disorders in the axis I.

An Arabic validated version of Hamilton rating scale for depression and anxiety (HAM-D and HAM-A) was used to score the severity of depressive and anxiety symptoms [20, 21]. The cutoff point for HAM-D was 7, and above it, different grades of severity have been diagnosed [22]. The cutoff point for HAM-A was 13, and above it, clinically significant anxiety has been diagnosed [23]. Patients with “on/off” complications were assessed during “on” states according to the recommendation of Movement Disorders Society Task Force [24].

An Arabic validated version of the World Health Organization Quality of Life (WHOQOL)-BREF [25] was used to assess quality of life for all patients included in the study. It has 26 items on a 5-point Likert scale, which includes two global items about QOL and health and 24 items relating to four domains of QOL. The two general questions are about an individual’s overall perception of quality of life and health. The four domain scores are scaled in a positive direction (i.e., higher scores denote higher quality of life).

Statistical analysis

The data were analyzed using SPSS 16.0 software. Qualitative data were described in frequency using percentage (%). Continuous variables were expressed in mean ± standard deviation (SD). Comparative statistical analysis between variables was done using chi-square for qualitative data and independent t test for continuous variables. A value of P < 0.05 was considered statistically significant. Pearson’s rank correlation coefficients were calculated to assess the direction and magnitude of association between variables in relation to depression and anxiety. A hierarchical multivariable regression analysis was performed, with variables being entered into the model according to the magnitude of correlation.

Results

Socio-demographic characteristics

Sixty-four patients with PD were examined; the mean age ± SD was 71.8 ± 10.7 with no significant difference compared with controls (69 ± 11.3); males to females were 52 to 48%, respectively; 59.4% were from urban areas; and 57.8% were illiterate. Middle socioeconomic level was recorded in 54.7%. Fourteen percent of cases were diabetic, 20.3% were hypertensive, and 7.8% were cardiac (Table 1).

Table 1 Socio-demographic, medical history, and frequency of depression and anxiety among studied groups (patients and controls)

Parkinson’s disease characteristics of the study subjects

The mean age ± SD of onset of PD patients was 66.2 ± 9, and the mean duration of illness was 5.8 ± 3.2. About 76.6% received specific antiparkinsonian treatment, and about 85.7% of those who received specific treatment had levodopa as their main line of treatment. The mean total UPDRS score was 86.3 ± 40.7 and for UPDRS-III was 51.5 ± 24.4. The percentage of each stage of Hoehn and Yahr staging was stage 1.5 = 10.9%, stage 2.5 = 32.8, stage 3 = 42.2%, and stage 4 = 14.1%.

Prevalence of depression and anxiety in patients with PD

Patients with PD had significant higher scores of depressive symptoms than the matched control group (P = 0.032). The frequency of depression among PD patients was 20 (31.25%) with 17.2% and 14.1% of those who were depressed having major and minor depression, respectively.

Similarly, patients with PD had significant higher scores of anxiety than the matched control group (P < 0.001). The frequency of anxiety disorders among patients with PD was 26 (40.6%). GAD was the most common anxiety disorders among cases (17.2%). Overlap between depression and anxiety was recorded in 23.4% (Table 1).

Socio-demographic characteristics among patients with and without depression and in those with and without anxiety

PD with depression was significantly common in those with female gender, low socioeconomic status, and past history of depression (P = 0.004, 0.004, < 0.001) compared with patients without depression, with no significant differences between them in other items. PD patients with anxiety were younger than patients without anxiety (P < 0.001) and were higher with those who had previous history of anxiety (P = 0.015) (Table 2).

Table 2 Socio-demographic, medical, and psychiatric risk factors among patients with and without depression and those with and without anxiety

Characteristics of PD patients with depression and anxiety

PD patients with depression significantly had advanced disease stage and higher UPDRS scores especially motor symptoms (P = 0.014 and P < 0.001, respectively).

Meanwhile, the age onset of PD for patients with anxiety was younger than patients without anxiety (P < 0.001). PD patients with anxiety had significantly advanced disease stage and higher UPDRS scores especially motor (part III) than patients without anxiety (P = 0.038 and P < 0.001, respectively)

Cognitive impairment was found to be higher in depressed patients (mean MMSE = 21.5 ± 4.9) with significant difference compared to non-depressed. Details are illustrated in Table 3.

Table 3 Comparison between Parkinson’s disease patients with and without depression and those with and without anxiety in demographic and clinical criteria

Correlation analysis results

Total UPDRS and Hoehn and Yahr scale both have significant positive correlation with HAM-D score (r = 0.576, P < 0.0001, and r = 0.359, P = 0.004 respectively), and MMSE has significant negative correlation with disease duration (r = − 302, P = 0.015).

Total UPDRS and Hoehn and Yahr staging were significantly correlated with HAM-A scale (r = 0.561, P < 0.0001, and r = 0.311, P = 0.012, respectively). Age of onset and age both have significant negative correlation with HAM-A (r = − 0.364, P = 0.003, and r = − 0.344, P = 0.005, respectively). Details are illustrated in Table 4.

Table 4 Correlation between anxiety and depression and various parametric variables

Multiple regression analysis results

All variables which have significant correlation entered hierarchical linear regression to obtain the predictors for depression and anxiety using HAM-D and HAM-A as dependent variables.

For depression, we entered total UPDRS as the first model as it has the strongest correlation; then, we add Hoehn and Yahr scale and MMSE as the second model. UPDRS beta weight was 0.576 (t = 5.554, P < 0.0001), and according to model 1, UPDRS accounted for 32% of variance of depression (f = 30.845, adjusted R2 = 0.321). Despite the fact that Hoehn and Yahr scale in model 2 has borderline significance with beta weight 2.582 (t = 1.981, P = 0.05), it is considered in the predicted direction. The whole three variables in model 2 accounted for 33.4% of the variance for depression (f = 11.99, adjusted R2 = 0.334) which means that Hoehn and Yahr scale and MMSE have a little effect for depression prediction (Table 5).

Table 5 Hierarchical multivariable regression analysis for depression

For anxiety, using HAM-A as dependent variable, we entered total UPDRS as the first model as it has the strongest correlation; then, we add age of onset to the second model followed by Hoehn and Yahr to the third model. Although the age variable has a strong negative correlation with HAM-A, it has a strong correlation with age of onset with variance inflation factor (VIF) at 13.433, so we removed it from the regression equation.

UPDRS in model 1 has beta weight 0.561 (t = 5.339, P < 0.001), and it is accounted for 30% of variance for anxiety (f = 28.503, the adjusted R2 = 0.304). Age of onset at model 2 has beta weight 0.317 (t = 3.218, P = 0.002) with about 9% change in adjusted R2 level (f = 21.578, adjusted R2 = 0.39), although Hoehn and Yahr has a good correlation but insignificant prediction to anxiety (P > 0.05) (Table 6).

Table 6 Hierarchical multivariable regression analysis for anxiety

Impact of depression and anxiety on quality of life

The physical, psychological, and environmental QOL assessed by WHOQOL-BREF questionnaire was significantly worse in PD patients with depression than PD patients without depression especially in physical and psychological domains (P < 0.001). Also, physical and psychological QOL was significantly worse in PD patients with anxiety than PD patients without anxiety (P < 0.001) (Table 7).

Table 7 Impact of depression and anxiety in Parkinson’s disease patients on quality of life

There was a significant negative correlation between overall QOL and HAM-D scale (r = − 0.617, P < 0.0001) and HAM-A scale (r = − 0.452, P < 0.0001); Figs. 1 and 2 illustrate the relation between them.

Fig. 1
figure1

Correlation between overall QOL and HAM-D scale. Significant moderate negative correlation between overall QOL and HAM-D scale, r = − 0.617, P < 0001

Fig. 2
figure2

Correlation between overall QOL and HAM-A scale. Significant weak negative correlation between overall QOL and HAM-A scale, r = − 0.452, P < 0001

Discussion

Depression and anxiety are the most disabling non-motor symptoms in PD patients that have impact on quality of life and affect the global outcome of illness. The present study evaluated anxiety and depression in PD patients using semi-structured scales.

Nearly 31% of patients met the DSM-IV criteria for at least one depressive disorder. Forty-one percent of patients met the DSM-IV criteria for at least one anxiety disorder. In two recent Egyptian studies, Shalash and colleagues [26] studied non-motor symptoms in 97 PD patients using BDI-score and found depression frequency at 76.7%. On the other hand, Ragab and colleagues found the prevalence at 47.5% [27]. Across literature, several studies [7, 28,29,30,31] found the prevalence of depression in PD was ranging from 32.6 to 41%. A systematic review conducted by Reijnders et al. reported that 17% and 22% of PD patients had MDD and minor depression, respectively [32]. van der Hoek et al. reported that among 256 patients with PD, minor depression and major depression were diagnosed in 36.3% and 12.9% of the subjects, respectively, according to BDI-score, with higher prevalence in the more advanced stages of illness with no difference between males and females [33]. This variability of findings may be attributed to the use of different methodologies, size of samples, and genetic variability of study populations.

In the present study, out of patients with anxiety disorders, 69.2% had mild anxiety while the other 30.8% had moderate to severe anxiety according to HAM-A score, and GAD was the most common anxiety diagnosed. This is in line with prevalence of anxiety among patients with PD by Broen et al. and Leentjens et al. ranging from 24.5 to 46.7 with GAD as the most common single disorder and 31.1% having mixed anxiety disorder [34, 35]. In Egypt, Ragab and colleagues report anxiety prevalence around 30% [27], while in Spain and France the prevalence was 68.7% and 51%, respectively [30, 31]. On the other hand, a Chinese study found the prevalence was much lower than others around 25.8% [36].

In the current study, female gender was a risk factor for depression but not for anxiety. Many previous studies showed a significant higher prevalence of depression among female patients with PD [30, 37, 38]. This may be because males are unwilling to exhibit depression, but biological origin rather than psychosocial factors may be the cause. However, other studies did not find any association with gender [39, 40].

Contrary to gender, the present study showed increased prevalence of anxiety among younger PD patients consistent with Zhu and coworkers [41] which may be explained by the fact that the work, financial burden, and care of children are more evident in the younger patients which may be the source of stress and anxiety. However, the mean age in the current study was 71.8 (± 10.7) with a narrow range of ages that makes findings unreliable and further studies comparing young onset and late onset PD are needed.

Previous literatures showed conflicting findings with respect to relationship between age and depression; in some, the older patients were more liable [35, 41, 42] while in others the younger were more depressed [43,44,45,46,47], while many other studies did not confirm any association [48].

In the current study, low socioeconomic status and severity of illness were positively correlated to increased rates of depression. This is feasible with respect to poor quality of life, dependence on others, restricted daily activities, hindering financial burden and inability to cope with regular medical follow-up and costly treatments, etc. This was consistent with the studies of Herath and colleagues and Worku and colleagues [49, 50], where the low SES was a risk factor for depression among patients with PD.

In the current study, PD characteristics were studied as predictors for depression and anxiety. Duration of illness and type and duration of treatment did not show any relationship with prevalence of depression or anxiety. Some studies reported more depression in PD patients with longer duration of illness [40, 47] while others showed no relationship [48]. In the present study, the severity of motor symptoms of PD according to UPDRS scoring was positively correlated to both depression and anxiety which could be explained by the increased physical disability, the increased burden of higher dosages of medications, and the need for caregiver; actually, the relationship between depression and motor disability is bimodal, as more severe disability was considered as a risk factor for developing depression in PD patients [43]; on the other hand, depression itself increases the motor disability of PD patients hence more levodopa doses [51].

Our results were consistent with previous literatures [47, 51,52,53], while other studies did not find such relationship [54]. Supporting this result, a higher stage of illness according to Hoehn and Yahr staging was positively correlated to both depression and anxiety which was consistent with previous literature [47, 52, 55]. Motor disability, gait disturbance, bed restriction, and non-motor symptoms in late stages of PD predispose to increased risk of depression.

In the current study, previous history of depression or anxiety increased the risk of depression and anxiety, respectively, in patients with PD. Previous studies had supported such finding [56,57,58,59].

Of particular interest, PD patients with depression have more cognitive impairment compared with non-depressed patients. There is a complex relationship between cognitive function in one the hand and depression in the other hand with bidirectional implications; depression can lead to worsening cognitive performance, but cognitive impairment is considered as a risk factor for future development of depression [30, 37, 41]. Meanwhile, depressive and anxiety symptoms are also a risk factor for cognitive decline. We found that depressed PD patients had higher potential to have memory problems compared with non-depressed patients. Similar previous studies have found that PD patients with depressive symptoms tended to have lower cognitive function [31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60].

We did not find significant relationship between anxiety and cognition. The relationship between anxiety in PD and cognition is unclear. Some studies have reported a correlation between anxiety symptoms and cognitive dysfunction [61, 62]. On the other hand, Burn and colleagues [63] reported that cognitive impairment was a significant predictor of depression but not anxiety. Further studies are needed to clarify the relationships between anxiety, depression, and cognitive function in PD.

The current study found both depression and anxiety scores had a significant negative correlation with the QOL scores. Our results were consistent with Shalash and colleagues [26] as they found depression was the primary predictor of QOL impairment in Egyptian patients. The finding is in line with other studies [30, 52, 64] which found that the impact of PD on the QOL measures is independently influenced by non-motor disease aspects. Recent systematic review found that nineteen out of 29 studies confirmed depression is the most important predictor of overall quality of life [65]. Depression impacts the quality of life by direct and indirect effect by impairment of activity of daily living which in turn affects quality of life [66].

Similar studies have demonstrated a correlation between anxiety and QOL in patients with PD [30, 67]. Hanna and Quelhas [67, 68] reported that symptoms of anxiety, more so than depression, cognitive status, or motor stage, significantly affected QOL among 38 non-demented patients with mild to moderate motor disability and that anxiety had a stronger impact on QOL in comparison to depression, although anxiety and depression were similarly associated with QOL in the present study.

Psychiatric disorders in PD like depression and anxiety have a major impact on quality of life even in early stages of disease compared to the later stages [69, 70]. This proves that depression and anxiety are not a reactive response to the disability but an integral part of PD spectrum.

Limitations

Main limitations of this study were the relatively small sample size and lack of follow-up of those patients. Larger cohort studies with follow-up are needed to explore variability of psychiatric disorders over time.

Conclusions

The frequency of depression and anxiety was high which was nearly similar to other literature findings. Those with female gender and low socioeconomic status were more vulnerable to be depressed. Anxiety was recorded more in young ages. Both depression and anxiety cause impairment of quality of life of PD patients in a similar manner.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author reasonable on request.

Abbreviations

PD:

Parkinson’s disease

UKPDS:

United Kingdom Parkinson’s Disease Society

UPDRS:

Unified Parkinson’s Disease Rating Scale

DSM-IV TR:

Diagnostic and Statistical Manual of Mental Disorders 4th Edition revised

HAM-D:

Hamilton Depression Rating Scale

HAM-A:

Hamilton Anxiety Rating Scale

WHOQOL-BREF:

The World Health Organization Quality of Life

SES:

Socioeconomic status

MMSE:

Mini-Mental State Examination

VIF:

Variance inflation factor

GAD:

Generalized anxiety disorder

QOL:

Quality of life

MDD:

Major depressive disorder

BDI-score:

Beck depression inventory score

References

  1. 1.

    Postuma RB, Berg D, Stern M, Stern M, Poewe W, Olanow CW, et al. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord. 2015;30:1591–600.

    PubMed  Article  Google Scholar 

  2. 2.

    Khedr EM, El Fetoh NA, Khalifa H, Ahmed MA, El Beh KM. Prevalence of non-motor features in a cohort of Parkinson’s disease patients. Clin Neurol Neurosurg. 2013;115(6):673–7.

    PubMed  Article  Google Scholar 

  3. 3.

    Weintraub D, Burn D. Parkinson’s disease: the quintessential neuropsychiatric disorder. Mov Disord. 2011;26:1022–31.

    PubMed  PubMed Central  Article  Google Scholar 

  4. 4.

    Hely MA, Morris JG, Reid WG, Trafficante R. Sydney multicenter study of Parkinson’s disease: non-L-dopa-responsive problems dominate at 15 years. Mov Disord. 2005;20:190–9.

    PubMed  Article  Google Scholar 

  5. 5.

    Dobkin RD, Rubino JT, Friedman J, Allen LA, Gara MA, Menza M. Barriers to mental health care utilization in Parkinson’s disease. J Geriatr Psychiatry Neurol. 2013;26:105–16.

    PubMed  PubMed Central  Article  Google Scholar 

  6. 6.

    Nilsson FM, Kessing LV, Sorensen TM, Andersen PK, Bolwig TG. Major depressive disorder in Parkinson’s disease: a register-based study. Acta Psychiatr Scand. 2002;106:202–11.

    PubMed  Article  Google Scholar 

  7. 7.

    Aarsland D, Påhlhagen S, Ballard CG, Ehrt U, Svenningsson P. Depression in Parkinson disease–epidemiology, mechanisms and management. Nat Rev Neurol. 2012;8:35–47.

    CAS  Article  Google Scholar 

  8. 8.

    Burn DJ. Depression in Parkinson’s disease. Eur J Neurol. 2002;9:44–54.

    PubMed  Article  Google Scholar 

  9. 9.

    Meyer PM, Strecker K, Kendziorra K, Becker G, Hesse S, Woelpl D, et al. Reduced α4β2*–nicotinic acetylcholine receptor binding and its relationship to mild cognitive and depressive symptoms in Parkinson disease. Arch Gen Psychiatry. 2009;66(8):866–77.

    CAS  PubMed  Article  Google Scholar 

  10. 10.

    Weintraub D, Mamikonyan E. The neuropsychiatry of Parkinson disease: a perfect storm. Am J Geriatr Psychiatry. 2019;27:998–1018.

    PubMed  PubMed Central  Article  Google Scholar 

  11. 11.

    Gibb WR, Lees AJ. The significance of the Lewy body in the diagnosis of idiopathic Parkinson’s disease. Neuropathol Appl Neurobiol. 1989;15:27–44.

    CAS  PubMed  Article  Google Scholar 

  12. 12.

    Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease. A clinico-pathological study of 100 cases. JNNP. 1992;55:181–4.

    CAS  Google Scholar 

  13. 13.

    Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    Farrag A, Farwiz HM, Khedr EH, Mahfouz RM, Omran SM. Prevalence of Alzheimer’s disease and other dementing disorders: Assiut-upper Egypt study. Dement Geriatr Cogn Dis. 1998;9(6):323–8.

    CAS  Article  Google Scholar 

  15. 15.

    Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology. 1967;17(5):427–42.

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Fahn S, Elton R. Members of the UPDRS development committee. In: Fahn S, Marsden CD, Calne DB, Goldstein M, editors. Recent developments in Parkinson’s disease, vol. 2. Florham Park: Macmillan Health Care Information; 1987. 153-163:293-304.

    Google Scholar 

  17. 17.

    El-Tawab A. Socioeconomic status scale, faculty of education, department of psychology. Assiut University; 2004.

    Google Scholar 

  18. 18.

    First MB, Spitzer RL, Gibbon M, Williams JBW, Benjamin LS. Structured clinical interview for DSM-IV-clinician version (SCID-CV) (user’s guide interview). Washington, DC: American Psychiatric Press; 1997.

    Google Scholar 

  19. 19.

    El Missiry A, Sorour A, Sadek A, Fahy T, Abdel Mawgoud M, Asaad T. Homicide and psychiatric illness: an Egyptian study [MD thesis]. Cairo: Faculty of Medicine, Ain Shams University; 2004.

    Google Scholar 

  20. 20.

    Alhadi AN, Alarabi MA, Alshomrani AT, Shuqdar RM, Alsuwaidan MT, McIntyre RS. Arabic translation, validation and cultural adaptation of the 7-item Hamilton depression rating scale in two community samples. SQUMJ. 2018;18:2.

    Article  Google Scholar 

  21. 21.

    Hallit S, Haddad C, Hallit R, Akel M, Obeid S, Haddad G, et al. Validation of the Hamilton anxiety rating scale and state trait anxiety inventory a and B in Arabic among the Lebanese population. Clin Epidemiol Glob Health. 2019;7(3):464–70.

    Article  Google Scholar 

  22. 22.

    Williams J, Hirsch E, Anderson K, Bush A, Goldstein S, Grill S, et al. A comparison of nine scales to detect depression in Parkinson disease: which scale to use? Neurology. 2012;78(13):998–1006.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  23. 23.

    Leentjens AFG, Dujardin K, Marsh L, Richard IH, Starkstein SE, Martinez-Martin P. Anxiety rating scales in Parkinson’s disease: a validation study of the Hamilton anxiety rating scale, the Beck anxiety inventory, and the hospital anxiety and depression scale. Mov Disord. 2011;26(3):407–15.

    PubMed  Article  Google Scholar 

  24. 24.

    Leentjens AFG, Dujardin K, Marsh L, Martinez-Martin P, Richard IH, Starkstein SE, et al. Anxiety rating scales in Parkinson’s disease: critique and recommendations. Mov Disord. 2008;23(14):2015–25.

    PubMed  Article  Google Scholar 

  25. 25.

    Ohaeri JU, Awadalla AW. The reliability and validity of the short version of the WHO quality of life instrument in an Arab general population. Ann Saudi Med. 2009;29(2):98–104.

    PubMed  PubMed Central  Article  Google Scholar 

  26. 26.

    Shalash AS, Hamid E, Elrassas HH, Bedair AS, Abushouk AI, Khamis M, et al. Non-motor symptoms as predictors of quality of life in Egyptian patients with Parkinson’s disease: a cross-sectional study using a culturally adapted 39-item Parkinson's disease questionnaire. Front Neurol. 2018;9:357.

    PubMed  PubMed Central  Article  Google Scholar 

  27. 27.

    Ragab OA, Elheneedy YA, Bahnasy WS. Non-motor symptoms in newly diagnosed Parkinson’s disease patients. Egypt J Neurol Psychiatr Neurosurg. 2019;55(1):24.

    Article  Google Scholar 

  28. 28.

    Zheng J, Yang X, Zhao Q, Tian S, Huang H, Chen Y, et al. Association between gene polymorphism and depression in Parkinson’s disease: a case-control study. J Neurol Sci. 2017;375:231–4.

    CAS  PubMed  Article  Google Scholar 

  29. 29.

    Timmer M, van Beek M, Bloem B, Esselink R. What a neurologist should know about depression in Parkinson’s disease. Pract Neurol. 2017;17:359–68.

    PubMed  Article  Google Scholar 

  30. 30.

    Chuquilín-Arista F, Álvarez-Avellón T, Menéndez-González M. Prevalence of depression and anxiety in Parkinson disease and impact on quality of life: a community-based study in Spain. J Geriatr Psychiatry Neurol. 2020;33(4):207–13.

    PubMed  Article  Google Scholar 

  31. 31.

    Nègre-Pagès L, Grandjean H, Lapeyre-Mestre M, Montastruc J, Fourrier A, Lépine J, et al. Anxious and depressive symptoms in Parkinson’s disease: the French cross-sectional DoPa MiP study. Mov Disord. 2009;25(2):157–66.

    Article  Google Scholar 

  32. 32.

    Reijnders J, Ehrt U, Weber W, Aarsland D, Leentjens A. A systematic review of prevalence studies of depression in Parkinson’s disease. Mov Disord. 2008;23(2):183–9.

    PubMed  Article  Google Scholar 

  33. 33.

    Van der Hoek TC, Bus BA, Matui P, van der Marck MA, Esselink RA, Tendolkar I. Prevalence of depression in Parkinson’s disease: effects of disease stage, motor subtype and gender. J Neurol Sci. 2011;310:1–2.

    Article  Google Scholar 

  34. 34.

    Broen M, Narayen N, Kuijf M, Dissanayaka N, Leentjens A. Prevalence of anxiety in Parkinson’s disease: a systematic review and meta-analysis. Mov Disord. 2016;31(8):1125–33.

    PubMed  Article  Google Scholar 

  35. 35.

    Leentjens AFG, Dujardin K, Marsh L, Martinez-Martin P, Richard IH, Starkstein SE. Anxiety and motor fluctuations in Parkinson’s disease: a cross-sectional observational study. Parkinsonism Relat Disord. 2012;18:1084–108.

    CAS  PubMed  Article  Google Scholar 

  36. 36.

    Cui S-S, Du J-J, Fu R, Lin Y-Q, Huang P, He Y-C, et al. Prevalence and risk factors for depression and anxiety in Chinese patients with Parkinson disease. BMC Geriatr. 2017;17(1):270.

    PubMed  PubMed Central  Article  Google Scholar 

  37. 37.

    Zhu K, van Hilten JJ, Marinus J. Associated and predictive factors of depressive symptoms in patients with Parkinson’s disease. J Neurol. 2016;263(6):1215–25.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  38. 38.

    Riedel O, Heuser I, Klotsche J, Dodel R, Wittchen H. Occurrence risk and structure of depression in Parkinson disease with and without dementia: results from the GEPAD study. J Geriatr Psychiatry Neurol. 2010;23(1):27–34.

    PubMed  Article  Google Scholar 

  39. 39.

    Reiff J, Schmidt N, Riebe B, Breternitz R, Aldenhoff J, Deuschl G, et al. Subthreshold depression in Parkinson’s disease. Mov Disord. 2011;26(9):1740–3.

    Article  Google Scholar 

  40. 40.

    Farabaugh A, Locascio J, Yap L, Weintraub D, McDonald W, Agoston M, et al. Pattern of depressive symptoms in Parkinson’s disease. Psychosomatics. 2009;50(5):448–54.

    PubMed  PubMed Central  Article  Google Scholar 

  41. 41.

    Zhu K, van Hilten JJ, Marinus J. Onset and evolution of anxiety in Parkinson’s disease. Eur J Neurol. 2017;24:404–11.

    CAS  PubMed  Article  Google Scholar 

  42. 42.

    Jasinska-Myga B, Putzke JD, Wider C, Wszolek ZK, Uitti RJ. Depression in Parkinson’s disease. Can J Neurol Sci. 2010;37(1):61–6.

    PubMed  PubMed Central  Article  Google Scholar 

  43. 43.

    Becker C, Brobert G, Johansson S, Jick S, Meier C. Risk of incident depression in patients with Parkinson disease in the UK. Eur J Neurol. 2010;18(3):448–53.

    PubMed  Article  Google Scholar 

  44. 44.

    Schrag. Quality of life and depression in Parkinson’s disease. J Neurol Sci. 2006;248:151–7.

    PubMed  Article  Google Scholar 

  45. 45.

    Ziropadja L, Stefanova E, Petrovic M, Stojkovic T, Kostic VS. Apathy and depression in Parkinson’s disease: the Belgrade PD study report. Parkinsonism Relat Disord. 2012;18:339–42.

    PubMed  Article  Google Scholar 

  46. 46.

    Fereshtehnejad S-M, Hadizadeh H, Farhadi F, Shahidi GA, Delbari A, Lökk J. Comparison of the psychological symptoms and disease-specific quality of life between early- and typical- onset Parkinson’s disease patients. Parkinson’s Dis. 2014;819260:1.

    Google Scholar 

  47. 47.

    Zhu J, Lu L, Pan Y, Shen B, Xu S, Hou Y, et al. Depression and associated factors in nondemented Chinese patients with Parkinson’s disease. Clin Neurol Neurosurg. 2017;163:142–8.

    PubMed  Article  Google Scholar 

  48. 48.

    Borek L, Kohn R, Friedman J. Mood and sleep in Parkinson’s disease. J Clin Psychiatry. 2006;67(06):958–63.

    PubMed  Article  Google Scholar 

  49. 49.

    Herath TB, Withana M, Rodrigo C, Gamage R, Gamage C. Prevalence and associations for symptoms of depression in patients with Parkinson’s disease: a Sri Lankan experience. Int J Ment Heal Syst. 2016;10:47.

    Article  Google Scholar 

  50. 50.

    Worku DK, Yifru YM, Postels DG, Gashe FE. Prevalence of depression in Parkinson’s disease patients in Ethiopia. J Clin Mov Disord. 2014;1:10.

    PubMed  PubMed Central  Article  Google Scholar 

  51. 51.

    Arun MP, Bharath S, Pal PK, Singh G. Relationship of depression, disability, and quality of life in Parkinson’s disease: a hospital-based case-control study. Neurol India. 2011;59:185–9.

    CAS  PubMed  Article  Google Scholar 

  52. 52.

    Yamanishi T, Tachibana H, Oguru M, Matsui K, Toda K, Okuda B, et al. Anxiety and depression in patients with Parkinson’s disease. Intern Med. 2013;52(5):539–45.

    PubMed  Article  Google Scholar 

  53. 53.

    Lee Y, Oh JS, Chung SJ, Lee JJ, Chung SJ, Moon H, et al. The presence of depression in de novo Parkinson’s disease reflects poor motor compensation. PLoS One. 2018;13(9):e0203303.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  54. 54.

    Kanda F, Oishi K, Sekiguchi K, Kuga A, Kobessho H, Shirafuji T, et al. Characteristics of depression in Parkinson’s disease: evaluating with Zung’s self-rating depression scale. Parkinsonism Relat Disord. 2008;14:19–23.

    PubMed  Article  Google Scholar 

  55. 55.

    Piccinni A, Marazziti D, Veltri A, Ceravolo R, Ramacciotti C, Carlini M, et al. Depressive symptoms in Parkinson’s disease. Compr Psychiatry. 2012;53:727–31.

    PubMed  Article  Google Scholar 

  56. 56.

    Dissanayaka NN, Sellbach A, Matheson S. Anxiety disorders in Parkinson’s disease: prevalence and risk factors. Mov Disord. 2010;25(7):838–45.

    PubMed  Article  Google Scholar 

  57. 57.

    Jacob EL, Gatto NM, Thompson A, Bordelon Y, Ritz B. Occurrence of depression and anxiety prior to Parkinson’s disease. Parkinsonism Relat Disord. 2010;16:576–81.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  58. 58.

    Leentjens AF, Dujardin K, Marsh L, Martinez-Martin P, Richard IH, Starkstein SE. Symptomatology and markers of anxiety disorders in Parkinson’s disease: a cross-sectional study. Mov Disord. 2011a;26:484–92.

    PubMed  Article  Google Scholar 

  59. 59.

    Leentjens AF, Moonen AJ, Dujardin K, Marsh L, Martinez-Martin P, Richard IH. Modeling depression in Parkinson disease: disease-specific and non-specific risk factors. Neurology. 2013;81:1036–43.

    PubMed  PubMed Central  Article  Google Scholar 

  60. 60.

    Dissanayaka NN, Sellbach A, Silburn PA, O'Sullivan JD, Marsh R, Mellick GD. Factors associated with depression in Parkinson’s disease. J Affect Disord. 2011b;132(1–2):82–8.

    PubMed  Article  Google Scholar 

  61. 61.

    Lee WJ, Tsai CF, Gauthier S, Wang SJ, Fuh JL. The association between cognitive impairment and neuropsychiatric symptoms in patients with Parkinson’s disease dementia. Int Psychogeriatr. 2012;24:1980–7.

    PubMed  Article  Google Scholar 

  62. 62.

    Foster PS, Drago V, Mendez K, Witt JC, Crucian GP, Heilman KM. Mood disturbances and cognitive functioning in Parkinson’s disease: the effects of disease duration and side of onset of motor symptoms. J Clin Exp Neuropsychol. 2013;35:71–82.

    PubMed  Article  Google Scholar 

  63. 63.

    Burn DJ, Landau S, Hindle JV. Parkinson’s disease motor subtypes and mood. Mov Disord. 2012;27:379–86.

    PubMed  Article  Google Scholar 

  64. 64.

    Menon B, Nayar R, Kumar S, Cherkil S, Venkatachalam A, Surendran K, et al. Parkinson’s disease, depression, and quality-of-life. Indian J Psychol Med. 2015;37(2):144–8.

    PubMed  PubMed Central  Article  Google Scholar 

  65. 65.

    Soh SE, Morris ME, McGinley JL. Determinants of health-related quality of life in Parkinson’s disease: a systematic review. Parkinsonism Relat Disord. 2011;17:1–9.

    PubMed  Article  Google Scholar 

  66. 66.

    Lawrence BJ, Gasson N, Kane R, Bucks RS, Loftus AM. Activities of daily living, depression, and quality of life in Parkinson’s disease. PLoS One. 2014;9(7):e102294.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  67. 67.

    Hanna K, Cronin-Golomb A. Impact of anxiety on quality of life in Parkinson’s disease. Parkinsons Dis. 2012;2012:640–707.

    Google Scholar 

  68. 68.

    Quelhas R, Costa M. Anxiety, depression and quality of life in Parkinson’s disease. J Neuropsychiatr Clin Neurosci. 2009;21:413–9.

    Article  Google Scholar 

  69. 69.

    Jeffrey S. Psychiatric symptoms have greater impact in early vs late PD. Medscape medical news; 2007.

    Google Scholar 

  70. 70.

    Shearer J, Green C, Counsell CE, Zajicek JP. The impact of motor and non-motor symptoms on health state values in newly diagnosed idiopathic Parkinson’s disease. J Neurol. 2011;259(3):462–8.

    PubMed  Article  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

Not applicable.

Author information

Affiliations

Authors

Contributions

EMK, AA, YE, AF, and AG contributed to the study concept and design, acquisition of data, draft and revision of the report, statistical analyses, and interpretation of data. AFZ, AA, and AG contributed to the case recruitments, acquisition of data, and statistical analyses. EMK, AFZ, and AG contributed to the editing of this report. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Eman M. Khedr.

Ethics declarations

Ethics approval and consent to participate

An informed consent was obtained from all the patients before participating in the study. The protocol was approved in January 2014 by the South Valley Medical School Ethical Review Board, and all participants or relatives gave written informed consent before participation in the study. The ethical approval reference number was not applicable at time of approval of the study. The confidentiality of the patients’ information was maintained during all the steps of the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Khedr, E.M., Abdelrahman, A.A., Elserogy, Y. et al. Depression and anxiety among patients with Parkinson’s disease: frequency, risk factors, and impact on quality of life. Egypt J Neurol Psychiatry Neurosurg 56, 116 (2020). https://doi.org/10.1186/s41983-020-00253-5

Download citation

Keywords

  • Frequency
  • Parkinson’s disease
  • Unified Parkinson’s disease rating scale
  • Depression
  • Anxiety
  • Quality of life
  • Hamilton depression rating scale
  • Hamilton anxiety rating scale