As any patient with a progressive condition like Parkinson's can tell us, the disease causes signficant mental burdens in additional to the physical ones.
UVA Health neurologist and movement disorders specialist Alex Dalrymple, MD, observed critical gaps in addressing patients' psychiatric symptoms in standard Parkinson's care. That prompted him to initiate a three-year longitudinal study of psychiatric predictors of quality of life in Parkinson's patients.
"Psychiatric comorbidities, like depression, anxiety, and even psychosis, are unfortunately fairly common in people with Parkinson’s disease, but are often only marginally addressed by physicians, as we are more focused on treating the motor symptoms of the disease," he shares. "We wanted to investigate how big a role these psychiatric symptoms played in quality of life over time in people with Parkinson’s disease."
In this Q&A, Dalrymple shares the study's findings and how clinicians can use them to improve patient care.
What are the most important takeaways from this study?
Depression and anxiety, which are both treatable comorbidities, were associated with worsened quality of life over time. Apathy was also associated with worsened quality of life over time, but is harder to treat. The biggest takeaway is for all physicians treating people with Parkinson’s to remember to discuss and treat mood symptoms if and when they arise!
What's your advice for recognizing depression, anxiety, and/or apathy in patients?
You won’t know unless you ask — make sure to ask about mood at every visit.
I find it helpful to ask in various ways. For example, don’t just ask, “Are you depressed or anxious,” but instead maybe ask, “Do you ever feel down, sad, hopeless, or worthless? Do you still have fun doing things you used to enjoy? Do you ever feel worried for minor reasons or no reason at all?”
How can providers best address these issues?
While neurologists and primary care physicians can certainly help the treatment of depression, anxiety, and other mood disorders, other members of the team are equally, if not more, helpful.
Social workers can help patients and families find local resources; therapists, counselors, and psychologists can help address any root causes of mood disorders; and cognitive neuropsychologists can help determine how much a mood disorder may be playing into cognitive complaints.
How does the team at UVA Health support Parkinson's patients with depression, anxiety, and/or apathy?
We've developed a comprehensive Parkinson’s disease clinic, where we've assembled a team consisting of movement disorders neurologists, a physical therapist, an occupational therapist, a speech and language pathologist, a dietician, neuropsychologists, a social worker, and nurse coordinators.
We carve out time for every member of the team to meet with the patient and family individually. We then come up with a holistic plan as a full team.
Based on the study results, what are the best next steps in terms of research?
The next steps, in my opinion, would be twofold:
- We need larger studies over longer periods of time to provide more robust associations between these various symptoms and changing quality of life over time.
- We need prospective studies looking at treatment of these mood symptoms, and what, if any, effect that has on quality of life over time.