Depression in Parkinson’s Disease: Aspects of the Psychopathological Structure and Nosological Qualification

Background: depression along with cognitive impairment is one of the most common non-motor psychopathological symptom of Parkinson's disease (PD), however, the problem of nosological differentiation and typology of affective disorders in PD is still unresolved. The goal: of this study is the investigation of psychopathological and nosological differentiation of depression in PD with the determination of the mode of association between affective and neurological disorders.

Patients and methods: the research was conducted at the Clinic of Nervous Diseases named after A.Ya. Kozhevnikov of the I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University). 28 patients (22 women, 6 men; mean age 64.4±9.4 years) with verified diagnoses of depression and PD were enrolled in the study. For assessment of depression we used Hamilton Depression Scale (HADS-21), for assessment of cognitive functions were used a brief neuropsychological examination of the cognitive sphere (KNOKS) and a brief mental status assessment scale (MMSE). Neurological examination was provided with unified Parkinson's disease rating scale (UPDRS).

Results: a clinical typology of depression in PD, considering the patterns of formation and the association between affective and neurological disorders, has been proposed. Two types of depressive disorders were identified, each of which included two clinical subtypes: (I) depression directly associated with the onset of PD, including (1) nosogenic and (2) organic subtypes; and (II) depressions manifesting independently of PD, including (3) reactive and (4) endogenous subtypes. In addition, a special group of endoform depressive states have been identified.

Conclusion: as the result of this study, the clinical and nosological heterogeneity of depression in PD was established, psychopathological structure of depressive episodes and the pattern of interaction between affective disorder and PD were determined. These findings expand the possibility of differential diagnosis, the determination of an individual prognosis and selection of personalized therapy.

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