Depressive symptoms effect subjective sleep quality in Chinese patients with Parkinson’s disease
Introduction
Parkinson's disease (PD) is the second most common neurodegenerative disease in Chinese population aged over 65-year old [1]. PD is mainly defined by the motor symptoms. Damaging of dopaminergic system play an impotent role in motor symptoms such as tremor, rigidity, bradykinesia, and postural instability in PD patients. These non-dopaminergic dysfunctions may play crucial roles in the development of the non-motor symptoms, including neuropsychiatric manifestations, autonomic and sensory dysfunctions, and sleep disturbances [2,3].
Sleep disturbances are common in many neurodegenerative diseases especially for PD which can severely affect the health-related quality of life of patients and their caregivers. [4,5]. In PD, patients may complaint sleep problems such as altered sleep duration, fragmented sleep, nocturia, excessive daytime sleepiness, and vivid dreaming experiences. The pathogenic mechanisms and risk factors for sleep disturbances in Chinese PD are not completely understood.
Patients with different degree of disability, motor and non-motor symptoms, and complications of therapy, all of them may have a differential impact on sleep quality [6,7]. Depression is the most common neuropsychiatric symptoms in PD, with an estimated prevalence of approximately 35% [8].In our previous study, using the HAMD cut-off scores of 8–20, 21–34, and ≥ 35, 46.2%, 15.4%, and 2.3% had mild, moderate, and severe depression [9]. Several studies have shown a relationship between sleep disorder and depression in PD [10,11].
The relationship between depression and cognition in PD patients is complex. Depressive symptoms can cause and increase cognitive disturbances in PD. A total of 245 patients were enrolled in the study [12] shows cognitive dysfunction to be a risk factor for depression occurrence in PD. Depressive symptoms are common in initial phase of dementia, and both syndromes could be accounted for the same neurochemical and neurodegenerative dysfunction. Although depressive symptoms can occur in PD patients without dementia, cognitive impairment is a correlate of most of these disturbances and, depressive symptoms are more frequent in patients with dementia. Whether their co-occurrence may highly influences sleep quality is still not clear.
The present study aims to assess how depressive symptoms measured with the Hamilton Rating Scale for Depression (HAMD) impact on subjective sleep quality in PD patients with or without cognitive disturbance. We hypothesized that: 1) There is a significant relationship between depression and sleep disturbances; 2) PD patients with cognitive disturbances present more depressive symptoms than PD patients without cognitive disturbances; 3) Sleep quality will suffer more burden when patients experience depressive symptoms with cognitive disturbances; 4) Depressive symptoms are the main determinants of sleep quality in PD patients with and without cognitive disturbances.
Section snippets
Patients and methods
A consecutive series of 491 patients recruited from neurological clinics in the Department of Neurology, Nanjing Brain Hospital of Nanjing Medical University between January 2014 and October 2019. The diagnosis of PD was based on the United Kingdom Parkinson Disease Society Brain Bank Clinical Diagnostic Criteria [13]. Patients with diagnoses of progressive supranuclear palsy, multiple system atrophy, corticobasal degeneration, and other forms of atypical Parkinsonism were excluded. Patients
Statistical analysis
All continuous data are presented as the mean ± standard deviation (SD), and categorical variables are shown as percentages. The Student’s t-test was applied for continuous data comparisons, and chi-square tests were performed to compare symptoms prevalence by cognition status. The continuous variables including the total scores for HAMD, PDSS as well as the scores for each domain of HAMD were compared using one-way analyses of covariance (ANCOVA) after adjustments for confounding factors,
Results
The demographic characteristics for 491 PD patients (313 males, 63.7% and 178 females, 36.3%) are presented in Table 1. The mean age was 65.78 ± 9.31 years and the mean age of onset was 60.02 ± 9.43 years. Duration of the disease was 5.77 ± 4.45 years. The mean H–Y score was 2.14 ± 0.83 and the mean UPDRS part III score was 24.29 ± 13.75. The patients had a mean total PDSS score of 118.25 ± 20.19. In total, 147 of 491 (29.9%) patients reported significant sleep disturbances (score ≤ 105). The
Discussion
Disturbed sleep is one of the most frequent problems, and is reported to affect 20%–90% of patients with PD in various populations [5,23,24]. This wide variation was probably due to differences in patient selection, diagnostic criteria and the statistical analyses used. This study is aimed to assess the impact of depressive symptoms and cognitive status on subjective sleep quality. The 15-item Parkinson’s disease sleep scale (PDSS) was a reliable and specific clinical tool for sleep evaluation
Conclusions
In conclusion, we found that subjective poor sleep quality has a prevalence of 29.9% in Chinese PD patients and have close relationships with global depression and each depressive domain. Patients with cognitive disturbance were likely to present with more depressive symptoms especially for anxiety/somatization, retardation symptoms, and hopelessness symptoms. Patients who suffer from depressives symptoms such as mental disorder, retardation and hopelessness with cognitive disturbance had
Author contributions
Drs Jun Zhu and Li Zhang participated in conception and design of the study, acquisition of raw data, analysis of data, drafting the article, and revising the manuscript.
Drs Min Zhong, Jun Yan, Zhuang Wu, Yang Pan, and Bo Shen participated in conception and design of the study, collection of date, analysis of data, and revising the manuscript.
Drs Jingde Dong participated in conception and design of the study, and revising the manuscript.
Declaration of Competing Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
We certify that we have participated sufficiently in the work to take public responsibility for the appropriateness of the experimental design and method, and the collection, analysis, and interpretation of the data.
We have reviewed the final version of the manuscript and approve it for publication. To the best of our
Acknowledgments
The authors thank the patients and their families for their participation in the study. The present study was supported by
(1) Special Funds of the Jiangsu Provincial Key Research and Development Projects (grant no. BE2018610 and BE2019612)
(2) Nanjing Medical Science and Technology Project (grant no. QRX17026)
(3) Nanjing Medical Science and Technical Development Foundation (grant no. ZKX17031)
(4) Special Funds of the Jiangsu Provincial 333 High-level Talent Cultivation Projects
(5) Jiangsu
References (41)
- et al.
Parkinson’s disease in China: prevalence in Beijing, Xian, and Shanghai
Lancet (London, England)
(2005) - et al.
Parkinson’s disease: the non-motor issues
Parkinsonism Relat. Disord.
(2011) - et al.
Non-motor symptoms of Parkinson’s disease: dopaminergic pathophysiology and treatment
Lancet Neurol.
(2009) - et al.
Increased likelihood of anxiety and poor sleep quality in Parkinson’s disease patients with pain
J. Neurol. Sci.
(2016) - et al.
Depression and associated factors in nondemented Chinese patients with Parkinson’s disease
Clin. Neurol. Neurosurg.
(2017) - et al.
Multifactorial sleep disturbance in Parkinson’s disease
Sleep Med.
(2017) - et al.
Staging of brain pathology related to sporadic Parkinson’s disease
Neurobiol. Aging
(2003) - et al.
Affective symptoms and cognitive functions in Parkinson’s disease
J. Neurol. Sci.
(2012) - et al.
Dissociations among daytime sleepiness, nighttime sleep, and cognitive status in Parkinson’s disease
Parkinsonism Relat. Disord.
(2013) - et al.
Sleep in Parkinson’s disease. The role of depression and anxiety
Psychosomatics
(1995)
The PRIAMO study: a multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson’s disease
Mov. Disord.
Sleep and parkinson disease
Med.
An overview of sleep and circadian dysfunction in Parkinson’s disease
J. Sleep Res.
Depression in Parkinson disease--epidemiology, mechanisms and management, Nature reviews
Neurology
Sleep disturbances and depression severity in patients with Parkinson’s disease
Brain Behav.
Decreased sleep quality in Parkinson’s patients is associated with higher anxiety and depression prevalence and severity, and correlates with pain intensity and quality
Neurol. Res.
Risk factors for depression in Parkinson disease
Arch. Neurol.
Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases
J. Neurol. Neurosurg. Psychiatr.
Systematic review of levodopa dose equivalency reporting in Parkinson’s disease
Mov. Disord.
Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results
Mov. Disord.
Cited by (4)
Assessment of sleep disturbance in patients with Wilson’s disease
2024, BMC PsychiatrySleep disturbances and associated factors in drug-naïve patients with parkinson’s disease
2021, Neuropsychiatric Disease and Treatment