Evaluation of frequency of depression in a subset of population with idiopathic parkinsonism in a tertiary care hospital

Objectives. To determine the frequency of depression in patients with idiopathic parkinsonism presenting to a tertiary care Hospital in Karachi. Material and methods. This case study was conducted at the neurology department Jinnah Postgraduate Medical Centre, Karachi (JPMC). The duration of the study was six months from 22nd January 2019 to 2nd June 2019. A total of 114 patients of parkinsonism (idiopathic Parkinson’s disease) were included in this study. Patients were assured of confidentiality. They were given questionnaire with Beck depression inventory while waiting in the neurology outpatient clinic. Questionnaire was taken back after 25 minutes. Patient score more than 9 was diagnosed as depression. The identified depressed patient was offered treatment. Results. Frequency of depression in patients with idiopathic Parkinson’s disease was observed in 48.25% (55/114) cases. Conclusions. It is concluded that our study indicates the burden of depression in Parkinson disease (PD) patients. However, even with stable or mild deficit in motor function, the wide prevalence of depression indicates that it should be suspected and treated. Over the past several years, systematic studies of depression and its treatment have contributed significantly to this most challenging psychiatric problem in PD. Hence, there is a need of policy for screening and prompt treatment of such patients so they could lead to enhance quality of life.

Role of Helicobacters in Neuropsychiatric Disease: A Systematic Review in Idiopathic Parkinsonism

Interest in an aetiopathogenic role for Helicobacter in neuropsychiatric diseases started with idiopathic parkinsonism (IP), where the cardinal signs can be assessed objectively. This systematic review, using an EMBASE database search, addresses Oxford Centre for Evidence-Based Medicine based questions on the inter-relationship of Helicobacter and IP, the benefits of eradicating Helicobacter in IP and the outcome of not treating. The search strategy was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines: 21 of 204 articles met the inclusion criteria. The results show that the assumption that any benefit of Helicobacter eradication results from improved levodopa bioavailability is unjustified. The inter-relationship between Helicobacter and IP is well-established. H. pylori virulence markers (associated with autoimmunity and immune tolerance) influence the risk, severity and progression of IP. The birth cohort effect for virulence marker antibodies, seen in controls, is obliterated in IP, suggesting causality. Successful H. pylori eradication in IP is disease-modifying (even in anti-parkinsonian treatment-naïve patients) but not preventive. Hypokinesia regresses with eradication and overall motor severity lessens. Eradication may influence gastrointestinal microbiota adversely, unlocking the next stage in the natural history, the development of rigidity. Failed eradication worsens hypokinesia, as does the presence/persistence of H. pylori at molecular level only. Adequate prognostic assessment of the consequences of not treating Helicobacter, for IP, is prevented by a short follow-up. We conclude that Helicobacter is a pathophysiological driver of IP.

Early predictors of mortality in parkinsonism and Parkinson disease

ObjectiveTo examine mortality and associated risk factors, including possible effects of mild cognitive impairment, imaging, and CSF abnormalities, in a community-based population with incident parkinsonism and Parkinson disease.MethodsOne hundred eighty-two patients with new-onset, idiopathic parkinsonism were diagnosed from January 2004 through April 2009, in a catchment area of 142,000 inhabitants in Sweden. Patients were comprehensively investigated according to a multimodal research protocol and followed prospectively for up to 13.5 years. A total of 109 patients died. Mortality rates in the general Swedish population were used to calculate standardized mortality ratio and expected survival, and Cox proportional hazard models were used to investigate independent predictors of mortality.ResultsThe standardized mortality ratio for all patients was 1.84 (95% confidence interval 1.50–2.22, p < 0.001). Patients with atypical parkinsonism (multiple system atrophy or progressive supranuclear palsy) had the highest mortality. In early Parkinson disease, a mild cognitive impairment diagnosis, freezing of gait, hyposmia, reduced dopamine transporter activity in the caudate, and elevated leukocytes in the CSF were significantly associated with shorter survival.ConclusionAlthough patients presenting with idiopathic parkinsonism have reduced survival, the survival is highly dependent on the type and characteristics of the parkinsonian disorder. Patients with Parkinson disease presenting with normal cognitive function seem to have a largely normal life expectancy. The finding of a subtle CSF leukocytosis in patients with Parkinson disease with short survival may have clinical implications.