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. 2023 Jan;16(1):68-78.
doi: 10.14802/jmd.22091. Epub 2022 Dec 20.

Association of Depression With Early Occurrence of Postural Instability in Parkinson's Disease

Yun Su Hwang  1   2 , Sungyang Jo  1 , Kye Won Park  3 , Seung Hyun Lee  1 , Sangjin Lee  1 , Sun Ju Chung  1
Affiliations

Association of Depression With Early Occurrence of Postural Instability in Parkinson's Disease

Yun Su Hwang et al. J Mov Disord. 2023 Jan.

Abstract

Objective: Depression in Parkinson's disease (PD) affects the quality of life of patients. Postural instability and gait disturbance are associated with the severity and prognosis of PD. We investigated the association of depression with axial involvement in early-stage PD patients.

Methods: This study involved 95 PD patients unexposed to antiparkinsonian drugs. After a baseline assessment for depression, the subjects were divided into a depressed PD group and a nondepressed PD group. Analyses were conducted to identify an association of depression at baseline with the following outcome variables: the progression to Hoehn and Yahr scale (H-Y) stage 3, the occurrence of freezing of gait (FOG), levodopa-induced dyskinesia, and wearing-off. The follow-up period was 53.40 ± 16.79 months from baseline.

Results: Kaplan-Meier survival curves for H-Y stage 3 and FOG showed more prominent progression to H-Y stage 3 and occurrences of FOG in the depressed PD group than in the nondepressed PD group (log-rank p = 0.025 and 0.003, respectively). Depression in drug-naïve, early-stage PD patients showed a significant association with the progression to H-Y stage 3 (hazard ratio = 2.55; 95% confidence interval = 1.32-4.93; p = 0.005), as analyzed by Cox regression analyses. In contrast, the occurrence of levodopa-induced dyskinesia and wearing-off did not differ between the two groups (log-rank p = 0.903 and 0.351, respectively).

Conclusion: Depression in drug-naïve, early-stage PD patients is associated with an earlier occurrence of postural instability. This suggests shared nondopaminergic pathogenic mechanisms and potentially enables the prediction of early development of postural instability.

Keywords: Freezing of gait; KeywordsaaDepression; Parkinson’s disease; Postural instability.

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Conflict of interest statement

Conflicts of Interest

The authors have no financial conflicts of interest.

Figures

Figure 1.
Figure 1.
Kaplan–Meier survival curves for the progression to Hoehn and Yahr stage 3 and the occurrence of freezing of gait among patients with Parkinson’s disease.
Figure 2.
Figure 2.
Kaplan–Meier survival curves for the occurrence of levodopa-induced dyskinesia and wearing-off among patients with Parkinson’s disease.
See this image and copyright information in PMC

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