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Depression et Maladie de Parkinson: étude d’une série de 135 parkinsoniens

Published online by Cambridge University Press:  14 September 2018

A. Anguenot ,
P.Y. Loll ,
J.P. Neau ,
P. Ingrand  and
R. Gil
A. Anguenot
Affiliation:
Service de Neurologie, Unité de Neuropsychologie, CHU de la Milétrie, 86021 Poitiers cedex
P.Y. Loll
Affiliation:
Service de Neurologie, Unité de Neuropsychologie, CHU de la Milétrie, 86021 Poitiers cedex
J.P. Neau
Affiliation:
Service de Neurologie, Unité de Neuropsychologie, CHU de la Milétrie, 86021 Poitiers cedex
P. Ingrand
Affiliation:
Département de Pédagogie et de Biostatistiques, Faculté de Médecine et de Pharmacie, 86005 Poitiers, France
R. Gil*
Affiliation:
Service de Neurologie, Unité de Neuropsychologie, CHU de la Milétrie, 86021 Poitiers cedex
*
Roger Gil, Service de Neurologie, CHU de la Milétrie, 86021 Poitiers, France
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Résumé:

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Objective:

La fréquence de la dépression au cours de la maladie de Parkinson (MP) conduit à s’interroger sur les difficultés du diagnostic et sur les liens entre la dépression et l’histoire naturelle de la maladie.

Méthodes:

Une série consécutive de 135 sujets atteints d’une MPidiopathique a été examinée sur le plan psychiatrique (DSM-III-R, échelle de dépression de Goldberg), neurologique (en distinguant les signes “axiaux” des autres signes parkinsoniens), neuropsychologique ( et en particulier tests frontaux).

Résultats:

Plus de la moitié des sujets ont une dépression qui apparaît plus fréquente dans les formes akinétiques et les formes fluctuantes de la maladie. Les sujets déprimés n’ont pas de déficit cognitif plus marqué mais leurs scores aux tests frontaux sont plus élevés. En outre les signes axiaux de la maladie (instabilité posturale, rigidité axiale) sont plus marqués chez les parkinsoniens déprimés, suggérant un lien entre la dépression et les lésions non dopaminergiques de la maladie. Alors que le ralentissement, les troubles de l’appétit et du sommeil, la fatigue peuvent être observés même chez des parkinsoniens non dépressifs, la séparation de la population parkinsonienne en plusieurs groupes montre que certains symptômes ne sont jamais rencontrés chez les parkinsoniens non dépressifs: il en est ainsi apparu que “l’impression que la vie ne vaut pas la peine d’être vécue”, “la perte d’espoir pour l’avenir”, “l’impression de ne pas être à la hauteur, de ne rien faire de bien”, “la baisse d’énergie”, “la tristesse matinale” caractérisent la dépression parkinsonienne. La dépression parkinsonienne revêt deux grandes formes cliniques. La première est la plus riche en manifestations somatiques: troubles du sommeil, fatigue matinale; elle correspond aux dépressions les plus sévères avec une absence d’espoir pour l’avenir , une perte de confiance en soi. La seconde est pauvre en manifestations somatiques alors que l’apathie y est très fréquente ainsi que le ralentissement.

Conclusions:

Cette étude permet ainsi de préciser les symptômes de la dépression parkinsonienne qui doit être mieux reconnue pour être plus souvent traitée. Les liens entre la dépression et les signes axiaux de la maladie expliquent sans doute pourquoi la L-dopa et les agonistes dopaminergiques améliorent les signes moteurs de la dépression sans agir le plus souvent sur les manifestations dépressives.

Abstract:

Abstract:Objectif:

The prevalence of depression in Parkinson’s disease (PD) raises the issues of the difficulties of diagnosing the condition and of the relationships between depression and the natural history of the disease.

Methods:

Acohort of 135 consecutive patients with idiopathic PD underwent psychiatric (DSM-III-R, Goldberg depression scale), neurological (distinguishing “axial” signs from other signs of parkinsonism), and neuropsychological (particularly frontal tests) evaluations.

Results:

Depression is present in more than half of the patients and it seems to be more frequent in patients with the akinetic and fluctuating forms of the disease. The subjects who are depressed do not have a greater degree of cognitive impairment, but their scores on frontal tests are higher. Moreover, the axial signs of the disease (postural instability, axial rigidity) are more severe in depressed parkinsonians suggesting a link between depression and the non-dopaminergic lesions of the disease. Even though slowness, appetite and sleep disturbances, and fatigue may be encountered in non-depressed parkinsonian patients, separation of the parkinsonian population into subgroups shows that certain symptoms are never seen in parkinsonians who are not depressed: it is thus evident that “the impression that life is not worth living”, “the hopelessness”, “the impression of being worthless and incompetent”, “the low level of energy”, “the morning sadness” are characteristic of parkinsonian depression. Parkinsonian depression has two major clinical forms. The first one is associated with a greater number of somatic manifestations: sleep disturbances, morning fatigue, corresponding to more severe depression with hopelessness and loss of self confidence. The second exhibits few somatic manifestations with apathy and slowness as frequent complaints.

Conclusions:

This study defines the symptoms of parkinsonian depression which should be better recognised in order to be treated. The link between depression and axial signs of the disease may explain why L-dopa and dopaminergic agonists improve the motor signs of depression without influencing depressive manifestations in most cases.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 29 , Issue 2 , May 2002 , pp. 139 - 146
Copyright
Copyright © Canadian Neurological Sciences Federation 2002

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