The simultaneous presence of demoralization, apathy, and depression has a detrimental impact on both cognitive function and motor symptoms in Parkinson's disease patients

Xiaobo Zhu; Jing Gan; Na Wu; Yu Zhang; Zhenguo Liu

doi:10.3389/fpsyt.2024.1345280

The simultaneous presence of demoralization, apathy, and depression has a detrimental impact on both cognitive function and motor symptoms in Parkinson's disease patients

Front Psychiatry. 2024 Feb 9:15:1345280. doi: 10.3389/fpsyt.2024.1345280. eCollection 2024.

Authors

Xiaobo Zhu^{1

2}, Jing Gan¹, Na Wu¹, Yu Zhang^#¹, Zhenguo Liu^#¹

Affiliations

¹ Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Department of Neurology, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.

^# Contributed equally.

Abstract

Objective: Parkinson's disease (PD) is marked not only by motor symptoms but also by neuropsychiatric manifestations, including demoralization, apathy, and depression. Understanding the clinical distribution and characteristics of these co-occurring symptoms is crucial for improving quality of life of PD patients.

Methods: This study enrolled 195 Chinese PD patients from Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine. The study involved analyzing the clinical characteristics related to the simultaneous presence of demoralization, apathy, and depression in PD patients. Linear regression was employed to elucidate the linear trend between the quantity of negative neuropsychiatric symptoms and cognitive function, as well as motor symptoms and motor complications. SPSS mediation models were utilized to investigate whether the severity of cognitive function mediated the connection between multiple negative neuropsychiatric symptoms and motor symptoms.

Results: Among PD patients, a notable 57.5% experience the presence of multiple concurrent negative neuropsychiatric symptoms. Our investigation unveiled a correlation where patients with more negative neuropsychiatric symptoms displayed heightened cognitive impairment (P=0.048) and more severe motor symptoms (P=0.024), following a linear trend with increasing symptom numbers. Additionally, cognitive impairment played a partial mediating role in the impact of multiple negative neuropsychiatric symptoms on motor symptoms (β=0.747; 95% bootstrap confidence interval: 0.195 to 1.532).

Conclusions: The co-occurrence of these negative neuropsychiatric symptoms has the potential to worsen cognitive function and motor symptoms in PD patients. Moreover, cognitive impairment was identified as playing a partial mediating role in the relationship between multiple negative neuropsychiatric symptoms and motor symptoms.

Keywords: Parkinson’s disease; apathy; cognitive function; demoralization; depression; motor symptoms.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the Project of Shanghai Science and Technology Commission (22015831100), Shanghai Pujiang Program(2020PJD032), Projects of National Science Foundation of China (81974173), Shanghai Municipal Commission of health (2019SY024), Projects of the Shanghai Committee of Science and Technology (19401932100), Pilot project of clinical cooperation between Chinese and Western medicine in Shanghai (ZXYXZ-201907), Special project of integrated traditional Chinese and Western medicine in Shanghai General Hospital(ZHYY-ZXYJHZX-202021).