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To examine predictive factors associated with onset of depression among individuals diagnosed with Parkinson's disease (PD).
Depression may precede or follow symptomatic parkinsonism in PD. It is frequently treatable but often overlooked.
The clinical series comprised 685 individuals who were diagnosed with PD and followed by one neurologist (RJU) from 1994 to 2007. The primary outcome was time to depression following the onset of PD. Diagnosis of depression was based on clinical assessment of depressive symptoms from patients (and spouse/family/caregiver) and antidepressant usage. A number of demographic, historical and clinical predictive factors were examined, including gender, age at symptomatic onset, disease duration, onset characteristics, clinical ratings, antiparkinsonian medications, cognitive status, depression history, and familial history of PD and other neurodegenerative disorders.
Seventy-two percent of patients developed depression within ten years of symptomatic PD onset, and the mean time to depression was 7.9 years (median: 5.7 years). Factors associated with depression included longer PD duration, greater impairment in activities of daily living, and positive family history of motor neuron disease (MND).
A high rate of individuals with PD develop depressive symptoms during the course of the disease. Based on first clinic visit characteristics, most factors examined were not helpful in identifying individuals with an increased risk of depression. However, disease duration, functional limitations and family history of MND should lead clinicians to an increased vigilance for identifying depression.
Sleep patterns of nursing home residents are extremely fragmented. This is manifested not only as disrupted night-time sleep, but also by frequent daytime sleeping. Poor sleep represents more than a mild annoyance for nursing home residents. Nursing home residents often suffer from multiple medical and psychiatric co-morbidities and are often in poor physical health. Circadian rhythm changes contribute to sleep problems in nursing home residents. Real change will require administrators and other staff to recognize that sleep is important and encouraging better sleep would benefit both residents and staff over the long term. Sleep disturbance is associated with negative outcomes among nursing home residents. While data to support the use of pharmacotherapy for sleep in the nursing home are limited, there is some suggestion that disturbed sleep improves with non-pharmacological treatments; however, these treatments have not been adapted for implementation into routine care.
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