Background Late onset depression (LOD) may precede the diagnosis of Parkinson’s disease (PD) or dementia with Lewy bodies (DLB). We aimed to determine the rate of clinical and imaging features associated with prodromal PD/DLB in patients with LOD.
Methods In a cross-sectional design, 36 patients with first onset of a depressive disorder (Diagnostic and Statistical Manual of Mental Disorders IV criteria) diagnosed after the age of 55 (LOD group) and 30 healthy controls (HC) underwent a detailed clinical assessment. In addition, 28/36 patients with LOD and 20/30 HC underwent a head MRI and 29/36 and 25/30, respectively, had dopamine transporter imaging by 123I-ioflupane single-photon emission computed tomography (SPECT) imaging. Image analysis of both scans was performed by a rater blind to the participant group. Results of clinical assessments and imaging results were compared between the two groups.
Results Patients with LOD (n=36) had significantly worse scores than HC (n=30) on the PD screening questionnaire (mean (SD) 1.8 (1.9) vs 0.8 (1.2); p=0.01), Movement Disorder Society Unified Parkinson’s Disease Rating Scale total (mean (SD) 19.2 (12.7) vs 6.1 (5.7); p<0.001), REM-sleep behaviour disorder screening questionnaire (mean (SD) 4.3 (3.2) vs 2.1 (2.1); p=0.001), Lille Apathy Rating Scale (mean (SD) −23.3 (9.6) vs −27.0 (4.7); p=0.04) and the Scales for Outcomes in PD-Autonomic (mean (SD) 14.9 (8.7) vs 7.7 (4.9); p<0.001). Twenty-four per cent of patients with LOD versus 4% HC had an abnormal 123I-ioflupane SPECT scan (p=0.04).
Conclusions LOD is associated with increased rates of motor and non-motor features of PD/DLB and of abnormal 123I-ioflupane SPECTs. These results suggest that patients with LOD should be considered at increased risk of PD/DLB.
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Contributors Design and conceptualisation of the study: A-ES, ZW and JB. Acquisition and analysis of the data: HK and A-ES. Recruitment of the IAPT sample: JEJB. Interpretation of the data:HK, A-ES and ZW. Drafting and revising the manuscript for intellectual content: HK, A-ES, ZW, JB, JEJB. Visual analysis of the MR scans: FK and SS. Processing the MR images, providing the volumetric data and advice on the analysis of the volumetric data: CHS.
Funding University College London (no grant code), GE Healthcare (DAT-12-02 LOD (Late Onset Depression Study), AS was funded by the UCL/H Biomedical Research Centre (no grant code), JEJB was funded through a Clinical Research Fellowship by the Wellcome Trust (grant reference code: 201292/Z/16/Z).
Competing interests ZW has received consultancy fees, travel expenses and research support from GE Healthcare and research support from Life molecular imaging. A-ES has received research support from GE Healthcare. JB has received research support from GE Healthcare (paid to the institution)
Patient consent for publication Not required.
Ethics approval All participants gave informed consent to participate in the study, which was approved by the Health Research Authority National Research Ethics Committee London-Hampstead (13/LO/0634).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. Anette Schrag ORCID 0000-0002-9872-6680.
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