BOSTON – Depression, anxiety, and sleep problems rather than disease explain why some patients with Parkinson's disease call their physicians more frequently than others, according to results of a study presented by Dr. Melissa J. Nirenberg in a poster presentation at the annual meeting of the American Academy of Neurology.
Treating these “invisible” symptoms may both help the patients' quality of life and decrease their health care use, she reported.
In the study, frequent callers–who made an average of 2.4 calls in 100 days–had significantly higher anxiety scores on the Beck Anxiety Inventory and higher depression scores on the Beck Depression Inventory than did those who called infrequently–or a mean of 0.6 calls in 100 days. They also had lower quality of life scores on the Parkinson's Disease Quality of Life scale, reported Dr. Nirenberg. Sleep problems were a universal complaint among frequent callers, but these issues were reported by only 36% of the infrequent callers, a significant difference.
While patients in both groups had moderate motor disability, no differences between groups were found as measured by the motor Unified Parkinson's Disease Rating Scale, Hoehn and Yahr scale, or Schwab and England Disability scale.
The study comprised 44 nondemented Parkinson's disease outpatients who were treated over 4 months in a movement disorders clinic. They all underwent neuropsychiatric and disability testing. Patients who called more than the mean rate of 1.9 calls in 100 days were assigned to the frequent callers group, and those who called less than the mean rate were assigned to the infrequent callers group. Calling history was determined by retrospective chart review.
“These [frequent callers] look good but feel bad,” says Dr. Nirenberg, who is the associate director of the Parkinson's Disease and Movement Disorders Institute at Cornell University, New York. She believes that because anxiety, depression, and sleep disorders are not readily apparent, it might make sense to focus instead on treating the motor symptoms. Even physicians who recognize the importance of the nonmotor symptoms of Parkinson's disease may not have time to ask about them during a routine office visit, and as a result, may be undertreating these symptoms.
Increased telephone health care use has a significant impact on physicians, said Dr. Nirenberg. These calls take up a tremendous amount of the time. While not assessed in this study, it is likely that these patients also make increased demands on other health care services.
“You need to have a high index of suspicion for anxiety and depression, particularly in patients who call frequently,” Dr. Nirenberg said. She says that while the ideal treatments for these nonmotor symptoms of Parkinson's disease have not been established, cognitive-behavioral therapy, anxiolytics, antidepressants, and Parkinson's medications may help. It is also important to be aware that treatment of one of these nonmotor problems might exacerbate another–for example, an SSRI prescribed for depression has the potential to worsen anxiety, she said.