Raymond Y Lo1, Karla P Figueroa2, Stefan M Pulst2, Susan Perlman3, George Wilmot4, Christopher Gomez5, Jeremy Schmahmann6, Henry Paulson7, Vikram G Shakkottai7, Sarah Ying8, Theresa Zesiewicz9, Khalaf Bushara10, Michael Geschwind11, Guangbin Xia12, Jui-Tsen Yu13, Lue-En Lee13, Tetsuo Ashizawa12, S H Subramony12, Sheng-Han Kuo14. 1. Department of Neurology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan. 2. Department of Neurology, University of Utah, Salt Lake City, UT, USA. 3. Department of Neurology, University of California, Los Angeles, CA, USA. 4. Department of Neurology, Emory University, Atlanta, GA, USA. 5. Department of Neurology, University of Chicago, Chicago, IL, USA. 6. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 7. Department of Neurology, University of Michigan, Ann Arbor, MI, USA. 8. Department of Neurology, Johns Hopkins University, Baltimore, MD, USA. 9. Department of Neurology, University of South Florida, Tampa, FL, USA. 10. Department of Neurology, University of Minnesota, Minneapolis, MN, USA. 11. Department of Neurology, University of California, San Francisco, CA, USA. 12. Department of Neurology and McKnight Brain Institute, University of Florida, Gainesville, FL, USA. 13. Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA. 14. Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA. Electronic address: sk3295@columbia.edu.
Abstract
BACKGROUND: Depression is a common comorbidity in spinocerebellar ataxias (SCAs) but its association with ataxia progression is not well understood. OBJECTIVES: To study the prevalence and influence of depressive symptoms in SCAs. METHODS: We studied 300 participants with SCA 1, 2, 3 and 6 from the Clinical Research Consortium for Spinocerebellar Ataxias (CRC-SCA) and repeatedly measured depressive symptoms by the 9-item Patient Health Questionnaire (PHQ-9) along with other clinical features including ataxia, functional status, and quality of life every 6 months for 2 years. We employed regression models to study the effects of depressive symptoms on clinical progression indexed by Scale for Assessment and Rating of Ataxia (SARA), Unified Huntington's Disease Rating Scale Part IV (UHDRS-IV) and EQ5D after adjusting for age, sex and pathological CAG repeats. RESULTS: Comorbid depression is common in SCAs (26%). Although the baseline prevalence of depression was similar among different SCA types, suicidal ideation was more frequently reported in SCA3 (65%). Depressive symptoms were associated with SARA scores but did not significantly progress over time within 2 years or deteriorate by increased numbers of pathological CAG repeats. The effects of depression on ataxia progression varied across different SCA types. Nevertheless, depression had consistently negative and significant impact on functional status and quality of life in all SCAs, even after accounting for ataxia progression. CONCLUSIONS: Depressive symptoms are not simply the consequence of motor disability in SCAs. Comorbid depression per se contributes to different health outcomes and deserves more attention when caring patients with SCAs.
BACKGROUND:Depression is a common comorbidity in spinocerebellar ataxias (SCAs) but its association with ataxia progression is not well understood. OBJECTIVES: To study the prevalence and influence of depressive symptoms in SCAs. METHODS: We studied 300 participants with SCA 1, 2, 3 and 6 from the Clinical Research Consortium for Spinocerebellar Ataxias (CRC-SCA) and repeatedly measured depressive symptoms by the 9-item Patient Health Questionnaire (PHQ-9) along with other clinical features including ataxia, functional status, and quality of life every 6 months for 2 years. We employed regression models to study the effects of depressive symptoms on clinical progression indexed by Scale for Assessment and Rating of Ataxia (SARA), Unified Huntington's Disease Rating Scale Part IV (UHDRS-IV) and EQ5D after adjusting for age, sex and pathological CAG repeats. RESULTS: Comorbid depression is common in SCAs (26%). Although the baseline prevalence of depression was similar among different SCA types, suicidal ideation was more frequently reported in SCA3 (65%). Depressive symptoms were associated with SARA scores but did not significantly progress over time within 2 years or deteriorate by increased numbers of pathological CAG repeats. The effects of depression on ataxia progression varied across different SCA types. Nevertheless, depression had consistently negative and significant impact on functional status and quality of life in all SCAs, even after accounting for ataxia progression. CONCLUSIONS:Depressive symptoms are not simply the consequence of motor disability in SCAs. Comorbid depression per se contributes to different health outcomes and deserves more attention when caring patients with SCAs.
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