Study of depression, anxiety, etc in PSP and MSA

This study by UK researchers looks at the psychological well-being and health status of 188 PSP patients and 286 MSA patients.

Researchers concluded that:

1. PSP patients had significantly higher depression scores. PSP patients “reported significantly more symptoms compatible with anhedonia and concentration/apathy.” (anhedonia = inability to experience pleasure)

To “establish whether depressive symptoms are a secondary, later phenomenon or an early feature of PSP, longitudinal follow-up shortly after diagnosis is necessary to map how the disease process, depression, anxiety, and health status evolve in the course of PSP or MSA.”

2. MSA patients had significantly greater pain/discomfort. “Pain is an important aspect of PD and MSA in which multiple mechanisms, including hypoperfusion, rheumatic, sensory, dystonic and off-period related aspects have been postulated. In a previous study, MSA with predominant parkinsonism was associated with more pain than MSA with predominant cerebellar ataxia.”

“Difference between pain in the MSA and PSP groups is likely to reflect the different clinical presentation of PSP with relatively less typical limb parkinsonism and more prominent axial symptoms, less common response to levodopa and fewer autonomic symptoms. However, we did not explore the type and location of pain experienced in MSA.”

3. Anxiety was the same in both groups.

“As expected, disease severity showed significant negative correlations with the EQ-5D summary index for both groups. In contrast to a previous finding in PSP, disease duration did not correlate significantly with health status for either the patients with PSP or patients with MSA. This lack of association between disease duration and health status could be explained by the variable rate of progression of these disorders.”

Researchers say that this is important information for clinicians and patients because these symptoms should be “important targets for clinical management. … The results of this study emphasize again the importance of depressive symptoms as important for health status for both patient groups, but also highlight anxiety as being associated with health status. In addition, pain is a particularly important aspect of MSA for patients, and should be targeted in their clinical management.”

I’ve copied the abstract below.


Movement Disorders. 2010 Apr 13;25(eight):1077-1081. [Epub ahead of print]

A comparison of depression, anxiety, and health status in patients with progressive supranuclear palsy and multiple system atrophy.

Schrag A, Sheikh S, Quinn NP, Lees AJ, Selai C, Mathias C, Litvan I, Lang AE, Bower JH, Burn DJ, Low P, Jahanshahi M.
Institute of Neurology, University College London, London.

The objective of this study was to compare subjective health status and its correlates in progressive supranuclear palsy (PSP) and multiple system atrophy (MSA). One hundred eighty-eight patients with PSP and 286 patients with MSA completed EQ-5D and Hospital Depression and Anxiety Scale.

The impact on mobility, usual activities, and self-care was similarly high in both groups after similar duration.

Fifty-six percent of PSP and 43% of MSA had probable depression, and 37% of both groups had probable anxiety. Patients with PSP had significantly higher depression scores, but groups did not differ in anxiety scores.

Patients with MSA had significantly greater pain/discomfort than patients with PSP.

The most important association with subjective health status was with depressive symptoms, which accounted for 38% and 29% of EQ-5D variance in patients with PSP and MSA, followed by disease severity and anxiety scores. We conclude that depressive symptoms were common in both disorders, but more severe in PSP.

Anxiety symptoms affected 37% of patients in both groups and contributed to impaired subjective health status.

Pain was more problematic in MSA than PSP. (c) 2010 Movement Disorder Society.

PubMed ID#: 20535826 (see for this abstract only)