The therapeutic potential of exercise to improve mood, cognition, and sleep in Parkinson's disease

Published in final edited form as: Mov Disord. 2016 January ; 31(1): 23–38. doi:10.1002/mds.26484.In addition to the classic motor symptoms, Parkinson's disease (PD) is associated with a variety of nonmotor symptoms that significantly reduce quality of life, even in the early stages of the disease. There is an urgent need to develop evidence‐based treatments for these symptoms, which include mood disturbances, cognitive dysfunction, and sleep disruption. We focus here on exercise interventions, which have been used to improve mood, cognition, and sleep in healthy older adults and clinical populations, but to date have primarily targeted motor symptoms in PD. We synthesize the existing literature on the benefits of aerobic exercise and strength training on mood, sleep, and cognition as demonstrated in healthy older adults and adults with PD, and suggest that these types of exercise offer a feasible and promising adjunct treatment for mood, cognition, and sleep difficulties in PD. Across stages of the disease, exercise interventions represent a treatment strategy with the unique ability to improve a range of nonmotor symptoms while also alleviating the classic motor symptoms of the disease. Future research in PD should include nonmotor outcomes in exercise trials with the goal of developing evidence‐based exercise interventions as a safe, broad‐spectrum treatment approach to improve mood, cognition, and sleep for individuals with PD.This work was supported by the National Institute of Mental Health (F31MH102961 to G.O.R.)

Effects of positive mood on attentional breadth for emotional stimuli

Although earlier studies have related positive emotions to affentional broadening, recent findings point out the complexity of this relation and show that these broadening effects interact with factors such as characteristics of the information that is presented. Besides stimuli characteristics, individual characteristics such as the presence of depressive symptoms could also influence the broadening effects as depressive symptoms have previously been related to a more narrow attentional scope. Therefore, the aim of this study was to further investigate the affentional broadening effects of positive emotions, testing whether this is influenced by the emotional valence of the information presented and secondly, how the presence of depressive symptoms might interact with this relationship. We used a performance based measure to assess fluctuations in affentional broadening for positive, neutral, and negative stimuli. We assessed the presence and severity of depressive symptoms in an unselected study sample and tested whether these symptoms moderate the relationship between induced positive mood and affentional breadth for emotional information. Results showed no direct relation between positive mood and affentional breadth, regardless of the emotional valence of the stimuli. However, the presence of depressive symptoms moderated this relationship in such a way that among low levels of depressive symptoms, positive mood was related to attentional broadening specifically when positive information was presented, while at high levels of depressive symptoms this relation was reversed. The current findings suggest that both stimuli characteristics, individual characteristics and their interplay should be taken into account when investigating the broadening effects of positve emotions

Lacunar infarcts, depression and anxiety symptoms one year after stroke

Background: Mood disorders are frequent after stroke and are associated with poorer quality of life. Previous studies have reported conflicting results as to stroke subtype in the incidence of poststroke mood disorders. We explored the relationship between subcortical ischemic stroke subtype (lacunar) and presence of such symptoms at 1 year after stroke. Methods: Anonymized data were accessed from the Virtual International Stroke Trials Archive. Stroke subtypes were classified according to the Trial of Org 10172 in Acute Stroke Treatment classification. Depression and anxiety symptoms were assessed using Hospital Anxiety and Depression Scale. We investigated independent predictors of depression and anxiety symptoms using a logistic regression model. Results: Data were available for 2160 patients. Almost one fifth of the patients developed both anxiety and depression at 1-year follow-up. After adjusting for confounders, the lacunar subtype was least associated with both anxiety (odds ratio [OR] = .61; 95% confidence interval [CI] = .46-.80) and depression symptoms (OR = .71; CI = .55-.93) versus other stroke subtypes. Conclusions: Lacunar strokes have a weaker association with presence of anxiety and depression symptoms compared with other subtypes

Binge Eating Disorder Mediates Links between Symptoms of Depression and Anxiety and Caloric Intake in Obese Women

Despite considerable comorbidity between mood disorders, binge eating disorder (BED), and obesity, the underlying mechanisms remain unresolved. Therefore, the purpose of this study was to examine models by which internalizing behaviors of depression and anxiety influence food intake in overweight/obese women. Thirty-two women (15 BED, 17 controls) participated in a laboratory eating-episode and completed questionnaires assessing symptoms of anxiety and depression. Path analysis was used to test mediation and moderation models to determine the mechanisms by which internalizing symptoms influenced kilocalorie (kcal) intake. The BED group endorsed significantly more symptoms of depression (10.1 versus 4.8, P=0.005 ) and anxiety (8.5 versus 2.7, P=0.003). Linear regression indicated that BED diagnosis and internalizing symptoms accounted for 30% of the variance in kcal intake. Results from path analysis suggested that BED mediates the influence of internalizing symptoms on total kcal intake. The associations between internalizing symptoms and food intake are best described as operating indirectly through a BED diagnosis. This suggests that symptoms of depression and anxiety influence whether one engages in binge eating, which influences kcal intake. Greater understanding of the mechanisms underlying the associations between mood, binge eating, and food intake will facilitate the development of more effective prevention and treatment strategies for both BED and obesity

Dissociative symptoms in female patients with mood and anxiety disorders: a psychopathological and temperamental investigation.

Abstract OBJECTIVE: Dissociative symptoms are frequent among psychiatric patients and may considerably affect patients' psychopathological condition and treatment outcomes. The objectives of the study are to assess the presence of dissociative symptoms in female patients with mood and anxiety disorders, to investigate their correlation with the clinical severity of the disorders and to investigate those personality traits that are more frequent in patients with high levels of dissociation. PATIENTS AND METHODS: 50 Caucasian females were enrolled in the study. Patients were assessed through the Self-Report Symptom Check-List, the Dissociative Experiences Scale (DES) and rating scales for Depression and Anxiety. RESULTS: The mean DES score in the overall sample was 16.6. 32% of patients had a DES score > 20. Depressive symptoms positively correlated with the DES total scores. Dissociator patients presented some significantly different temperamental characteristics in comparison with non dissociator patients. CONCLUSIONS: Dissociative symptoms are highly present in patients with mood and anxiety disorders and correlate with the severity of depressive symptoms. Specific personality traits more frequently observed in dissociator people may represent predisposing factors; their early identification could be clinically relevant

THE CONNECTION BETWEEN BIPOLAR SPECTRUM DISORDERS AND EATING DISORDERS

The bipolar spectrum of mood, in its broadest sense that includes all kinds of mood instability, presents various symptoms related to instability and mood swing, including symptoms and manifestations of "mixed states" (the symptoms of "mixity") and symptoms of eating disorders (ED). It is essential not to forget that depression itself is only "a phase" of the wider bipolar spectrum of mood, which therefore remains the pathology to be treated adequately with a polytherapy composed by mood regulators and antidepressants. "Mixed" symptoms (including symptoms of eating disorders), if not properly treated, can subtly enter the patient\u27s life, leading to a worsening of the clinical picture to a clear chronicity

Sex differences in health at ages 11, 13 and 15

This paper tests the hypothesis of an emerging or increasing female excess in general ill-health and physical symptoms, as well as psychological distress, during early to mid-adolescence. Self-reported data on general health (longstanding illness and health in the last 12 months), recent symptoms (classified as ‘physical’ and ‘malaise’) and depressive mood were obtained from a large, Scottish, school-based cohort at ages 11, 13 and 15. Generally high levels of health problems at age 11 tended to increase with age, these increases being greater for females than males, not only in respect of depression and ‘malaise’ symptoms, but also limiting illness, ‘poor’ self-rated health, headaches, stomach problems and dizziness. The consequence, by age 15, is the emergence of a female excess in general ill-health and depressive mood, and a substantial strengthening of the small excess in both ‘physical’ and ‘malaise’ symptoms already apparent at 11 years. These findings are discussed in relation to explanations for the adult female excess in poorer health, and the emergence of a female excess of depression during adolescence

Sleep and behavioural problems associate with low mood in Finnish children aged 4-12 years : an epidemiological study

Background: Few studies have examined the associations between sleep, mood and behaviour in young children in the early stages of developing psychopathology. The purpose here was to examine the association of emotional problems, especially mood, with family and child characteristics, sleep and behavioural problems in 4-12 year-old children. Methods: The sample was population-based and included 1714 children. Parents filled in the Strengths and Difficulties Questionnaire and a background questionnaire on child and family characteristics. The associations between (a) emotional symptoms/mood and background variables, (b) emotional problems and conduct problems/hyperactivity and (c) mood and conduct problems/hyperactivity were examined with ordinal regression in univariate and multivariate models. Results: Of the background variables, child's sleeping problems had the most powerful association with emotional symptoms and mood. Abnormal emotional problems score and emotional symptoms were associated with abnormal conduct problems and hyperactivity scores. Of the emotional symptoms, low mood was the one associated most strongly with conduct problems and hyperactivity after controlling for all significant background variables and other emotional symptoms. Conclusions: We conclude that in young children sleep problems associate with low mood. Low mood associates with behavioural problems. When a child presents with low mood or behavioural problems, a comprehensive assessment of their psychiatric symptoms, as well as their sleep problems, is recommended.Peer reviewe

Patterns of Symptom Improvement among Depressed Adolescents treated with Interpersonal Psychotherapy Adolescent Skills Training (IPT-AST) in School Based Clinics

Subthreshold symptoms of depression (defined as symptoms that do not meet full criteria for the disorder) are a significant concern, associated with a range of behavioral and emotional problems, raising the risk of adolescents developing more severe depression later. Yet research on subthreshold depression is lacking, and the relationship between affective and somatic symptom improvement has not been adequately studied. Prior research with adult samples lend credence to the hypothesis that symptoms of mood/motivation respond faster to psychotherapy (Rush, Beck, Kovacs, Weissenburger, and Hollon, 1982) than pharmacotherapy with the opposite response for vegetative symptoms such as sleep and appetite (DiMascio, Weissman, Prusoff, and Neu 1979). The current study was built upon prior research that found Interpersonal Psychotherapy Adolescent Skills Training (IPT-AST) to be an efficacious prevention intervention for adolescents with subthreshold depression, as compared to school counseling (Young, Mufson and Gallop, 2010). In this investigation, we sought to compare the trends in symptomatic improvement among 32 participants treated with IPT-AST over eight weeks. Clusters of mood/ motivation and vegetative symptoms were followed from baseline to the end of treatment. The results suggest that mood symptoms improved significantly before vegetative symptoms, within the first four weeks of preventive treatment. Significant improvement in vegetative symptoms was found to occur later between weeks 6 and 8. Thus adolescents receiving IPT-AST preventive treatment demonstrated faster reduction in mood/motivation symptoms than vegetative symptoms. Analyses revealed that fewer participants were identified as having not improved on the mood/motivation cluster than on the vegetative cluster indicating a better response for adolescents with mood symptoms than vegetative symptoms. Although, no relationships in improvements in mood/motivation and vegetative clusters were found controlling for baseline mood/motivation and vegetative symptoms; positive associations were found between cluster variables (mood, vegetative and total depression) over time. Gender was also not found to moderate the relationship between improvement on mood and vegetative symptoms over time indicating no significant differences in the improvement between males and females. Overall, findings from the current investigation strengthen the results from previous studies regarding the timeline of symptom improvement with IPT-AST

Prenatal Maternal Mood Patterns Predict Child Temperament and Adolescent Mental Health

Background This study quantifies the dynamics of maternal mood focusing on unpredictability, and to assess if greater unpredictability of prenatal maternal mood predicts child temperament and internalizing symptoms through early adolescence. Methods The association between prenatal mood predictability and child internalizing symptoms were assessed in two longitudinal cohorts (N’s = 227 and 180). Maternal mood was assessed repeatedly during pregnancy as early as 15 weeks’ gestation. Predictability of maternal mood was calculated by applying Shannon’s entropy to the distribution of responses on mood questionnaires. Maternal reports of child negative affectivity (a predictor of later internalizing) were collected at 6, 12, 24 months and 7 years of age. Child self-reports of anxiety symptoms were collected at 10 years and reports of depression symptoms at 13 years. Results Fetal exposure to more elevated maternal mood entropy predicted higher levels of child negative affectivity at 12 months (r = .36; p \u3c 01), 24 months (r = .31; p \u3c 01) and 7 years (r = .32; p \u3c 01) of age. In addition, children exposed to higher prenatal maternal mood entropy, reported higher levels of anxiety symptoms at 10 years (r = .24; p \u3c 01) and elevated depressive symptoms at 13 years (r = .29; p \u3c .01). These associations persisted after adjusting for maternal pre and postnatal mood valence (e.g. depression levels) and for other relevant demographic characteristics. Conclusions Our findings provide strong support for the notion that patterns of maternal mood influence the developing brain. More specifically, they suggest that prenatal maternal mood predictability may be a critical predictor of developmental mental health trajectories and should be considered when assessing early life influences on lifespan mental health