Catatonic symptoms and other disorders in DLB and PD
This Italian research is about the greater presence of somatoform disorders in DLB (12%) than Parkinson's Disease (7%) or other neurodegenerative disorders, such as AD, MSA, PSP, or FTD (0-3%).
Like probably most of you, I hadn't a clue as to what a "somatoform disorder" was. And I wasn't going to pass this research abstract along until I saw the phrase "catatonic symptoms." This seems to be a great description of what sometimes caregivers report: the person with LBD is semi-conscious, not awake but not asleep either. I have also heard this called "catatonic stupor."
Somatoforms disorders (SFMD) is the "general category grouping, on the basis of medically unexplained symptoms, somatization and conversion disorders (once defined as hysteria), pain, and hypochondria..." Obviously, "somatoform" and "psychosomatic" share the same root.
Wikipedia defines SFMD as "a mental disorder characterized by physical symptoms that mimic physical disease or injury for which there is no identifiable physical cause. ...medical test results are either normal or don't explain the person's symptoms."
This info from the introduction of the article on Parkinson's Disease is interesting: "Recent literature on the psychiatric manifestations of Parkinson disease (PD) identified depression and impulse control disorders as mental disorders preceding or occurring concomitantly with parkinsonism and its treatment. ...[A] recent survey on patients hospitalized for PD found that prior hospitalizations for mental disorders other than depression equally increased the risk of PD occurrence. The present study hypothesized that somatoform disorders (SFMD) might be part of the presentation of PD and dementia with Lewy Bodies (DLB). ... Several reasons anchored our interest on SFMD in PD: SFMD might precede the onset of neurodegenerative disorders, conversion type SFMD were described anecdotally in patients who developed PD, alexithymia (inability to distinguish feelings from bodily sensation of emotional arousal) is increased in PD, and, finally, the remarkable intensity of response to placebo in PD, evidences that there is suggestibility in PD and suggestibility was historically defined as the hallmark of hysteria-SFMD."
The authors note: "All findings suggest that SFMD in patients with PD is a predictor of the development of dementia of the DLB type. ... SFMD with variable patterns, including conversion, or somatic delusion and catatonic signs might be useful in the diagnosis of DLB or PDD, or might be added to definitions of clinical features in DLB and PDD."
Several in our local LBD support group have told me that their loved ones got deep brain stimulation (DBS) when they had a Parkinson's Disease diagnosis, and that dementia symptoms began after DBS. The Italian authors suggest that anyone with PD who has SFMD might be excluded from DBS.
And one last bit about catatonic symptoms: "Recent neurobiological evidence suggests that hysteria (conversion-somatization SFMD) and catatonia, both characterized by overactivity of orbitofrontal and anterior cingulate gyrus, might both represent the expression of an archetypal sham death reflex (playing possum) present in animals as a life-saving behavior..."
A short video is available online that shows two Italian patients with "catatonic stereotypical posture of hand." The third patient has a "psychological pillow." See: (Italian is spoken in the video)
http://www.neurology.org/content/vol74/ ... ideo_3.wmv
I've copied the abstract below.
Neurology. 2010 May 18;74(20):1598-606.
Cohort study on somatoform disorders in Parkinson disease and dementia with Lewy bodies.
Onofrj M, Bonanni L, Manzoli L, Thomas A.
Department of Neurology, University G. d'Annunzio of Chieti-Pescara, Italy.
OBJECTIVE: To assess somatoform disorder (SFMD) prevalence and impact in Parkinson disease (PD) and dementia with Lewy bodies (DLB).
METHODS: SFMD were assessed by direct observation of symptoms in the year coincident (+/-6 months) with definite diagnosis of PD, DLB, Alzheimer disease, multiple system atrophy, progressive supranuclear palsy, or frontotemporal dementia, and by interviews with patients, caregivers, and general practitioners, and reviews of prior hospital admissions, in a cohort of 942 patients with neurodegenerative disorders. Matched groups of patients with PD and patients with DLB without vs with SFMD were selected for comparisons and followed up over 4 years.
RESULTS: The frequency of SFMD was higher in DLB (15 patients, 12%) and PD (29 patients, 7%) than in other neurodegenerative diseases (0%-3%).
SFMD consisted of conversion motor or sensory disorders, often accompanied by delusional thought content; in one patient catatonic symptoms were observed concomitantly with PD diagnosis. Evidence of SFMD symptoms, preceding diagnosis by 6 months-10 years, was obtained in 28 patients with PD and all patients with DLB. A total of 22 patients with PD and all patients with DLB could be followed for 4 years. SFMD symptoms recurred during follow-up, with catatonic signs developing in 9 patients with PD and 8 patients with DLB. Most baseline demographic and clinical features did not differ between subjects with or without SFMD. Decline of cognitive function was greater in PD-SFMD patients than in those without SFMD (p < 0.01); it was comparable to that observed in DLB.
CONCLUSIONS: The frequency of somatoform disorder (SFMD) (with catatonic signs) in Parkinson disease and dementia with Lewy bodies suggests that SFMD are part of the spectrum of Lewy body diseases.
PubMed ID#: 20479358 (see pubmed.gov for this abstract only)