Caregiver Depression Linked to Worse Parkinson's Outcomes

Pauline Anderson

August 18, 2023


Patients with Parkinson's disease (PD) whose caregivers have depression are more likely to have worse quality of life and more emergency department visits than those whose caregivers don't have depression, results of a new study suggest.


  • Research shows that caregiver burden is correlated with greater motor symptoms, cognitive impairment, and disrupted sleep among people with PD, but there's little information regarding the impact of caregiver burden on the prognosis of a patient with PD.

  • This retrospective cohort study included 454 people with PD living at home (mean age, 67.3 years) and their unpaid family member or friend acting as a caregiver (mean age, 65.9 years) enrolled in the Parkinson's Foundation Parkinson's Outcomes Project.

  • Researchers collected scores on the 39-item, self-report Parkinson's Disease Questionnaire (PDQ-39) that measures health-related quality of life (QOL; range, 0-100, with higher scores indicating worse QOL), scores on the self-reported Center for Epidemiologic Studies Depression Scale (CES-D), a 20-item measure to identify depression (scores higher than 16 indicate higher risk for depression), self-reported hospitalizations, and number of emergency department (ED) visits.

  • The study controlled for patient age, sex, disease duration, Hoehn and Yahr scale stage (a rating scale of motor deficits in PD patients), and cognitive measures, as well as caregiver financial status and self-reported health.


  • After a mean of 2.0 annual visits, the study showed that having a caregiver with a higher risk for depression (CES-D score >16) was associated with worse QOL in patients than not having a caregiver with depression (mean PDQ-39 score, 33.78 vs 24.50: β = 6.89; 95% confidence interval [CI], 4.09 to 9.69; P < .001).

  • Having a caregiver with greater depression symptoms was also associated with an increase in patient annual ED visits (β = 0.02; 95% CI, 0 to 0.04; P = .03).

  • There was no significant association between caregiver depression symptoms and patient hospitalizations, possibly due to lack of power.


The findings suggest that screening for caregiver depression and more support are important for the health of patients with PD and their caregivers, the authors conclude, adding that approaches such as interdisciplinary home visits, cognitive behavioral therapy, and comprehensive skill training can reduce caregiver strain.


The study was conducted by Rudmila Rashid, MD, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, and colleagues. It was published online August 11, 2023, in JAMA Network Open.


Follow-up data were missing for several participants. It's possible that confounding due to unmeasured factors played a role in the findings. Patients in the sample were highly educated and had access to specialty movement disorder clinics, which limits the generalizability of the study for underserved populations.


The study received support from the Parkinson's Foundation and the Parkinson's Foundation Summer Student Fellowships Program. Rashid reported receiving grants from the Parkinson's Foundation during the conduct of the study; see the paper for disclosures of other authors.

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