NLM Citation ID:
12020264 (PubMed)
Full Source Title:
Archives of Neurology
Publication Type:
Journal Article; Review; Review, Multicase
Language:
English
Author Affiliation:
Department of Neurology, Emory University, 1639
Pierce Dr, Suite 6000, Atlanta, GA 30322, USA. msokun@dnamail.com
Authors:
Okun MS; McDonald WM; DeLong MR
Number of References:
30
Abstract:
BACKGROUND: Many patients with Parkinson
disease (PD) suffer from nonmotor symptoms including depression, anxiety, sexual
dysfunction, decreased energy level, and an overall decline in quality of life.
Comorbid depression, hypothyroidism, and sleep disorders may account for some,
but not all, of these problems. Testosterone
deficiency affects 20% to 25% of males over the age of 60 years in the general
population and may cause signs and symptoms of the nonmotor symptoms seen in PD.
We observed numerous patients with PD whose nonmotor symptoms were refractory to
treatment. OBJECTIVE: To determine whether treatment of comorbid testosterone deficiency in male patients with PD can lead
to improvements in refractory nonmotor symptoms. METHODS: Case studies were
reviewed of the first 5 male patients who had PD with symptoms of testosterone deficiency who were treated in our clinic. All
patients had low serum testosterone levels.
Screening for testosterone deficiency symptoms
using the St Louis Testosterone Deficiency
Questionnaire was performed for 4 of the 5 patients. Additionally, to assess the
prevalence of PD, total testosterone levels in 68
patients in our PD registry were sent for evaluation. RESULTS: Following
testosterone replacement therapy, all 5 patients
experienced significant improvements in their refractory nonmotor symptoms. Of
68 male patients with PD enrolled in our PD registry, 24 (35%) had plasma
evidence of testosterone deficiency. We also noted
that the risk of testosterone deficiency per
decade was found to increase 2.8-fold per decade (P<.001), paralleling that
which is found in the general elderly male population. CONCLUSIONS: The findings
from this study reveal the heretofore unrecognized high prevalence of
testosterone deficiency in elderly male patients with PD similar to that found
in the general population. These symptoms, which may be refractory to
antidepressants, anxiolytics, and antiparkinsonian medications, may respond to
treatment with testosterone. More rigorous controlled studies will need to be
undertaken to examine the treatment of this common comorbidity in male patients
with PD.
Additional Subjects:
Chemical Compound Name:
(Gonadal Steroid Hormones);
58-22-0(Testosterone)