MOOD alterations are a potential early indicator of sporadic Creutzfeldt-Jakob disease (sCJD), new research has shown, with increased SSRI prescriptions observed up to three years prior to symptom onset.
Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare, rapidly progressive neurodegenerative disease with a fatal prognosis. Diagnosis is definitive only post-mortem, leaving the early prodromal phase largely uncharacterised. This study investigated whether prescription medication usage, specifically antidepressants, differs between patients with sCJD and matched controls, to identify potential early clinical indicators.
In this retrospective case-control study, data from January 2013 to December 2020 was analysed in 2023. Researchers linked 129 patients with autopsy-confirmed sCJD to insurance claims data, matching each patient with ten controls based on sex, age, and residence. Prescriptions for medications used by at least 10% of the sCJD cohort in the five years before disease onset were evaluated. Conditional regression analyses revealed a 2.86-fold higher likelihood of selective serotonin reuptake inhibitor (SSRI) prescriptions in sCJD patients in the year prior to symptom onset compared to controls (odds ratio, 2.86; 95% CI, 1.63–4.95; P < .001). Additionally, SSRI prescriptions began to increase three years prior to disease onset in sCJD patients.
These findings suggest mood alterations, reflected in increased SSRI prescriptions, may be a prodromal feature of sCJD, emerging as early as three years before symptoms appear. While sCJD remains an exceptionally rare condition, clinicians should consider neurodegenerative diseases when significant mood changes occur in older adults, particularly those requiring antidepressant treatment. Further research is needed to explore the mechanisms driving this association and to refine potential early diagnostic tools. Improving the ability to recognise prodromal symptoms may help extend the diagnostic window and offer earlier intervention opportunities.
Katrina Thornber, EMJ
Reference
Wurm R et al. Mood alterations in the prodromal phase of sporadic Creutzfeldt-Jakob disease. JAMA Neurol. 2024;DOI:10.1001/jamaneurol.2024.4447.
