Practice parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology.
Practice parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology.
American Academy of Neurology - Medical Specialty Society
Summary,
GUIDELINE OBJECTIVE(S)
To make evidence-based treatment recommendations for patients with Parkinson disease (PD) with dementia, depression, and psychosis based on these questions:
1. What tools are effective to screen for depression, psychosis, and dementia in PD?
2. What are effective treatments for depression and psychosis in PD?
3. What are effective treatments for PD dementia or dementia with Lewy bodies (DLB)?
TARGET POPULATION
Patients with Parkinson disease
INTERVENTIONS AND PRACTICES CONSIDERED
Screening
Depression
1. Beck Depression Inventory-I (BDI-I)
2. Hamilton Depression Rating Scale (HDRS)
3. Montgomery Asberg Depression Rating Scale (MADRS)
Dementia
1. Mini-Mental State Examination (MMSE)
2. Cambridge Cognitive Examination (CAMCog)
Treatment
Depression
1. Amitriptyline
Psychosis
1. Clozapine
2. Quetiapine
Dementia
1. Donepezil
2. Rivastigmine
Interventions and practices considered but not recommended include Parkinson Psychosis Rating Scale (PPRS), electroencephalogram (EEG), non-tricyclic antidepressants, olanzapine, transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), and piracetam.
MAJOR OUTCOMES CONSIDERED
* Rates of depression, psychosis, and dementia in patients with Parkinson disease
* Specificity and sensitivity of screening tools
* Side effects of treatment
* Symptom improvement
