Practice Parameter: Evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review): [RETIRED]

Abstract

Abstract-Objective: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)? Methods: A nine-member multispecialty committee evaluated available evidence from a structured literature review using MEDLINE, and the Cochrane Database of Health and Psychosocial Instruments from 1966 to 2004. Additional articles were identified by panel members. Results: The Beck Depression Inventory-I, Hamilton Depression Rating Scale, and Montgomery Asberg Depression Rating Scale should be considered to screen for depression in PD (Level B). The Mini-Mental State Examination and the Cambridge Cognitive Examination should be considered to screen for dementia in PD (Level B). Amitriptyline may be considered to treat depression in PD without dementia (Level C). For psychosis in PD, clozapine should be considered (Level B), quetiapine may be considered (Level C), but olanzapine should not be considered (Level B). Donepezil or rivastigmine should be considered for dementia in PD (Level B) and rivastigmine should be considered for DLB (Level B). Conclusions: Screening tools are available for depression and dementia in patients with PD, but more specific validated tools are needed. There are no widely used, validated tools for psychosis screening in Parkinson disease (PD). Clozapine successfully treats psychosis in PD. Cholinesterase inhibitors are effective treatments for dementia in PD, but improvement is modest and motor side effects may occur. NEUROLOGY 2006;66:996-1002 Statement of purpose.The Quality Standards Subcommittee (QSS) develops scientifically sound, clinically relevant practice parameters to guide the practice of neurology. This article discusses treatments for the management of patients with depression, psychosis, and dementia in Parkinson disease (PD). These recommendations address the needs of neurologists and other clinicians caring for people with PD, patients and caregivers, research funding agencies, and researchers in movement disorders.Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the April 11 issue to find the title link for this article. R E T I R E D R E T I R E DThis guideline provides answers to the following questions:1. In patients with PD, what are the most accurate tools to screen for depression, psychosis, and dementia? 2. In patients with PD, what are the best treatments for depression and psychosis? 3. What is the most effective treatment of dementia in PD or dementia with Lewy bodies (DLB)?Background and justification. PD is the second most common neurodegenerative disease. 1 Characterized by the cardinal signs of bradykinesia, rigidity, tremor at rest, and abnor...

Pimavanserin, a Serotonin2A Receptor Inverse Agonist, for the Treatment of Parkinson's Disease Psychosis

“…Furthermore, in three placebo-controlled, double-blind, randomized trials, quetiapine failed to show superiority to placebo on measures of psychosis in PDP (Ondo et al, 2005;Rabey et al, 2006;Shotbolt et al, 2009). Nevertheless, it remains widely used as the initial drug treatment for PDP, at doses from 25 to 300 mg/day, and is the drug of choice for PDP according to the American Academy of Neurology Practice Parameters Task Force on the treatment of PD (Miyasaki et al, 2006); clozapine is recommended only after quetiapine fails to manage psychotic symptoms (Chou et al, 2007;Reddy et al, 2002;Mancini et al, 2004). Recent reports of increased mortality in elderly demented patients treated with various antipsychotic drugs (Wang et al, 2005;Ballard et al, 2009) raises additional concerns about the safety of these drugs in patients with PDP and supports the need for the development of safer treatments.…”

Psychiatric considerations in deep brain stimulation for Parkinson’s disease

“…A recent double-blind RCT demonstrated efficacy of paroxetine and venlafaxine in major depression of PD (Richard et al, 2012). Tricyclic antidepressants such as nortriptyline and desipramine have been shown to be efficacious (Miyasaki et al, 2006). Psychotherapy or couple counseling should be considered, given the significant changes in identity and social interactions.…”

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“…65 Advanced age, impaired vision, depression, sleep disorders, and longer disease duration and quetiapine (level C). 67 Although there are stronger data for the efficacy of clozapine for PD psychosis, it is used rarely in practice because of the concern for agranulocytosis and mandated blood monitoring. As a result, quetiapine is typically used first and, if it is not helpful, clozapine is then substituted.…”