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.
RATIONALE FOR RETIREMENT
The 2006 AAN guideline “Practice Parameter: Evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review)” has been retired by the Guideline Development, Dissemination, and Implementation Subcommittee on February 23, 2018, due to this guideline not having been updated or reaffirmed in five years or less after the previous publication or reaffirmation, per the Board of Directors-approved automatic retirement policy, which mandates that all guidelines that fit this criteria will be will be retired automatically unless an update is identified and initiated. The recommendations and conclusions in all retired guidelines are considered no longer valid and no longer supported by the AAN. Retired guidelines will remain available on our website for reference use only. If you would like more information on this guideline or the guideline process, please email guidelines{at}aan.com.
Disputes & Debates: Rapid online correspondence
- Practice Parameter: Evaluation and treatment of depression, psychosis, and dementia in PD
- Practice Parameter: Evaluation and treatment of depression, psychosis, and dementia in PD
- Reply from the Authors (to Aarsland et al and Montgomery)
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