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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

University of Toronto, Toronto, Ontario, Canada
Neurology (Impact Factor: 8.3). 05/2006; 66(7):996-1002. DOI: 10.1212/01.wnl.0000215428.46057.3d
Source: PubMed

ABSTRACT 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)?
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.
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).
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.

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    • "In PDD, extrapyramidal signs precede cognitive changes by 1 year or longer, whereas in DLB, dementia and parkinsonism co-occur within a year of each other. PD patients develop dementia at a rate of up to 10% per year (Aarsland et al., 2003), with a prevalence of 20% to 30% (Miyasaki et al., 2006). DLB is a common dementia subtype that has been recognized only in the past decades. "
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    • "In PDD, extrapyramidal signs precede cognitive changes by 1 year or longer, whereas in DLB, dementia and parkinsonism co-occur within a year of each other. PD patients develop dementia at a rate of up to 10% per year (Aarsland et al., 2003), with a prevalence of 20% to 30% (Miyasaki et al., 2006). DLB is a common dementia subtype that has been recognized only in the past decades. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Personality describes persistent human behavioral responses to broad classes of environmental stimuli. Change in personality may be an early sign of dementia. Our goal was to review scientific literature on the association between personality and dementia. Medline and Google Scholar searches were conducted for relevant articles, chapters, and books published since 1980. Search terms used included personality, dementia, Alzheimer's disease, frontotemporal dementia, dementia with Lewy bodies. People with dementia commonly exhibit changes in personality that sometimes precede the other early clinical manifestations of the condition, such as cognitive impairment. Premorbid personality might be a determining factor so that caricature or exaggeration of original personality emerges as dementia progresses. Although it is generally accepted that these personality changes reflect the impact of progressive brain damage, there are several possible patterns of personality alterations with dementia. Early identification of personality modifications might assist with the timely diagnosis of dementia.
    Journal of Nervous & Mental Disease 03/2015; 203(3):210-4. · 1.81 Impact Factor
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