Background
Methods
Search strategy
Selection & eligibility
Assessment of quality
Data extraction & synthesis of evidence
Results
Study selection
Guideline characteristics
Author (year) | Organiz-ation | Primary conditiona | Focus | Region of origin | # of Committee membersi | #of Refs | Systematic search (Y/N) | Grading of evidence (Y/N) | Funding (NS, P, NC, G)j | Mean quality score |
---|---|---|---|---|---|---|---|---|---|---|
Zesiewicz et al. (2010) [35] | The American Academy of Neurology (AAN) | PD | Treatment | USA | 9 | 40 | Y | Y | NC | 4.5 |
No Author (2010)b [37] | Scottish Intercollegiate Guidelines Network (SIGN) | PD | Diagnosis Treatment | Scotland | 20 | 189 | Y | Y | G | 6 |
Grimes et al. (2012)c [34] | Canadian Neurological Sciences Federation (CNSF) & Parkinson Society Canada | PD | Diagnosis Treatment | Canada | 22 | 62 | Y | Y | NC & P | 6.5 |
Berardelli et al. (2013) [38] | European Federation of Neurological Societies & Movement Disorder Society—European Section (EFNS-MDS-ES) | PD | Diagnosis | Europe | 25 | 245 | Y | Y | NS h | 5 |
Ferreira et al. (2013) [40] | European Federation of Neurological Societies & Movement Disorder Society—European Section (EFNS-MDS-ES) | PD | Treatment | Europe | 22 | 363 | Y | Y | NC | 4.5 |
Hort et al. (2010) [47] | European Federation of Neurological Societies (EFNS) | Dementia | Diagnosis Treatment | Europe | 8 | 100 | Y | Y | NC | 4.25 |
No Author (2010) [42] | Ministry of Health, Social Services and Equality & Agency for Health Quality and Assessment of Catalonia (AIAQS) | Dementia | Diagnosis Treatment | Spain | 67 | 688 | Y | Y | NC & G | 5.75 |
No Author (2011)d [41] | National Institute for Health and Care Excellence, National Collaborating Centre for Mental Health, British Psychological Society & The Royal College of Psychiatrists (NICE) | Dementia | Diagnosis & Treatment | UK | 28 | NNh | Y | Y | NC & G | 6.5 |
Ihl et al. (2011) [44] | World Federation of Societies of Biological Psychiatry (WFSBP) | Dementia | Treatment | International | 39 | 215f | Y | Y | NC | 4.5 |
No Author (2011) [43] | Clinical Research Centre for Dementia (CRCD) | Dementia | Diagnosis | South Korea | 20 | NNh | Y | Y | G | 5.25 |
O’Brien et al. (2011) [60] | British Association of Psychopharmacology (BPA) | Dementia | Treatment | UK | 16 | 148f | N | Y | NC & P | 4 |
Sorbi et al. (2012) [45] | European Federation of Neurological Societies & European Neurological Society (EFNS-ES) | Dementia | Diagnosis Treatment | Europe | 17 | 189 | Y | Y | NC | 4.5 |
Gauthier et al (2012)e [50] | Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD4) | Dementia | Diagnosis Treatment | Canada | 38 | 19 | Y | Y | NC | 5.5 |
Gelenberg et al. (2010)g [39] | American Psychiatric Association (APA) | Depression | Treatment | USA | 7 | 1170 | Y | Y | NC | 4.75 |
Dua et al. (2011) [49] | World Health Organization (WHO) | Mental Health | Diagnosis Treatment | International | 29 | 36 | Y | Y | NC & G | 5.5 |
No Author (2012) [46] | Ministry of Health, Social Services and Equality & Galician Health Technology Assessment Agency (Availia-T) | Suicide | Diagnosis Treatment | Spain | 24 | 683 | Y | Y | NC & G | 5 |
Mitchell et al. (2013) [48] | Institute for Clinical Systems Improvement (ICSI) | Depression | Diagnosis Treatment | USA | 14 | 331 | Y | Y | NC | 5.75 |
Study quality
Guideline (year) | Domain 1 score scope & purpose | Domain 2 score stakeholder involvement | Domain 3 score rigour of development | Domain 4 score clarity of presentation | Domain 5 score applicability | Domain 6 score editorial independence |
---|---|---|---|---|---|---|
Parkinson’s Disease | ||||||
Zesiewicz et al. (2010) [35] | 56.9 | 29.2 | 64.6 | 72.2 | 17.7 | 79.2 |
SIGN (2010)a [37] | 80.6 | 80.6 | 72.9 | 91.7 | 72.9 | 22.9 |
Grimes et al. (2012)c [34] | 70.8 | 95.8 | 90.6 | 87.5 | 60.4 | 58.3 |
Berardelli et al. (2013) [38] | 72.2 | 19.4 | 47.9 | 86.1 | 12.5 | 6.3 |
Ferreira et al. (2013) [40] | 47.2 | 15.3 | 43.2 | 66.7 | 6.25 | 20.8 |
Dementia | ||||||
NICE (2011)b [41] | 83.3 | 81.9 | 86.5 | 87.5 | 64.6 | 47.9 |
Hort et al. (2010) [47] | 58.3 | 38.9 | 54.2 | 66.7 | 25.0 | 62.5 |
AIAQS (2010) [42] | 87.5 | 69.4 | 73.4 | 84.7 | 57.3 | 79.2 |
Ihl et al. (2011) [44] | 68.1 | 38.9 | 57.8 | 48.6 | 19.8 | 64.6 |
CRCD (2011) [43] | 86.1 | 62.5 | 74.5 | 81.9 | 51.0 | 54.2 |
O’Brien et al (2011) [60] | 59.7 | 63.9 | 46.4 | 76.4 | 20.8 | 68.8 |
Sorbi et al. (2012) [45] | 68.1 | 38.9 | 53.7 | 65.3 | 26.0 | 62.5 |
Gauthier et al (2012)d [50] | 73.6 | 70.8 | 70.8 | 87.5 | 50.0 | 79.2 |
Mental Health | ||||||
Gelenberg et al. (2010) [39] | 68.1 | 41.7 | 61.5 | 66.7 | 32.3 | 60.4 |
Dua et al. (2011) [49] | 70.8 | 41.7 | 66.7 | 84.7 | 68.7 | 93.8 |
Avalia-T (2012) [46] | 88.9 | 70.8 | 79.2 | 75.0 | 49.0 | 60.4 |
Mitchell et al. (2013) [48] | 86.1 | 66.7 | 75.0 | 80.6 | 71.9 | 85.4 |
Average Domain Score (SD) | 72.1 (12.1) | 54.5 (23.3) | 65.8 (13.9) | 77.0 (11.4) | 41.5 (22.6) | 59.2 (23.7) |
Guideline recommendations
Anxiety | |
Evidence for the Management & Treatment of Anxiety in PD is Lacking. | |
Level of Evidence | AAN Level U (Uncertain or Lack of Evidence) |
Guidelines | |
Depression | |
Screening for Depression in PD is recommended. | |
Level of Evidence | EFNS Level A (Effective), SIGN Grade C (Case Control to Cohort Evidence) |
Guidelines | |
There are several available tools screening for Depression in PD. | |
Level of Evidence | SIGN Level C & Good Practice Point (GDS, BDI, HADS, MADRS & HDRS) & EFNS Class I (Diagnostic Accuracy Study)(MDS-UPDRS) |
Guidelines | |
Comment | A patient with PD should be screened for depression with either a clinician or self-rated tool. Diagnosis should not be based on the solely on the tool. Those with a positive screening test should be referred for further assessment and diagnosis (including collateral history). |
Practitioners should have a low threshold for diagnosing Depression in PD. | |
Level of Evidence | CFNS Good Practice Point |
Guidelines | Grimes et al. (2012) [34] |
Treatment of Depression in PD needs to be individualized to each case. | |
Level of Evidence | CFNS Good Practice Point |
Guidelines | Grimes et al. (2012) [34] |
Anti-depressant Therapy is recommended; there is little evidence to suggest one agent over another. | |
Guidelines | |
Tricyclic Antidepressants (e.g. Amitriptyline or Desipramine) have some evidence for treatment, but this must be balanced with the adverse effects (e.g. Anticholinergic). | |
Level of Evidence | CFNS Level C (Possibly Effective) |
Guidelines | |
Selective Serotonin Reuptake Inhibitors have some evidence for treatment, but this must be balanced with the adverse effects (e.g. RLS, PLM, RBD). | |
Level of Evidence | EFNS Class II (Prospective Matched Group Cohort or Controlled Trial) to Class IV (Uncontrolled Studies), APA Level II (Moderate Clinical Evidence) |
Guidelines | |
Certain agents such as Amoxapine or Lithium should be avoided due to worsening of PD Symptoms. | |
Guidelines | Gelenberg et al. (2010) [39] |
There is some evidence for the use of dopamine agonists (e.g. Pramipexole) & MAOI (e.g. Selegiline) for depression, but not for levodopa. | |
Level of Evidence | EFNS Class I (RCT), Class III (Other Controlled Trial), APA Level I (Recommended with substantial confidence) |
Guidelines | |
There is insufficient evidence regarding the use of ECT, TCMS and psychotherapy in depression with PD. | |
Guidelines |
Anxiety | |
Patients with Dementia should be assessed for Anxiety (e.g. HADS). | |
Level of Evidence | AIAQS Level D (Expert Opinion) |
Guidelines | |
Psychological Interventions can be considered for Anxiety in Dementia | |
Guidelines | NICE (2011) [41] |
There is little evidence about the treatment of Anxiety in those with Dementia. Cholinesterase Inhibitors can be considered for treating Dementia-related behaviours, including anxiety. | |
Level of Evidence | AIAQS Level A (Meta-analysis or RCT) |
Guidelines | AIAQS (2010) [42] |
Depression | |
Patients experiencing Dementia should be evaluated for Depression, including possible secondary causes. | |
Level of Evidence | CRCD Level A (Useful), AIAQS Level D, WFSBP Grade 3 (Limited Evidence from Controlled Studies), EFNS GPP |
Guidelines | |
Patients with Depression in Dementia should be evaluated for suicide risk, however evidence varies. | |
Level of Evidence | APA Level I (Substantial Clinical Confidence) or Inconclusive |
Guidelines | |
Use of a valid screening tool (e.g. CSDD, GDS, HADS or DMAS) for Depression is recommended. | |
Level of Evidence | AIAQS Level D to Good Practice Point, Low Quality Evidence, EFNS GPP/Class II (Prospective Study) |
Guidelines | |
fMRI needs further study to determine its utility in Depression in the context of Dementia | |
Level of Evidence | CCCDT4 Grade 2C (Moderate Recommendation, Low Level Evidence) |
Guidelines | Gauthier et al. (2012) [50] |
Therapy for Depression in Dementia should include a variety of Non-pharmacologic options. | |
Level of Evidence | AIAQS Level C (Case-control, Cohort), APA Level II (Moderate Clinical Confidence) |
Guidelines | |
Comment | These include: cognitive behavioural therapy, reminiscence therapy, multi-sensory stimulation, animal-assisted therapy, exercise, stimulation-oriented treatment (recreational or pleasurable activities), or improvements to a living situation. Consider the involvement of carers. |
Although evidence is mixed, a trial of Anti-depressants could be considered for Depression in Dementia. | |
Level of Evidence | CCCDT4 Grade 2A (Moderate Recommendation, High Level Evidence), EFNS Class IV (Un-blinded, Expert Opinion), WFSBP Grade 5 (Inconsistent Results), APA Level II (Moderate Clinical Confidence) |
Guidelines | |
When choosing an anti-depressant (E.g. SSRIs, SNRIs or TCAs) it is important to consider the anticholinergic side effects. | |
Level of Evidence | EFNS Level B (Case-control, Cohort), EFNS Class IV (Un-blinded, Expert Opinion), APA Level I (Substantial Clinical Confidence) to APA Level II (Moderate Clinical Confidence), AIAQS Level B |
Guidelines | |
Comment | SSRIs (Citalopram or Sertraline) and TCAs have similar efficacy, but TCAs are not recommended given anticholinergic effects. SSRIs appear to be better tolerated. Other agents such as bupropion, venlafaxine and mirtazapine may be effective. |
Stimulants can be considered for treatment of Depression in Dementia. | |
Level of Evidence | APA Level III (Depends on Individual Circumstances), AIAQS Level B (Case-control, Cohort) |
Guidelines | |
Cholinesterase Inhibitors can be considered for treating Dementia-related behaviours, including depression. | |
Level of Evidence | AIAQS Level A (Meta-analysis or RCT) |
Guidelines | AIAQS (2010) [42] |
ECT can be considered in certain cases for Depression in those with Dementia. | |
Level of Evidence | APA Level II (Moderate Clinical Confidence) |
Guidelines | Gelenberg et al. (2010) [39] |
Cholinesterase Inhibitors may improve neuropsychiatric symptoms in Lewy Body Disease | |
Level of Evidence | Level A (Meta-analysis or RCT) |
Guidelines | O’Brien et al (2011) [60] |