Guidelines for dementia or Parkinson's disease with depression or anxiety: a systematic review.

Scott Patten,Zahra Goodarzi,Bria Mele,Heather Hanson,Tamara Pringsheim,Nathalie Jette,Selynne Guo,Jayna Holroyd-Leduc

doi:10.1186/s12883-016-0754-5

Scott Patten, Zahra Goodarzi + Show 6 more

Open Access

https://doi.org/10.1186/s12883-016-0754-5

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Abstract

BackgroundDepression and anxiety remain under-diagnosed and under-treated in those with neurologic diseases such as dementia or Parkinson’s Disease (PD). Our objectives were to first, to provide a synthesis of high quality guidelines available for the identification and management of depression or anxiety in those with dementia or PD. Second, to identify areas for improvement for future guidelines.MethodsWe searched MEDLINE, PsycINFO, and EMBASE (2009 to July 24, 2015), grey literature (83 sources; July 24-Sept 6, 2015), and bibliographies of included studies. Included studies were evaluated for quality by four independent reviewers the AGREE II tool. Guideline characteristics, statements and recommendations relevant to depression or anxiety for dementia and PD were then extracted. (PROSPERO CRD: 42016014584)Results8121 citations were reviewed with 31 full text articles included for assessment with the AGREE II tool. 17 were of sufficient quality for inclusion. Mean overall quality scores were between 4.25 to 6.5. Domain scores were lowest in the areas of stakeholder involvement, applicability, and editorial independence.Recommendations for the screening and diagnosis of depression were found for PD and dementia. There was little evidence to guide diagnosis or management of anxiety. Non-pharmacologic therapies were recommended for dementia patients. Most advocated pharmacologic treatment for depression, for both PD and dementia, but did not specify an agent due to lack of evidence.ConclusionsThe available recent high quality guidelines outline several recommendations for the management of comorbid depression or anxiety in PD or dementia. However there remain significant gaps in the evidence.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-016-0754-5) contains supplementary material, which is available to authorized users.

Highlights

Depression and anxiety remain under-diagnosed and under-treated in those with neurologic diseases such as dementia or Parkinson’s Disease (PD)
20% of PD patients diagnosed with depression receive therapy [18]
The study protocol follows the recommendations provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)—Protocols Statement [29] and guidelines and the protocol was registered with PROSPERO [30] (CRD: 42016014584)

Summary

Introduction

Depression and anxiety remain under-diagnosed and under-treated in those with neurologic diseases such as dementia or Parkinson’s Disease (PD). Persons experiencing neurologic disorders, such as dementia or Parkinson’s disease (PD), and depressive or anxiety disorders have poorer outcomes with reduced quality of life, poor functional status and worsened cognition [1,2,3,4,5,6,7,8]. In PD, approximately 17% of Despite awareness of these comorbidities, depression and anxiety remain under-diagnosed and under-treated in those with neurologic diseases [1, 3, 13,14,15,16,17]. 20% of PD patients diagnosed with depression receive therapy [18]. CPGs are targeted at practitioners who apply the recommendations to clinical decision-making and reduce disparities in care [19,20,21,22]

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