Methods of Optimal Depression Detection in Parkinson's

描述(由申请人提供)：MOOD-PD研究的目标是优化帕金森氏病(PD)患者抑郁障碍的检测。帕金森病影响1%的65岁以上人口。虽然进行性运动异常是帕金森氏症的特征，但抑郁症影响多达50%的患者，比运动功能障碍更容易导致生活质量受损，加剧运动和认知障碍，是过度残疾、经济压力和照顾者痛苦的主要来源。然而，临床医生往往未能充分诊断或治疗帕金森病患者的抑郁。由于大多数帕金森病患者不去看精神科医生，帕金森病和情绪障碍方面的专家已经认识到，需要有效的方法来促进非精神科临床医生对抑郁症的认识。为了解决内科疾病患者对抑郁症认识不足的问题，美国预防服务工作组现在建议在初级保健环境中进行常规抑郁症筛查。然而，在没有对其有效性进行具体评估的情况下，不能向PD患者推荐通用方法。这是因为抑郁症的临床特征与PD本身的临床特征直接重叠，PD中的大多数抑郁障碍不符合严重抑郁症的标准，并且PD中其他常见的精神疾病(例如，冷漠和焦虑)可能被误诊为抑郁症。此外，时间限制限制了对运动和情绪状态的全面评估。因此，帕金森病抑郁的最佳检测需要有效和高效的筛查方法。为了提供这样的方法，MOOD-PD研究将从两个社区神经学实践中抽取800名PD患者作为样本。使用筛查和诊断的两阶段设计，将根据一个在老年精神病学和运动障碍方面具有专业知识的精神病学家小组确定的最佳估计诊断来评估抑郁评级工具的心理测量特性。与以前的研究不同，MOOD-PD研究的结果将直接适用于临床环境。具体目的是：1)相对于金标准诊断程序，评估和比较用于识别PD患者中的抑郁障碍(例如，重度抑郁和轻微抑郁)的现有抑郁评估工具的心理测量学特性；2)确定其他非抑郁情感综合征(例如，焦虑和冷漠)对用于检测PD患者中的抑郁障碍的抑郁评估工具的性能的影响；3)对由黄金标准程序确定为抑郁症的诊断为抑郁症的患者进行跟踪评估，以评估抑郁措施识别持续抑郁的能力；4)根据目标1-3的结果，开发使用抑郁评估工具的指南，以优化对帕金森病患者临床上有意义的抑郁的检测。

DESCRIPTION (provided by applicant): The goal of the MOOD-PD Study is to optimize detection of depressive disorders in patients with Parkinson's disease (PD). PD affects 1% of the population over age 65. While progressive motor abnormalities are the hallmark of PD, depression affects up to 50% of patients, contributes to impaired quality of life more than motor dysfunction, aggravates motor and cognitive deficits, and is a major source of excess disability, economic strain, and caregiver distress. Yet, clinicians often fail to diagnose or treat depression in PD adequately. Since most PD patients do not see psychiatrists, specialists in both PD and mood disorders have identified the need for valid methods to facilitate depression recognition by nonpsychiatric clinicians. To address under-recognition of depression in the medically ill, the US Preventive Services Task Force now recommends routine depression screening in primary care settings. However, generic approaches cannot be recommended for PD patients without specific assessment of their validity. This is because clinical features of depression overlap directly with those of PD itself, most depressive disorders in PD do not meet criteria for major depression, and other common psychiatric co-morbidities in PD (e.g., apathy and anxiety) can be misdiagnosed as depression. In addition, time constraints limit comprehensive assessments of motor and mood status. Thus, optimal detection of depression in PD requires valid and efficient screening methods. In order to provide such methods, the MOOD-PD study will draw on a sample of 800 PD patients from two community-based neurology practices. Using a two-stage design for screening and diagnosis, the psychometric properties of depression rating instruments will be assessed relative to the best estimate diagnoses determined by a panel of psychiatrists with expertise in geriatric psychiatry and movement disorders. Unlike previous studies, results of the MOOD-PD study will be directly applicable in clinical settings. The Specific Aims are: 1) To evaluate and compare the psychometric properties of existing depression assessment tools, relative to gold-standard diagnostic procedures, for identifying depressive disorders (e.g., major depression and minor depression) in PD patients; 2) To determine the influence of other nondepressive affective syndromes (e.g., anxiety and apathy) on performance of depression rating tools for detecting depressive disorders in PD patients; 3) To conduct follow-up assessments in the patients with the diagnosis of depression, as determined by the gold-standard procedures, to evaluate the ability of the depression measures to identify persistent depression; 4)To develop guidelines using depression assessment tools for optimizing the detection of clinically significant depression in PD, based on the results of Aims 1-3.