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病（PD）患者抑郁障碍的检测。65岁以上的人群中有1%患有帕金森病。虽然进行性运动异常是帕金森病的标志，但抑郁症影响多达50%的患者，比运动功能障碍更严重地影响生活质量，加重运动和认知缺陷，并且是过度残疾、经济压力和照顾者痛苦的主要来源。然而，临床医生往往不能充分诊断或治疗PD患者的抑郁症。由于大多数PD患者不去看精神科医生，PD和情绪障碍的专家已经确定需要有效的方法来促进非精神科临床医生对抑郁症的识别。为了解决在医学疾病中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机构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本身的特征直接重叠，PD中的大多数抑郁症不符合重性抑郁症的标准，并且PD中其他常见的精神合并症（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，PD患者抑郁症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病学实践中抽取800名PD患者的样本。使用筛选和诊断的两阶段设计，抑郁评级工具的心理测量特性将相对于由具有老年精神病学和运动障碍专业知识的精神病学家小组确定的最佳估计诊断进行评估。与以往的研究不同，MOOD-PD研究的结果将直接适用于临床环境。具体目的是：1)评估和比较现有抑郁评估工具的心理测量特性，相对于金标准诊断程序，用于识别PD患者的抑郁障碍（例如，重度抑郁和轻度抑郁）；2)确定其他非抑郁情感综合征（如焦虑和冷漠）对PD患者抑郁评定工具检测抑郁障碍性能的影响；3)对经金标准程序确定的抑郁症患者进行随访评估，评价抑郁测量方法识别持续性抑郁的能力；4)基于Aims 1-3的结果，利用抑郁评估工具制定指南，优化PD患者临床显著抑郁的检测。

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.