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）患者抑郁症的检测。PD影响65岁以上人口的1%。虽然进行性运动异常是PD的标志，但抑郁症影响高达50%的患者，其对生活质量的影响超过运动功能障碍，加重运动和认知缺陷，并且是过度残疾、经济压力和护理者痛苦的主要来源。然而，临床医生往往不能充分诊断或治疗PD中的抑郁症。由于大多数PD患者不看精神科医生，PD和心境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识别抑郁症。为了解决抑郁症在医学上的认识不足，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中的大多数抑郁症不符合重度抑郁症的标准，并且PD中的其他常见精神病合并症（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，PD中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。使用两阶段设计进行筛选和诊断，抑郁症评定工具的心理测量学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科医生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。具体目标是：1）评估和比较现有抑郁症评估工具的心理测量学特性，相对于金标准诊断程序，用于识别抑郁症（例如，重度抑郁症和轻度抑郁症）; 2）确定其他非抑郁情感综合征（例如，（3）对诊断为抑郁症的患者进行随访评估，以评估抑郁量表识别持续性抑郁症的能力; 4）根据目标1-3的结果，使用抑郁评估工具制定指南，以优化PD中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.