Journal
MOVEMENT DISORDERS
Volume 36, Issue 11, Pages 2549-2558Publisher
WILEY
DOI: 10.1002/mds.28548
Keywords
Parkinson' s disease; telemedicine; depression; evidence‐ based care
Categories
Funding
- US Department of Veterans Affairs, Health Services Research and Development Service [IRR 14-353]
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This study compared the efficacy of individual Parkinson's-informed, video-to-home cognitive-behavioral therapy with clinic-based treatment for depression in Parkinson's disease. The results showed that video-to-home cognitive-behavioral therapy outperformed clinic-based treatment across multiple depression measures, with effects maintained through 6 months follow-up.
Background For several decades, a myriad of factors have contributed to the inadequate diagnosis and management of depression in Parkinson's disease (PD), leaving up to 60% of significantly symptomatic patients untreated. Poor access to evidence-based neuropsychiatric care is one major barrier to achieving optimal Parkinson's outcomes. Objective The goal of this study was to compare the efficacy of individual Parkinson's-informed, video-to-home cognitive-behavioral therapy (experimental group), to clinic-based treatment as usual (control group), for depression in PD. Method Ninety United States military veterans with clinical diagnoses of both depression and PD were computer-randomized (1:1) to either the experimental or control group; randomization was stratified by baseline antidepressant use and blind to all other baseline data. The acute treatment period spanned 10 weeks and was followed by a 6-month extension phase. The Hamilton Depression Rating Scale was the a priori primary outcome. Depression treatment response was defined as a score <= 2 on the Clinical Global Impression Improvement Scale. All statistical analyses were intent to treat. Results Video-to-home cognitive-behavioral therapy outperformed clinic-based treatment as usual across three separate depression measures (P < 0.001). Effects were observed at the end of acute treatment and maintained through 6-month follow-up. Number needed to treat (based on treatment response classification) was 2.5 with an absolute risk reduction of 40%. Conclusion Video-to-home cognitive-behavioral therapy may be an effective intervention to bypass access barriers to specialized, evidence-based depression care in PD and to address the unmet neuropsychiatric treatment needs of the Parkinson's community. (c) 2021 International Parkinson and Movement Disorder Society
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