Dobkin Roseanne D, Mann Sarah L, Weintraub Daniel, Rodriguez Kailyn M, Miller Rachael B, St Hill Lauren, King Arlene, Gara Michael A, Interian Alejandro
Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey, USA.
VA New Jersey Health Care System, Lyons, New Jersey, USA.
Mov Disord. 2021 Nov;36(11):2549-2558. doi: 10.1002/mds.28548. Epub 2021 Mar 12.
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.
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.
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.
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%.
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. © 2021 International Parkinson and Movement Disorder Society.
几十年来，众多因素导致帕金森病（PD）患者的抑郁症诊断和管理不足，多达60%有明显症状的患者未得到治疗。难以获得循证神经精神科护理是实现最佳帕金森病治疗效果的一个主要障碍。
本研究的目的是比较针对帕金森病患者的个体化视频居家认知行为疗法（实验组）与常规门诊治疗（对照组）对PD患者抑郁症的疗效。
90名临床诊断为抑郁症和PD的美国退伍军人通过计算机随机（1:1）分为实验组或对照组；随机分组按基线抗抑郁药使用情况分层，对所有其他基线数据设盲。急性治疗期为10周，随后是6个月的延长期。汉密尔顿抑郁量表是预先设定的主要结局指标。抑郁治疗反应定义为临床总体印象改善量表评分≤2分。所有统计分析均采用意向性分析。
在三项独立的抑郁测量指标上，视频居家认知行为疗法的效果优于常规门诊治疗（P<0.001）。在急性治疗结束时观察到效果，并在6个月的随访中持续存在。治疗所需人数（基于治疗反应分类）为2.5，绝对风险降低40%。
视频居家认知行为疗法可能是一种有效的干预措施，可绕过PD患者获得专业循证抑郁护理的障碍，并满足帕金森病群体未得到满足的神经精神治疗需求。©2021国际帕金森病和运动障碍协会。
