Innovating Parkinson's Care: A Randomized Controlled Trial of Telemedicine Depression Treatment

Abstract

A BS TRACT: 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 evidencebased 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-tohome 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.

Depression in Patients with Parkinson’s Disease: Current Understanding of its Neurobiology and Implications for Treatment

“…In addition, randomized clinical trials consistently demonstrated the effectiveness of cognitive behavioral therapy in depressed patients with PD [21,288]. Interestingly, use of telemedicine with video-to-home cognitive behavioral therapy was recently demonstrated to be an effective treatment in randomized controlled clinical trials in comparison with usual clinic-based treatment [291], in addition to the efficacy of telephone-based cognitive behavioral therapy [292,293], confirming an earlier randomized controlled trial in depressed PD outpatients [294].…”

Diagnosis and Treatment of Cognitive and Neuropsychiatric Symptoms in Parkinson Disease and Dementia With Lewy Bodies

“…Psychological interventions for depression, such as cognitive-behavioral therapy (CBT), are beneficial in treating PD. Recently, RCTs of a telemedicine intervention found that a 3-month course of PD-tailored CBT (administered either by phone or web-based video conferencing) was associated with significant improvements in depression when compared with usual care, 21-23 with results comparable to those observed in face-to-face trials. Various forms of aerobic training (eg, stretching-strengthening exercise, walking, and stepping movement) have also been found to positively impact depression 24 .…”

Criticism in the Parkinson’s Caregiving Relationship: A Key Target for Intervention

“…Participants were recruited as part of a randomized controlled trial examining a telehealth intervention for depression in PD. 25 The current study focused on baseline data for the subset of participants who enrolled with a caregiver (83 out of 90 Veterans). Please refer to the consort diagram in the primary publication for additional details related to the recruitment pipeline.…”

“…Please refer to the consort diagram in the primary publication for additional details related to the recruitment pipeline. 25…”

“…Since the current study is based on secondary analysis of baseline data from a randomized controlled trial, sample size estimates were derived to support the RCT's primary analyses. 25…”