Provisional diagnostic criteria for depression in Parkinson's disease: Report of an NINDS/NIMH Work Group

Abstract

Mood disorders are the most common psychiatric problem associated with Parkinson's disease (PD), and have a negative impact on disability and quality of life. Accurate diagnosis of depressive disturbances in PD is critical and will facilitate the testing and use of new interventions; however, there are no clear diagnostic criteria for depressive disorders in PD. In their current form, strict Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria are difficult to use in PD and require attribution of specific symptoms to PD itself or the depressive syndrome. Additionally, DSM criteria for major depression and dysthymia exclude perhaps half of PD patients with comorbid clinically significant depression. This review summarizes an NIH-sponsored workshop and describes recommended changes to DSM diagnostic criteria for depression for use in PD. Participants also recommended: (1) an inclusive approach to symptom assessment to enhance reliability of ratings in PD and avoid the need to attribute symptoms to a particular cause; (2) the inclusion of subsyndromal depression in clinical research studies of depression of PD; (3) the specification of timing of assessments for PD patients with motor fluctuations; and (4) the use of informants for cognitively impaired patients. The proposed diagnostic criteria are provisional and intended to be defined further and validated but provide a common starting point for clinical research in PD-associated depression.

Depression rating scales in Parkinson's disease: Critique and recommendations

“…It is unclear whether an inclusive approach (i.e., rating all symptoms that are present on a depression scale without judgment of their specific relation to depression) should be adopted for rating scales as has been suggested when applying diagnostic criteria for depression. 9 The decision about how to rate these symptoms is not trivial and markedly affects study results. 10 The use of scales (and diagnostic criteria), which automatically include all somatic symptoms may lead to inflated depression scores.…”

“…com/jpages/0885-3185/suppmat. Whilst we recognize the limitations of the diagnostic criteria in DSM-IV and the recent recommendations to improve these criteria, 9 these criteria and structured/semistructured interviews for DSM-IV or ICD-10 diagnoses were used as the available "gold standard" and as a measure of criterion validity in the available literature.…”

“…The criteria for assessment of depressive disorder of dPD are undergoing changes, 9 and the validity of depression rating scales using these assessment criteria will need to be established.…”

“…However, the use of these criteria (or other criteria such as the those of the International Classification of Diseases ) in PD has shortfalls, and recommendations have been made to revise the DSM-IV criteria for depressive disorder when applied to PD to overcome these methodological difficulties. 9 Although a discussion of the validity of these criteria for depression in patients with PD is not the subject of this manuscript, these problems and their impact on the use of scales to assess of presence and severity of depression in patients with PD are recognized and discussed.…”

Depression in Older Adults

“…Depression associated with Parkinson's disease (PD) is a milder form of depression and is less frequently associated with dysphoria and anhedonia than is depression in older adults without neurological illness (Ehrt, Bronnick, Leentjens, Larsen, & Aarsland, 2006). In order to avoid underdiagnosing depression in PD, a study group that proposed a specific syndrome, depression of Parkinson's disease, recommends an inclusive approach in which all symptoms are "counted" towards a diagnosis of major depression even if they overlap with PD symptoms (Marsh et al, 2006).…”