Portal de Periódicos da CAPES

Depression Rating Scales in Parkinson’s Disease: Critique and Recommendations

2012; Oxford University Press; Linguagem: Inglês

10.1093/med/9780199783106.003.0784

Anette Schrag,

Parkinson's Disease Mechanisms and Treatments

Abstract Depression is a common comorbid condition in Parkinson’s disease and a major contributor to poor quality of life and disability. However, depression can be difficult to assess in patients with PD due to overlapping symptoms and difficulties in the assessment of depression in cognitively impaired patients. The scales to assess depression in PD reviewed here are the Beck Depression Inventory (BDI), Hamilton Depression Scale (Ham-D), Hospital Anxiety and Depression Scale (HADS), Zung Self-Rating Depression Scale (SDS), Geriatric Depression Scale (GDS), Montgomery-Asberg Depression Rating Scale (MADRS), Unified Parkinson’s Disease Rating Scale (UPDRS) Part I, Cornell Scale for the Assessment of Depression in Dementia (CSDD), and Center for Epidemiologic Studies Depression Scale (CES-D). In keeping with the previous MDS-commissioned Task Force report, the recommendation is that the most appropriate scale (and cutoff) is dependent on the clinical or research goal. A diagnosis of depressive illness should not be made based on scale scores alone. Overall, observer-rated scales are preferred if the study or clinical situation permits. The Ham-D, MADRS, BDI, HADS, CSDD, and GDS are “Recommended” instruments in dPD for screening for dPD. The SDS also fulfilled criteria for “Recommended” but needs further validation studies. The CES-D has not been adequately tested in dPD. The UPDRS and MDS-UPDRS depression item is a single question, and whilst formally fulfilling criteria for a “Recommended” scale, it should be used with caution. For severity rating, currently the Ham-D, MADRS, BDI, and SDS are “Recommended.” The HADS and the GDS include limited motor symptom assessment and may therefore be most useful in rating depression severity across a range of PD severity; however, these scales appear insensitive in severe depression and have not been sufficiently assessed for rating severity of dPD. To account for overlapping motor and non-motor symptoms of depression, adjusted instrument cutoff scores should be employed in screening for dPD, and scales to assess severity of motor symptoms (e.g., MDS-UPDRS) should be used to adjust for overlapping symptoms in studies assessing depression severity.