Definitions of the classification of screening evidence (Class I–IV), classification of therapeutic evidence (Class I–IV), and strength of recommendations (A, B, C, U) are provided at the end of the "Major Recommendations" field.
In Patients with Parkinson Disease (PD), Which Are the Most Accurate Tools to Screen for Depression?
Recommendations
The Beck Depression Inventory-I (BDI-I) and Hamilton Depression Rating Scale (HDRS) should be considered for depression screening in PD (Level B).
Montgomery Asberg Depression Rating Scale (MADRS) may be considered for screening for depression associated with PD (Level C).
In Patients with PD, Which Are the Most Accurate Tools to Screen for Psychosis?
Recommendations
No recommendation is made.
In Patients with PD, Which Are the Most Accurate Tools to Screen for Dementia?
Recommendation
The Mini-Mental State Examination (MMSE) and the Cambridge Cognitive Examination (CAMCog) should be considered as screening tools for dementia in patients with PD (Level B).
In Patients with PD, What Is the Best Pharmacologic Treatment for Depression?
Recommendations
Amitriptyline may be considered in the treatment of depression associated with PD (Level C). Although the highest level of evidence is for amitriptyline, it is not necessarily the first choice for treatment of depression associated with PD. There is insufficient evidence to make recommendations regarding other treatments for depression in PD. Absence of literature demonstrating clear efficacy of non-tricyclic antidepressants is not the same as absence of efficacy.
In Patients with PD and Depression, What Are the Best Nonpharmacologic Treatments?
Recommendation
No recommendations were made.
In Patients With PD and Psychosis, What Is the Best Treatment?
Recommendations
For patients with PD and psychosis, clozapine should be considered (Level B). Clozapine use is associated with agranulocytosis that may be fatal. The absolute neutrophil count must be monitored. Monitoring requirements may vary according to country.
For patients with PD and psychosis, quetiapine may be considered (Level C).
For patients with PD and psychosis, olanzapine should not be routinely considered (Level B).
What Is the Most Effective Treatment for Dementia in PD or Dementia with Lewy Bodies (DLB)?
Recommendations
Donepezil should be considered for the treatment of dementia in PD (Level B).
Rivastigmine should be considered for the treatment of dementia in PD or DLB (Level B).
Definitions:
Classification of Evidence for Screening Articles
Class I: A statistical, population-based sample of patients studied at a uniform point of time (usually early) during the course of the condition. All patients undergo the intervention of interest. The outcome, if not objective, is determined in an evaluation that is masked to the patients' clinical presentations.
Class II: A statistical, non-referral-clinic-based sample of patients studied at a uniform point in time (usually early) during the course of the condition. Most patients undergo the intervention of interest. The outcome, if not objective, is determined in an evaluation that is masked to the patients' clinical presentations.
Class III: A sample of patients studied during the course of the condition. Some patients undergo the intervention of interest. The outcome, if not objective, is determined in an evaluation by someone other than the treating physician.
Class IV: Expert opinion, case reports or any study not meeting criteria for class I to III.
Classification of Evidence for Therapeutic Articles
Class I: Prospective, randomized, controlled clinical trial with masked outcome assessment, in a representative population. The following are required:
- primary outcome (s) is/are clearly defined
- exclusion/inclusion criteria are clearly defined
- adequate accounting for drop-outs and cross-overs with numbers sufficiently low to have minimal potential for bias
- relevant baseline characteristics are presented and substantially equivalent among treatment groups or there is appropriate statistical adjustment for differences
Class II: Prospective matched group cohort study in a representative population with masked outcome assessment that meets a-d above OR a randomized controlled trial (RCT) in a representative population that lacks one criterion a-d.
Class III: All other controlled trials including well-defined natural history controls or patients serving as own controls in a representative population, where outcome assessment is independently assessed or independently derived by objective outcome measurement.*
Class IV: Evidence from uncontrolled studies, case series, case reports, or expert opinion.
* Objective outcome measurement: an outcome measure that is unlikely to be affected by an observer's (patient, treating physician, investigator) expectation or bias (e.g., blood tests, administrative outcome data)
Classification of Recommendations
Level A = Established as effective, ineffective, or harmful for the given condition in the specified population. (Level A rating requires at least two consistent Class I studies.)
Level B = Probably effective, ineffective, or harmful for the given condition in the specified population. (Level B rating requires at least one Class I study or at least two consistent Class II studies.)
Level C = Possibly effective, ineffective, or harmful for the given condition in the specified population. (Level C rating requires at least one Class II study or two consistent Class III studies.)
Level U = Data inadequate or conflicting; given current knowledge, treatment is unproven.