Table 1. Management of Depression, Psychosis,
and Dementia in Parkinson Disease
Screening:
> Beck Depression Inventory (self-
completion questionnaire,
21 items, range 0–52);
> Hamilton Depression
Rating Scale (professionally
administered, 17 items,
range 0–63);
> Montgomery Asberg Depression
Rating Scale (professionally
administered, 10 items,
range 0–60).
Treatment:
> Consider amitriptyline;
> Anticholinergic side effects,
especially problematic with TCAs
(potential worsening of cognition,
orthostatic hypotension
increasing risk of falls).
Screening:
> Cambridge Cognitive
Examination (95% sensitivity,
94% specificity, covers
additional domains of
orientation, concentration,
expression,
memory, abstract thinking,
drawing, understanding,
writing);
> Mini-Mental State Examination
(98% sensitivity, 77%
specificity,
quicker to administer).
Treatment:
> Consider rivastigmine (modest
improvement of cognitive
function, also in dementia with
Lewy bodies; tremor may be
exacerbated);
> Consider donepezil (modest
improvement of cognitive
function).
Treatment:
> Consider clozapine (associated with possibly fatal agranulocytosis,
monitor absolute neutrophil count);
> Consider quesiapine.
Depression
Psychosis
Dementia
