Guidelines and Reviews Analysis
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Introduction
This assignment aims to analyze the article whose topic is; Guidelines for dementia or Parkinson’s disease with depression or anxiety: a systematic review. The authors of this article are Zahra Goodarzi, Bria Mele, Selynne Guo, Heather Hanson, Nathalie Jette, Scott Patten, Tamara Pringsheim, and Jayna Holroyd-Leduc.
No ethical review was present in the article.
Methodological Review
The article focused on searching for reliable literature from databases such as EMBASE, MEDLINE, and PsycINFO. The selection of studies was based on quality, statements, recommendations, and guideline features relating to anxiety or depression for Parkinson’s diseases and dementia. Four independent reviewers used the AGREE II tool to extract the information.
Analysis of the findings
The authors found limited guidelines that discussed anxiety in patients with Parkinson’s disease. There was little information in the guidelines relating to the diagnosis and treatment of anxiety in Parkinson’s disease. There was also little evidence for the treatment of anxiety with levodopa.
The authors were able to identify clear recommendations for the diagnosis of depression in Parkinson’s disease. Based on the review, it is difficult to make a diagnosis for depression in PD, and clinicians need to have a low threshold for the diagnosis. The authors noted that two guidelines advocated for the use of a certified tool in the detection of depression. The common tools that were recommended include the UPDRS and the HDRS. The guidelines added that the tools could not be reliable if used solely. This means that it was important to base the diagnosis on a clinical interview as well as look for collateral information from carers.
It is worth noting that the review found that patients should have an individualized agent and that it was important for the practitioner to find out about drug interactions and side effects before commencing the treatment. Some guidelines recommended antidepressant therapy, but there lacked sufficient evidence for supporting one agent over the other. According to one guideline, selective serotonin reuptake inhibitors (SSRIs) were beneficial but could worsen PD symptoms of periodic leg movement, restless legs, and sleep behavior disorder.
The findings were reliable because they were mostly based on clinical experience. The authors noted that it was recommended for patients with dementia to be assessed regularly for depression and anxiety. This should involve assessing different causes of depression and anxiety by using a valid screening tool such as the CSDD and Dementia Mood Assessment. Non-pharmacologic alternatives such as reminiscence, cognitive-behavioral, and stimulation oriented therapies were recommended.
Limitations
The article does not give conclusive guidelines on how to diagnose and treat Parkinson’s disease and dementia. The article does not provide comprehensive information that can help clinicians determine the most effective tool for diagnosing the two diseases as well as the different types of treatment options that can be applied to a particular patient. The search strategy was not effective enough for the review to identify other useful guidelines.
Discussion
The findings of this study revealed some gaps in the evidence and guideline quality, which should be considered in future research. Some of the recommendations in the guidelines could not be applied due to barriers in implementation and monitoring. If a guideline does not have a clear knowledge translation plan, implementing it to practice is a challenge. Most of the guidelines did not engage caregivers and patients, making the recommendations difficult to implement.
Application to the Practice
People suffering from dementia and PD need screening for depression and anxiety. It is important to use validated tools when carrying out the diagnosis of anxiety and depression to ensure effectiveness. Early intervention is important because it can help avoid suicide risk, which can occur if treatment is delayed.
Future Implication
Caregivers and patients of dementia and Parkinson’s disease need to be consulted to come up with recommendations that are comprehensive, applicable, and adaptable to a specific group. Since evidence keeps on changing, guidelines should also be updated regularly to ensure that procedures are in line with the available evidence.
Reference
Goodarzi, Z., Mele, B., Guo, S., Hanson, H., Jette, N., Patten, S., … & Holroyd-Leduc, J. (2016). Guidelines for dementia or Parkinson’s disease with depression or anxiety: a systematic review. BMC neurology, vol. 16 no.1. 244.