Neurology: Remote cognitive behavioral therapy can effectively intervene the depression of Parkinson's patients

Remote cognitive behavioral therapy can effectively intervene in the depressive state of Parkinson's patients.
Depression affects up to 50% of Parkinson's disease (PD) patients and has a wide-ranging impact on PD management.

Parkinson’s disease depression (dPD) and faster physical and cognitive decline, earlier initiation of dopaminergic replacement therapy, non-compliance with medications, greater expected fall risk, and greater use of medical services It is related to cost.

It is closely related to PD-related disability and pain, and exceeds the severity of the disease, becoming the worst factor affecting the quality of life of PD patients.

The best dPD management can restore the patient's baseline of non-depressive function, but automatic remission is rare.

In more than 60% of patients with obvious symptoms, dPD is ignored and often undertreated.

Although antidepressants usually constitute first-line interventions, data on efficacy, tolerability, and patient acceptance are mixed.

This unmet need for treatment makes the treatment outcome of Parkinson’s disease more complicated and emphasizes the need for innovative care models to increase treatment participation.

Cognitive behavioral therapy (CBT) is a personalized, coping skills-based treatment method that has shown good effects on dPD in pilots and a randomized controlled trial (RCT).

Although patients may prefer non-pharmacological depression treatments, physical, geographic, and labor barriers restrict access to PD-based psychotherapy.

In this way, Roseanne D.
and others of Rutgers–Robert Wood Johnson Medical School in the United States explored whether telephone-based cognitive behavioral therapy (T-CBT) is better than conventional therapy (TAU) for patients with depression and Parkinson's disease (PD) It can significantly alleviate the symptoms of depression.They conducted a randomized controlled trial to evaluate the efficacy of 10 courses of T-CBT intervention on PD depression, compared with TAU.

A total of 72 PD patients (PWP, people with PD) were randomized to receive T-CBT+TAU or only TAU treatment.

T-CBT customized according to the unique needs of PWPs is provided for 3 months a week, and then once a month during the 6-month follow-up.

CBT targets negative thoughts (such as "I can't control"; "I am helpless") and behaviors (such as social withdrawal, excessive worry).

And to train the nursing staff to help PWP develop healthy habits.

Finally, the results were evaluated at baseline, mid-treatment, end of treatment, 1 month and 6 months after treatment.

Their research found that T-CBT is superior to TAU in all measures of depression, anxiety and quality of life.

At the end of treatment, the main outcome (Hamilton Depression Rating Scale score) was significantly improved in T-CBT compared to TAU.

Compared with the baseline, the average improvement of T-CBT was 6.
53 points, and the average improvement of TAU was -0.
27 points (P <0.
0001); the benefits persisted during the 6-month follow-up (P <0.
0001).

Negative thoughts in the T-CBT group were significantly reduced, which reflects the effectiveness of the treatment goals.

The important significance of this research is that it is discovered that T-CBT may be an effective intervention for depression.
It can solve a large number of unmet needs for PD treatment and bypass the high requirements of multidisciplinary, evidence-based care.Original source: Dobkin, RD, Mann, SL, Gara, MA, Interian, A.
, Rodriguez, KM, & Menza, M.
(2020).
Telephone-based cognitive behavioral therapy for depression in Parkinson disease: A randomized controlled trial.
_Neurology_, _94_(16), e1764-e1773.
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