As people are living longer, we are seeing more neurodegenerative diseases (NDs). NDs have both neurological and psychiatric manifestations. Depression and anxiety are common comorbidities in Alzheimers and Parkinsons disease. The diagnosis and intervention of depression and anxiety on the background of the aforementioned NDs is complicated by cognitive and motor disturbance. We aim to capture a general overview of the diagnostic and management challenges and compare these with the National Institute for Health and Care Excellence (NICE) guidance to identify any disparities that may exist.
A general review of this topic was sought through the MEDLINE database. Papers matching search terms were selected based on size, novelty and relevance to diagnostics or treatment of the psychiatric complications, namely depression and anxiety, in Parkinsons (PD) and Alzheimers disease (AD). Large systematic reviews helped establish strong evidence, novelty allowed for emerging ideas to be identified and all articles were relevant to either PD or AD.
The general approach to these psychiatric manifestations by non-specialists is as a one-size-fits-all approach. The efficacy of pharmacological treatments is questionable as often the side effects are much worse in this population and the action may vary on the degenerating anatomy. Many non-pharmacological treatments exist with some less traditional methods showing positive results including therapies focused on informal carers.
Drawing on the expertise of neuropsychiatrists and non-conventional therapies could yield better management of these patients and inform NICE guidance which would improve practice nationally.
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