The ePark study protocol: A decentralized trial of individual video-assisted cognitive behavioural therapy for depressive disorder in Parkinson's disease

Abstract

Parkinson's disease (PD) is the second most common neurodegenerative disorder, affecting 1.2 million Europeans [1]. The prevalence of PD in people over 60 is about 1%, increasing to 4% in people 80 years and older [2]. Although PD is defined as a motor disorder, non-motor symptoms including neuropsychiatric symptoms such as depression and anxiety, are frequent and disabling, with a major impact on quality of life, caregiver burden and healthcare costs [3].

Current pharmacological treatments for PD neuropsychiatric symptoms, including depression, are often unsatisfactory for several reasons, including frequent adverse effects of medication, elevated risk of polypharmacy, and limited availability for non-pharmacological treatment options [4,5]. Previously published RCTs have demonstrated large effect sizes of face-to-face, telephone administered and online CBT for depressive symptoms in PD [[6], [7], [8]]. Despite strong evidence that cognitive behavioural therapy (CBT) is effective and cost-efficient in reducing depressive symptoms in PD, few patients are offered this treatment [3,[6], [7], [8], [9], [10]]. This is likely due in part to a shortage of CBT therapists at neurological outpatient clinics, particularly in rural areas, resulting in geographical differences in the availability of CBT treatment. This calls for the development of novel, evidence based online therapeutic strategies, which may significantly improve the lives of PD patients suffering from depressive symptoms.