The Montgomery-Asberg Depression Rating Scale and the Cornell Scale for Depression in Dementia: a validation study with patients exhibiting early-onset dementia

Multifaceted Music Therapy for Depression in Dementia: A Network Meta-Analysis of Randomized Controlled Trials

This study aimed to assess the efficacy of various music therapy interventions in ameliorating depressive symptoms in dementia patients, utilizing a network meta-analysis approach. We rigorously selected randomized controlled trials focused on music therapy for dementia with depressive symptoms from major electronic databases. The primary outcome measured was the impact on depressive symptoms, with the secondary outcome evaluating dropout rates across different intervention groups and standard care control groups. The research protocol has been duly registered with PROSPERO (Registration ID: CRD42023393059). Our network meta-analysis incorporated 14 randomized controlled trials involving a total of 1080 participants and examined a range of interventions, including active music therapy, listening to music, rhythmic music therapy, singing, and tailored music interventions. The analysis revealed that active music therapy combined with singing emerged as the most effective intervention, demonstrating a significant improvement in depressive symptoms in dementia patients (Standardized Mean Difference [SMD] = -0.89, 95% Confidence Interval [CI]: -1.48 to -0.30). In contrast, listening to music alone showed a smaller effect (SMD = -0.26, 95% CI: -0.71 to 0.20). This study was particularly noteworthy for not showing higher dropout rates compared to standard care, indicating its feasibility and acceptability in clinical settings. The findings of our study indicate that active music therapy combined with singing is an effective approach to reducing depressive symptoms in dementia patients, potentially due to enhanced social interaction. These results offer new perspectives for dementia care, suggesting a promising direction for further research and clinical application.

The External Validation of the Nursing Homes Short Depression Inventory in Older Adults with Major Neurocognitive Disorders in Long-Term Care Centers

INTRODUCTION

Depression is often difficult to detect in long-term care (LTC) patients with major neurocognitive disorders (MNCD), and an observer-rated screening scale could facilitate assessments. This study aimed to establish the external validity and reliability of the Nursing Homes Short Depression Inventory (NH-SDI) in LTC patients with MNCD and to compare its estimates to the Cornell Scale for Depression in Dementia (CSDD), the most used scale for depression in MNCD.

METHODS

A focus discussion group of experts assessed the content validity of the NH-SDI. Then, a convenience sample of 93 LTC patients with MNCD was observer-rated by trained nurses with the NH-SDI and CSDD. For 57 patients, a medical assessment of depression was obtained, and screening accuracy estimates were generated.

RESULTS

The prevalence of depression was 8.8% as per reference standard. NH-SDI's content validity was judged acceptable with minor item wording modifications and specifications. The NH-SDI (cut-off ≥3) achieved 100% (95% confidence interval [CI]: 46-100%) sensitivity, 83% (95% CI: 69-91%) specificity, and 36% (95% CI: 14-64%) positive predictive value (PPV). The CSDD (cut-off ≥3) achieved 100% (95% CI: 46-100%) sensitivity, 75% (95% CI: 61-86%) specificity, and 28% (95% CI: 11-54%) PPV. No significant differences in areas under the receiver operating characteristic curve were found between scales. The NH-SDI and CSDD were highly correlated (rs = 0.913; p < 0.001) and reliable (ICC = 0.77; p < 0.001).

CONCLUSION

The NH-SDI appears valid and reliable in LTC patients with MNCD and quicker than the CSDD to rule out depression in a busy or short-staffed setting.

The course of depressive symptoms in Lewy body dementia and Alzheimer's disease

BACKGROUND

Depressive symptoms frequently affect patients with neurocognitive disorders. In cross-sectional studies, patients with Lewy body dementia (DLB) showed higher levels of depressive symptoms than those with Alzheimer's disease (AD). We here describe the 5 year course of depressive symptoms in patients with DLB and AD.

METHODS

Secondary analysis of a dementia study in Western Norway (DemVest) longitudinal cohort study.

SETTING

This multicenter study was conducted in memory clinics in Western Norway. 187 patients newly diagnosed with AD (n = 111) and DLB (n = 76) were followed up annually for 5 years. Depressive symptoms were assessed using the Montgomery Åsberg Depression Rating Scale (MADRS). MADRS subclusters dysphoria, retardation, vegetative, anhedonia were analyzed. The impact of proximity of death and the role of risk factors for depression and dementia on the course of depressive symptoms were evaluated.

RESULTS

We observed continuously increasing mean levels of depressive symptoms in DLB, while patients with AD showed a delayed increase at later follow-up visits. Increase in MADRS total score was mainly driven by increases in the anhedonia and retardation subclusters. Proximity to death was associated with an increase in depressive symptoms in DLB, while it tended to decrease in AD. Previous smoking and hearing loss were associated with higher MADRS scores during follow-up in the total sample.

LIMITATIONS

Yearly assessment of depressive symptoms might be too infrequent.

CONCLUSION

Depressive symptom load was consistently higher in DLB compared to AD during five years after diagnosis, but tended to become more similar at later stages.

Distinguishing apathy from depression: A review differentiating the behavioral, neuroanatomic, and treatment-related aspects of apathy from depression in neurocognitive disorders

OBJECTIVES

This narrative review describes the clinical features of apathy and depression in individuals with neurocognitive disorders (NCDs), with the goal of differentiating the two syndromes on the basis of clinical presentation, diagnostic criteria, neuropathological features, and contrasting responses to treatments.

METHODS

Literature was identified using PubMed, with search terms to capture medical conditions of interest; additional references were also included based on our collective experience and knowledge of the literature.

RESULTS

Evidence from current literature supports the distinction between the two disorders; apathy and depression occur with varying prevalence in individuals with NCDs, pose different risks of progression to dementia, and have distinct, if overlapping, neurobiological underpinnings. Although apathy is a distinct neuropsychiatric syndrome, distinguishing apathy from depression can be challenging, as both conditions may occur concurrently and share several overlapping features. Apathy is associated with unfavorable outcomes, especially those with neurodegenerative etiologies (e.g., Alzheimer's disease) and is associated with an increased burden for both patients and caregivers. Diagnosing apathy is important not only to serve as the basis for appropriate treatment, but also for the development of novel targeted interventions for this condition. Although there are currently no approved pharmacologic treatments for apathy, the research described in this review supports apathy as a distinct neuropsychiatric condition that warrants specific treatments aimed at alleviating patient disability.

CONCLUSIONS

Despite differences between these disorders, both apathy and depression pose significant challenges to patients, their families, and caregivers; better diagnostics are needed to develop more tailored treatment and support.

Predictive validity of the Cornell Scale for depression in dementia among older adults with and without dementia: A systematic review and meta-analysis

This review analyzes the predictive validity of the Cornell Scale for Depression in Dementia (CSDD), considering cognitive function. Electronic searches were performed using MEDLINE, EMBASE, CINAHL, and PsycINFO databases. Overall, 20 studies were reviewed, including 3,499 older adults, with and without dementia, who satisfied the selection criteria. Participants were stratified into the dementia, non-dementia, and mixed groups, and the diagnostic performance of the CSDD was assessed using receiver operating characteristic (ROC) curves. In the dementia and non-dementia groups, the area under the curve was ≥ 0.9, confirming high accuracy of the test. The pooled sensitivity was the highest in the dementia group (0.87), followed by the mixed group (0.84) and non-dementia group (0.82). In the subgroup analysis based on the Mini-Mental State Examination (MMSE), the ROC curve was 0.90 for older adults with MMSE scores < 15 and 0.87 for those with an MMSE score ≥ 15. Therefore, the CSDD can be considered excellent tool for assessing depression in all older adults, although its predictive ability is better for older adults with dementia compared to that in those without dementia. It can be used as a first-line screening tool for depression, regardless of cognitive function.

Vietnamese Version of Cornell Scale for Depression in Dementia at an Outpatient Memory Clinic: A Reliability and Validity Study

Background

In Vietnam, there has been, currently, no standardized tool for depression assessment for people with dementia (PWD). Cornell Scale for Depression in Dementia (CSDD) is a widely studied and used scale for PWD worldwide.

Objectives

The aim of this study was to standardize the Vietnamese version of the CSDD (V-CSDD) in depression assessment in PWD through reliability and validity examination.

Methods

V-CSDD was rated in terms of reliability and validity with gold standard regarding “major depressive episode” and “major depressive-like episode” of DSM-5. Cronbach's α, ICC, exploratory factor analysis (EFA), and receiver operating characteristic analysis were performed.

Results

V-CSDD was found to have a high internal consistency reliability (Cronbach's α = 0.80), inter-rater reliability at sound ranking (ICC = 0.89; 95% CI = 0.81–0.94), maximum cut-off mark of 13 (sensitivity = 70%, specificity = 92%), and EFA, which suggested that V-CSDD may comprise 5 factors.

Conclusions

Results indicate the V-CSDD to be a reliable and valid assessment and to be beneficial in classifying and diagnosing depression in dementia outpatients in clinical contexts.

Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study

Background

Care home staff have a critical bearing on quality. The staff employed, the training they receive and how well they identify and manage residents’ needs are likely to influence outcomes. The Care Act 2014 (Great Britain. The Care Act 2014. London: The Stationery Office; 2014) requires services to improve ‘well-being’, but many residents cannot self-report and are at risk of exclusion from giving their views. The Adult Social Care Outcomes Toolkit enables social care-related quality of life to be measured using a mixed-methods approach. There is currently no equivalent way of measuring aspects of residents’ health-related quality of life. We developed new tools for measuring pain, anxiety and depression using a mixed-methods approach. We also explored the relationship between care home quality, residents’ outcomes, and the skill mix and employment conditions of the workforce who support them.

Objectives

The objectives were to develop and test measures of pain, anxiety and depression for residents unable to self-report; to assess the extent to which regulator quality ratings reflect residents’ care-related quality of life; and to assess the relationship between aspects of the staffing of care homes and the quality of care homes.

Design

This was a mixed-methods study.

Setting

The setting was care homes for older adults in England.

Participants

Care home residents participated.

Results

Three measures of pain, anxiety and low mood were developed and tested, using a mixed-methods approach, with 182 care home residents in 20 care homes (nursing and residential). Psychometric testing found that the measures had good construct validity. The mixed-methods approach was both feasible and necessary with this population, as the majority of residents could not self-report. Using a combined data set (n = 475 residents in 54 homes) from this study and the Measuring Outcomes in Care Homes study (Towers AM, Palmer S, Smith N, Collins G, Allan S. A cross-sectional study exploring the relationship between regulator quality ratings and care home residents’ quality of life in England. Health Qual Life Outcomes 2019;17:22) we found a significant positive association between residents’ social care-related quality of life and regulator (i.e. Care Quality Commission) quality ratings. Multivariate regression revealed that homes rated ‘good/outstanding’ are associated with a 12% improvement in mean current social care-related quality of life among residents who have higher levels of dependency. Secondary data analysis of a large, national sample of care homes over time assessed the impact of staffing and employment conditions on Care Quality Commission quality ratings. Higher wages and a higher prevalence of training in both dementia and dignity-/person-centred care were positively associated with care quality, whereas high staff turnover and job vacancy rates had a significant negative association. A 10% increase in the average care worker wage increased the likelihood of a ‘good/outstanding’ rating by 7%.

Limitations

No care homes rated as inadequate were recruited to the study.

Conclusions

The most dependent residents gain the most from homes rated ‘good/outstanding’. However, measuring the needs and outcomes of these residents is challenging, as many cannot self-report. A mixed-methods approach can reduce methodological exclusion and an over-reliance on proxies. Improving working conditions and reducing staff turnover may be associated with better outcomes for residents.

Future work

Further work is required to explore the relationship between pain, anxiety and low mood and other indicators of care homes quality and to examine the relationship between wages, training and social care outcomes.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 19. See the NIHR Journals Library website for further project information.

Dialectical behavior therapy-based psychological intervention for woman in late pregnancy and early postpartum suffering from COVID-19: a case report

At the end of 2019, a new form of pneumonia disease known as the corona virus disease 2019 (COVID-19) rapidly spread throughout most provinces of China, and the total global number of COVID-19 cases has surpassed 500 000 by Mar. 27, 2020 (WHO, 2020). On Jan. 30, 2020, the World Health Organization (WHO) declared COVID-19 a global health emergency (WHO, 2020). COVID-19 causes most damage to the respiratory system, leading to pneumonia or breathing difficulties. The confirmed case fatality risk (cCFR) was estimated to be 5% to 8% (Jung et al., 2020). Besides physical pain, COVID-19 also induces psychological distress, with depression, anxiety, and stress affecting the general population, quarantined population, medical staff, and patients at different levels (Kang et al., 2020; Xiang et al., 2020). Previous research on patients in isolation wards highlighted the risk of depressed mood, fear, loneliness, frustration, excessive worries, and insomnia (Abad et al., 2010).

Management of Late-Life Depression in the Context of Cognitive Impairment: a Review of the Recent Literature

PURPOSE OF REVIEW

Evidence regarding the treatment of late-life depression is not necessarily generalizable to persons with a neurocognitive disorder and comorbid depression. Thus, this article reviews recent evidence that pertains to the treatment of depression in older adults with neurocognitive disorders, and synthesizes and critically analyzes this literature to identify methodological issues and gaps for the purpose of future research.

RECENT FINDINGS

Controlled trials and meta-analyses examining depression treatment in neurocognitive disorders, published between 2015 and 2019 (N = 16 reports), can be divided into those addressing pharmacotherapy, psychological and behavioral therapy, and somatic therapy. The evidence generally does not support benefit of antidepressant medication over placebo in treating depressive disorders in dementia. No pharmacological studies since 2015 have examined antidepressant medication in participants with mild cognitive impairment (MCI). Problem adaptation therapy demonstrates efficacy for depression in MCI and mild dementia. Other psychological and behavioral interventions for depressive symptoms in dementia demonstrate mixed findings. The only somatic treatment trials published since 2015 have assessed bright light therapy, with positive findings but methodological limitations. Psychological, behavioral, and somatic treatments represent promising treatment options for depression in neurocognitive disorders, but further studies are needed, particularly in participants with depressive disorders rather than subclinical depressive symptoms. Little is known about the treatment of depression in patients with MCI, and rigorous identification of MCI in late-life depression treatment trials will help to advance knowledge in this area. Addressing methodological issues, particularly the diagnosis and measurement of clinically significant depression in dementia, will help to move the field forward.

The 2002 NIMH Provisional Diagnostic Criteria for Depression of Alzheimer's Disease (PDC-dAD): Gauging their Validity over a Decade Later

Presented herein is evidence for criterion, content, and convergent/discriminant validity of the NIMH-Provisional Diagnostic Criteria for depression of Alzheimer's Disease (PDC-dAD) that were formulated to address depression in Alzheimer's disease (AD). Using meta-analytic and systematic review methods, we examined criterion validity evidence in epidemiological and clinical studies comparing the PDC-dAD to Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV), and International Classification of Disease (ICD 9) depression diagnostic criteria. We estimated prevalence of depression by PDC, DSM, and ICD with an omnibus event rate effect-size. We also examined diagnostic agreement between PDC and DSM. To gauge content validity, we reviewed rates of symptom endorsement for each diagnostic approach. Finally, we examined the PDC's relationship with assessment scales (global cognition, neuropsychiatric, and depression definition) for convergent validity evidence. The aggregate evidence supports the validity of the PDC-dAD. Our findings suggest that depression in AD differs from other depressive disorders including Major Depressive Disorder (MDD) in that dAD is more prevalent, with generally a milder presentation and with unique features not captured by the DSM. Although the PDC are the current standard for diagnosis of depression in AD, we identified the need for their further optimization based on predictive validity evidence.

Effect of Vascular Risk Factors on the Progression of Mild Alzheimer's Disease and Lewy Body Dementia

BACKGROUND

Vascular risk factors (VRF) are associated with an increased risk of neurodegenerative disease.

OBJECTIVE

To examine the association between VRF and cognitive decline in patients with Alzheimer's disease (AD) and Lewy body dementia (LBD).

METHODS

We included consecutive referrals with mild AD or LBD to dementia clinics in western Norway from 2005 to 2013. The Mini-Mental Status Exam (MMSE) and Clinical Dementia Rating Scale Sum of Boxes (CDR-SB) were administered at baseline and then annually for up to five years. The VRF include diabetes mellitus, hypertension, hypercholesterolemia, overweight and smoking. Generalized Estimating Equations (GEE) were used to examine the potential association between VRF scores and the change in MMSE and CDR-SB scores, adjusting for age, sex, and the apolipoprotein ɛ4 allele (APOE4).

RESULTS

A total of 200 patients were included (113 AD, 87 LBD) (mean age 76 years, mean baseline MMSE 24.0, mean follow-up time 3.5 years). Smoking was the only VRF significantly associated with a more rapid cognitive decline, however only in the AD group. Being overweight at baseline was associated with a slower cognitive decline. Moreover, hypertension at baseline predicted a slower decline in MMSE scores. In the LBD group diabetes mellitus was found to be associated with a slower increase in CDR-SB scores.

CONCLUSION

With the exception of smoking, VRF at time of dementia diagnosis were not associated with a more rapid cognitive decline.

Depression in dementia

People with dementia of any type have a high incidence of major depression. The occurrence of a first major depressive episode in an older adult is a risk factor for developing dementia. Management of depression in a person with dementia should be enthusiastic with an aim to optimise quality of life. Non-pharmacological and pharmacological strategies are both important in treating depression in dementia and management of these patients requires a collaborative approach. Selective serotonin reuptake inhibitors are the first-line pharmacotherapy for depression in dementia, although they are less likely to be effective in older people.

Confirmatory factor analysis of the Cornell scale for depression in dementia among patient with dementia of various degrees

BACKGROUND

Depression in dementia is difficult to diagnose. The psychometric qualities of the Cornell scale for depression in dementia and whether depression varies depending on the dementia severity are still controversial.

DESIGN

Cross-sectional study of memory clinic and nursing-home patients.

METHODS

A sample of 1682 patients (750 from memory clinics and 932 from nursing homes) with Clinical dementia rating scale score of one or higher was evaluated with the Cornell scale. The sample was randomly divided into two groups. Exploratory factor analysis was performed on one-half of the patients and confirmatory factor analysis on the other half. It was further analysed whether the scores of the sub-scales differed across CDR score.

RESULTS

A five-factor solution fitted the data best according to both the exploratory and confirmatory factor analysis: 'mood', 'physical', 'cyclic', 'retardation' and 'behaviour'. Further, it was found that the sum score of the Cornell scale differs significantly across dementia severity (p=0.018). The mood and the cyclic sub-scales scores did not vary across dementia severity, unlike the three remaining sub-scales scores.

CONCLUSION

A five-factor solution of the Cornell scale best fitted the data according to both exploratory and confirmatory factor analysis. The mood and cyclic factors' scores did not vary across dementia severity, and this might suggest that they are the core symptoms of depression that are equally present regardless of dementia severity. The other factors scores were higher in severe dementia, which might suggest that these factors are related to the dementia.

Prophylactic efficacy of fluoxetine, escitalopram, sertraline, paroxetine, and concomitant psychotherapy in major depressive disorder: outcome after long-term follow-up

The acute efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of major depressive disorder (MDD) is well established; however their role in longer-term prevention of recurrence remains unconfirmed. This study aims at examining: the prophylactic efficacy of four commonly used SSRIs in MDD in a naturalistic setting with long-term follow-up, the effect of concomitant cognitive behavioral therapy (CBT), and the predictors of outcome. In a prospective cohort study, 387 patients who either remitted or responded following treatment with four different SSRIs-fluoxetine, escitalopram, sertraline and paroxetine-were followed up over several years. During an average follow-up period of 34.5 months, 76.5% of patients experienced MDD recurrence. Escitalopram and fluoxetine showed a numerically higher prophylactic efficacy than paroxetine and sertraline but the difference was statistically insignificant. The prophylactic efficacy for SSRI-only treatment was limited, with a recurrence rate of 82.0%, compared to 59.0% of patient recurrence rate in concomitant Cognitive Behavioral Therapy (CBT). The relatively small size of the CBT group and the lack of randomization may undermine the extrapolation of its findings to clinical practice. Nevertheless, the study preliminary data may help in defining the clinical utility of antidepressants and CBT in the prophylaxis from MDD recurrence.

Prevalence and correlates of psychotropic drug use in community-dwelling people with young-onset dementia: the NeedYD-study

BACKGROUND

Young-onset dementia (YOD) is defined as dementia that develops before the age of 65 years. The prevalence and type of neuropsychiatric symptoms (NPS) in YOD differ from patients with late onset dementia. NPS in dementia patients are often treated with psychotropic drugs. The aim of this study was to investigate psychotropic drug use (PDU) in Dutch community-dwelling YOD patients and the association between age, gender, dementia etiology and severity, symptoms of depression, disease awareness, unmet needs, and type of NPS.

METHODS

Psychotropic drug use in 196 YOD patients was registered. Drugs were categorized according to the Anatomical Therapeutical Chemical classification. The association between age, gender, dementia type, dementia stage, type of NPS, depressive symptoms, disease awareness, and amount of unmet needs on total PDU was analyzed using binomial logistic regression analysis.

RESULTS

Fifty-two percent of the patients were prescribed at least one psychotropic drug; 36.2% of patients used one drug, and 12.2% used two different drugs. Antidepressants (36.2%) and antipsychotic drugs (17.3%) were the most frequently prescribed psychotropic drugs. Anti-dementia drugs were prescribed in 51.5% of the patients. Increasing age and moderate to severe depressive symptoms were positively associated with the total use of psychotropic drugs.

CONCLUSIONS

Community-dwelling YOD patients have a high prevalence of PDU. More research is needed to study the association between unmet needs, NPS, and PDU, and psychosocial interventions have to be developed to limit the use of psychotropic drugs in YOD.

The merits and problems of Neuropsychiatric Inventory as an assessment tool in people with dementia and other neurological disorders

Objective

The Neuropsychiatric Inventory (NPI) is one of the most commonly used assessment scales for assessing symptoms in people with dementia and other neurological disorders. This paper analyzes its conceptual framework, measurement mode, psychometric properties, and merits and problems.

Method

All articles discussing the psychometric properties and factor structure of the NPI were searched for in Medline via Ovid. The abstracts of these papers were read to determine their relevance to the purpose of this paper. If deemed appropriate, a full paper was then obtained and read.

Results

The NPI has reasonably good content validity and internal consistency, and good test–retest and interrater reliability. There is limited information about its sensitivity, specificity, positive and negative predictive values, and, in particular, responsiveness. Merits of the NPI include being comprehensive, avoiding symptom overlap, ease of use, and flexibility. It has problems in scoring (no multiples of 5, 7, and 11) and, therefore, analysis using parametric tests may not be appropriate. The use of individual subscales also warrants further investigation.

Conclusion

In terms of its content and concurrent validity, intra- and interrater reliability, test–retest reliability, and internal consistency, the NPI can be considered as valid and reliable, and can be used across different ethnic groups. The tool is most likely unable to deliver as good a performance in terms of discriminating between different disorders. More studies are required to further evaluate its psychometric properties, particularly in the areas of factor structure and responsiveness. The clinical utility of the NPI also needs to be further explored.

A comparison of the cornell scale for depression in dementia and the Montgomery-Aasberg depression rating scale in a memory clinic population

BACKGROUND

The aim of this study was to explore the correlation between the Cornell Scale for Depression in Dementia (CSDD) and the Montgomery-Aasberg Depression Rating Scale (MADRS) among memory clinic patients.

METHODS

The CSDD (based on an interview with the caregiver) and the MADRS (based on the patient's opinion) were filled in independently of each other among 520 patients. Principal component and correlation analyses were performed.

RESULTS

The mean score of the CSDD was 7.6 (SD: 6.0), and the mean MADRS score was 9.7 (SD: 6.7). The correlation between the two scales was 0.36 for the whole group, 0.22 in the group with dementia and 0.48 for those without dementia, respectively. Principal component analyses revealed four factors for the CSDD and two factors for the MADRS.

CONCLUSIONS

Using two different sources of information, we found a poor correlation between the two scales. We suggest that evaluation of depression among memory clinic patients should be done by interviewing both the patient and the caregiver.

Cornell scale for depression in dementia: study of residents in a northern thai long-term care home

OBJECTIVE

This study aimed to analyse the validity of the Thai version of the Cornell Scale for Depression in Dementia (CSDD) when using DSM-IV criteria.

METHODS

A cross-sectional study was carried out of 84 elderly residents in a residential care home setting in Thailand. The participants went through a comprehensive geriatric assessment which included a Mini-Mental State Examination, a Mini-International Neuropsychiatric Interview (MINI) and use of the CSDD tool. A ROC analysis was performed in order to test the validity of the CSDD as against the DSM-IV when used by the MINI.

RESULTS

ROC analysis revealed a better score for those areas found under the curve for the CSDD-as against the DSM-IV criteria (0.96). With a cut-off score of >6, the CSDD yielded the highest sensitivity score (100%), plus produced a specificity of 81% and a negative predictive value of 100%. It also had a positive predictive value of 69%. The validity of the CSDD was found to be better for the group experiencing cognitive impairment than with the non-cognitive impairment group in terms of the agreement of CSDD items between patients and caregivers. The CSDD yielded a high internal consistency (Cronbach's alpha=0.87).

CONCLUSION

CSDD is a valid tool to use for identifying depressive disorders among Thai LTC home residents - those experiencing and those not experiencing cognitive impairment.

Discrepancies in Cornell Scale for Depression in Dementia (CSDD) items between residents and caregivers, and the CSDD's factor structure

Purpose

This validation study aims to examine Cornell Scale for Depression in Dementia (CSDD) items in terms of the agreement found between residents and caregivers, and also to compare alternative models of the Thai version of the CSDD.

Patients and methods

A cross-sectional study was conducted of 84 elderly residents (46 women, 38 men, age range 60–94 years) in a long-term residential home setting in Thailand between March and June 2011. The selected residents went through a comprehensive geriatric assessment that included use of the Mini-Mental State Examination, Mini-International Neuropsychiatric Interview, and CSDD instruments. Intraclass correlation (ICC) was calculated in order to establish the level of agreement between the residents and caregivers, in light of the residents’ cognitive status. Confirmatory factor analysis (CFA) was adopted to evaluate the alternative CSDD models.

Results

The CSDD yielded a high internal consistency (Cronbach’s alpha = 0.87) and moderate agreement between residents and caregivers (ICC = 0.55); however, it was stronger in cognitively impaired subjects (ICC = 0.71). CFA revealed that there was no difference between the four-factor model, in which factors A (mood-related signs) and E (ideational disturbance) were collapsed into a single factor, and the five-factor model as per the original theoretical construct. Both models were found to be similar, and displayed a poor fit.

Conclusion

The CSDD demonstrated a moderate level of interrater agreement between residents and caregivers, and was more reliable when used with cognitively impaired residents. CFA indicated a poorly fitting model in this sample.

A cross-cultural comparison of the phenotype of depression as measured by the Cornell Scale and the MADRS in two elderly outpatient populations

BACKGROUND

Different cutoff points for a depressive disorder on depression scales exist in different countries. The reasons could be that the presence or the intensity of the various symptoms on the scales differ. We wanted to explore differences in scores on depression scales among patients in Brazil and Norway.

METHODS

The Cornell Scale for Depression in Dementia (CSDD) and the Montgomery-Aasberg Depression Rating Scale (MADRS) were completed independently among 211 elderly outpatients in Brazil and Norway. A psychiatrist, blind to the results, diagnosed depression using the ICD-10 and DSM-IV criteria.

RESULTS

According to the ICD-10 criteria, 29 (33.7%) Brazilian and 51 (40.8%) Norwegian patients had depression (p=0.3). Mean CSDD score was 14.4 (SD 8.9) in Brazil and 6.8 (SD 4.9) in Norway (p<0.001). Mean MADRS score was 13.2 (SD 12.1) in Brazil and 8.4 (SD 6.8) in Norway (p=0.02). We analyzed the scores for the depressed and the non-depressed patients separately. In both groups the Brazilian patients had significantly higher scores on both scales compared to the Norwegian patients. In an adjusted linear regression analysis the variable "country" was associated with the CSDD score (beta=-0.29, p=0.01).

LIMITATIONS

The protocols in the two countries were not exactly the same. Only one psychiatrist evaluated the patients.

CONCLUSIONS

The scores on the MADRS and the CSDD were higher in patients in Brazil than in Norway. In an adjusted linear regression analysis, "country" was the only variable associated with the higher CSDD score.

The Hospital Anxiety and Depression Scale: low sensitivity for depression screening in demented and non-demented hospitalized elderly

BACKGROUND

We currently use the depression subscale (HADD) of the Hospital Anxiety and Depression Scale (HADS) for depression screening in elderly inpatients. Given recent concerns about the performance of the HADD in this age group, we performed a quality-control study retrospectively comparing HADD with the diagnosis of depression by a psychiatrist. We also studied the effect of dementia on the scale's performance.

METHODS

HADS produces two 7-item subscales assessing depression or anxiety. The HADD was administered by a neuropsychologist. As "gold standard" we considered the psychiatrist's diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Patients older than 65 years, assessed by both the HADD and the psychiatrist, with a clinical dementia rating (CDR) score lower than 3, were included. The effect of dementia was assessed by forming three groups according to the CDR score (CDR0-0.5, CDR1, and CDR2). Simple and multiple logistic regression models were applied to predict the psychiatrist's depression diagnosis from HADD scores. Areas under the receiver operating characteristics curve (AUC) were plotted and compared by χ(2) tests.

RESULTS

On both univariate and multiple analyses, HADD predicted depression diagnosis but performed poorly (univariate: p = 0.009, AUC = 0.60 (95% confidence interval (CI) = 0.53-0.66); multiple: p = 0.007, AUC = 0.65 (95% CI = 0.58-0.71)), regardless of cognitive status. Because mood could have changed between the two assessments (they occurred at different points of the hospital stay), the multiple analyses were repeated after limiting time interval at 28, 21, and 14 days. No major improvements were noted.

CONCLUSION

The HADD performed poorly in elderly inpatients regardless of cognitive status. It cannot be recommended in this population for depression screening without further study.

The validity of the Montgomery-Aasberg depression rating scale as a screening tool for depression in later life

BACKGROUND

The aims of the study were to examine the validity of the MADRS and to compare it with the validity of the Cornell Scale for Depression in Dementia (CSDD).

METHODS

We included 140 patients without dementia, with mean age 81.5 (sd 7.7) years. Trained psychiatric nurses interviewed all of them using the MADRS. In addition, for 70 patients caregivers were interviewed using the CSDD. A psychiatrist who had no access to the MADRS or the CSDD results made a diagnosis of depression according to the DSM-IV criteria for major depression, and the ICD-10 criteria was also applied for the 70 patients assessed with the CSDD.

RESULTS

Twenty-two out of the 140 had depression according to the DSM IV criteria, whereas 25 out of 70 had depression according to the ICD-10 criteria. The area under the curve (auc) in a receiver operating characteristic analysis was 0.86 (95% CI 0.79-0.93) for the MADRS using the DSM-IV criteria. The best cut-off point was 16/17 with sensitivity of 0.80 and specificity of 0.82. The AUC for the CSDD was 0.83 (95% CI 0.71-0.95). The recommended cut-off score on the CSDD of 7/8 was valid but not the best in this study.

LIMITATIONS

The patients were diagnosed with a diagnosis of depression by only one psychiatrist, and the procedures in the two centres were not exactly the same.

CONCLUSIONS

The MADRS has good discriminating power to detect depression in elderly persons and should be preferred to the CSDD for use with persons without dementia.

Comparative validation of proxy-based Montgomery-Åsberg depression rating scale and cornell scale for depression in dementia in nursing home residents with dementia

OBJECTIVE

To 1) compare the accuracy of the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Cornell Scale for Depression in Dementia (CSDD) in nursing home residents with dementia when professional caregivers are the only available source of information and 2) explore different methods to account for missing items.

DESIGN

Cross-sectional design.

SETTING

Nursing home (NH).

PARTICIPANTS

One hundred one residents with dementia.

MEASUREMENTS

NH residents with dementia were assessed on the presence of clinical depression using Provisional Diagnostic Criteria for Depression of Alzheimer's Disease. The MADRS and CSDD were administered in a structured interview with professional primary caregivers.

RESULTS

Receiver operating characteristic analyses revealed no significant differences between areas under the empirical curve for MADRS and CSDD. Imputation of a lowest possible item score for missing items revealed larger areas than three other methods (significant result only for CSDD). A MADRS cutoff score of ">13" yielded the highest sum of sensitivity (78%) and specificity (66%). A CSDD cutoff score of ">6" yielded the highest sum of sensitivity (94%) and specificity (49%). Both scales showed high negative predictive values up to 100% and low positive predictive values not exceeding 50%.

CONCLUSION

The proxy-based MADRS and CSDD did not differ in distinguishing depressed from nondepressed NH residents and may be used for screening purposes. For missing items, imputation of a lowest possib le item score may be applied. The MADRS and CSDD may be better used for ruling out rather than for ruling in depression.

Nijmegen observer-rated depression scale for detection of depression in nursing home residents

OBJECTIVE

This study aims to test the accuracy of the Nijmegen observer-rated depression (NORD) scale, a new short scale for screening of depression in nursing home (NH) residents with and without dementia.

METHODS

This cross-sectional study with 103 residents with dementia (N = 19 depressed) and 72 residents without dementia (N = 10 depressed) was undertaken in 13 Dutch NH units. An elderly care physician and a psychologist of each unit assessed residents for the presence of clinical depression. Primary professional caregivers administered the NORD scale.

RESULTS

Five of the six proposed items showed acceptable performance in screening for depression. Receiver operating characteristic analyses revealed significant areas under the empirical curve (AUC) for the 5-item NORD scale in the total sample (AUC = 0.83, p < 0.001), as well as in residents with dementia (AUC = 0.84, p < 0.001) and without dementia (AUC = 0.84, p < 0.001). The cutoff score of >1 showed the highest sum of sensitivity (100) and specificity (69) in non-dementia and >2 the highest sum of sensitivity (79) and specificity (77) in dementia. The cutoff score of >1 showed the lowest negative likelihood ratio of 0.0 in non-dementia and of 0.2 in dementia. The highest positive likelihood ratios were found for the cutoff of >2 in non-dementia (3.4) and for >4 in dementia (26.5).

CONCLUSION

The 5-item NORD scale showed acceptable accuracy comparable with those of more extensive scales in other studies. It is easy and quick to administer and can be used for screening of depression in NH residents with or without dementia.

Validation of Montgomery-Åsberg Rating Scale and Cornell Scale for Depression in Dementia in Brazilian elderly patients

BACKGROUND

There are few studies on validation of depression scales in the elderly in Latin America. This study aimed to assess the validity of Montgomery-Åsberg. Depression Rating Scale (MADRS) and Cornell Scale for Depression in Dementia (CSDD) in Brazilian elderly outpatients.

METHODS

A convenience sample of 95 outpatients was diagnosed for dementia and depression according to DSM-IV-TR, ICD-10, and PDC-dAD criteria. Receiver Operating Curves (ROC) were used to calculate the area under the curve (AUC) and to assess MADRS and CSDD cut-offs for each diagnostic criterion.

RESULTS

Dementia was diagnosed in 71 of 95 patients. Depression was diagnosed in 35, 30, and 51 patients by ICD-10, DSM-IV, and PDC-dAD, respectively. MADRS cut-off score of 10 correctly diagnosed 67.4% and 66.3% patients as depressed according to DSM-IV and ICD-10. A cut-off of 9 correctly identified 74.7% by PDC-dAD criteria; a CSDD cut-off score of 13 best recognized depression according to DSM-IV and ICD-10. A score of 11 diagnosed depression according to PDC-dAD, while MADRS = 9 recognized depression in dementia. CSDD was more efficient in showing depression in mild than in moderate/severe dementia according to DSM-IV/ICD-10. PDC-dAD behaved nicely for any severity stage.

CONCLUSION

MADRS and CSDD cut-offs of 10 and 13 were the optimal ones to diagnose depression in elderly, respectively. CSDD cut-offs are higher than those found in other countries. Other Latin American studies are needed to compare results with our study.

A comparison of the validity of the Cornell Scale and the MADRS in detecting depression among memory clinic patients

BACKGROUND

The aim of the study was to compare the validity of the Cornell Scale for Depression in Dementia (CSDD) and the Montgomery-Aasberg Depression Rating Scale (MADRS) among memory clinic patients.

METHODS

The scales were independently completed for 125 patients. The diagnosis of depression was made by psychiatrists blinded to the depression scores.

RESULTS

The mean score of the Mini-Mental State Examination was 25.5 (SD: 4.6), of the CSDD 6.8 (SD: 4.9), and of the MADRS 8.5 (SD: 6.8). In receiver operation characteristics (ROC) analyses, the AUC for the CSDD was 0.73 (95% CI: 0.63-0.82) using the International Classification of Diseases-10 (ICD-10) criteria for depression, and 0.68 (95% CI: 0.57-0.79) using the DSM-IV criteria. The AUC was 0.88 (95% CI: 0.81-0.95) for the MADRS using the ICD-10 criteria, and 0.84 (95% CI: 0.76-0.92) using the DSM-IV criteria.

CONCLUSION

Both scales are suitable as screening tools. According to the ROC analyses, the MADRS seems better at distinguishing depressed from nondepressed patients.

White matter hyperintensities and the course of depressive symptoms in elderly people with mild dementia

Objectives

To explore the relationship between white matter hyperintensities (WMH) and the prevalence and course of depressive symptoms in mild Alzheimer's disease (AD) and Lewy body dementia. Design: This is a prospective cohort study conducted in secondary care outpatient clinics in western Norway. Subjects: The study population consisted of 77 elderly people with mild dementia diagnosed according to standardised criteria.

Methods

Structured clinical interviews and physical, neurological, psychiatric, and neuropsychological examinations were performed and routine blood tests were taken. Depression was assessed using the depression subitem of the Neuropsychiatric Inventory and the Montgomery-Åsberg Depression Rating Scale (MADRS). A standardised protocol for magnetic resonance imaging scan was used, and the volumes of WMH were quantified using an automated method, followed by manual editing.

Results

The volumes of total and frontal deep WMH were significantly and positively correlated with baseline severity of depressive symptoms, and depressed patients had significantly higher volumes of total and frontal deep WMH than non-depressed patients. Higher volumes of WMH were also associated with having a high MADRS score and incident and persistent depression at follow-up. After adjustment for potential confounders, frontal deep WMH, in addition to prior depression and non-AD dementia, were still significantly associated with baseline depressive symptoms (p = 0.015, OR 3.703, 95% CI 1.294–10.593). Similar results emerged for total WMH.

Conclusion

In elderly people with mild dementia, volumes of WMH, in particular frontal deep WMH, were positively correlated with baseline severity of depressive symptoms, and seemed to be associated with persistent and incident depression at follow-up. Further studies of the mechanisms that determine the course of depression in mild dementia are needed.

A potential role for zinc alterations in the pathogenesis of Alzheimer's disease

Alzheimer's disease (AD), one of the major causes of disability and mortality in Western societies, is a progressive age-related neurodegenerative disorder. Increasing evidence suggests that the etiology of AD may involve disruptions of zinc (Zn) homeostasis. This review discusses current evidence supporting a potential role of Zn and zinc transporters (ZnTs) in processing of the amyloid beta protein precursor (APP) and amyloid beta (Aβ) peptide generation and aggregation.

Depressive symptoms in Alzheimer's disease and lewy body dementia: a one-year follow-up study

OBJECTIVE

To explore the course of depression in people with mild dementia and identify predictors for depression at 1-year follow-up.

METHODS

Patients with mild dementia (n = 199) were assessed using Montgomery and Åsberg Depression Rating Scale (MADRS) and the depression item from Neuropsychiatric Inventory (NPI) at baseline and after 1 year. A score above 6 on MADRS indicates at least mild depression. Linear and logistic regression analyses were performed to identify predictors of change in depression scores.

RESULTS

Among subjects with depression at baseline, 68.1% remained depressed at follow-up, whereas 31.9% had remitted, based on MADRS. Among patients without depression at baseline, 77.1% remained non-depressed at follow-up, whereas 22.9% had incident depression. The proportion with persistent depression was higher in the combined dementia with Lewy bodies (DLB)/Parkinson's disease with dementia (PDD) group (45.5%) compared to AD (28%) (p < 0.05). Greater decline on the Mini Mental State Examination (p < 0.001) and higher baseline MADRS score (p < 0.001) were significant predictors of increased MADRS score.

CONCLUSION

Two thirds of patients with depression at baseline were still depressed at follow-up, more so in DLB with PDD compared to AD. Cognitive decline was associated with worsening of depressive symptoms.

Depression in mild dementia: associations with diagnosis, APOE genotype and clinical features

BACKGROUND

Depression is common in dementia, with important clinical implications. Few studies of depression in dementia with Lewy bodies are available, and the results are inconsistent.

OBJECTIVE

To examine the frequency of depression and its characteristics and correlates, in people with mild dementia.

METHODS

All referrals for patients with a first time diagnosis of dementia to geriatric and older psychiatry outpatient clinics in the counties of Rogaland and Hordaland in Western Norway from March 2005 to March 2007 were screened for the study. Participants and their caregivers underwent a comprehensive and standardised diagnostic and assessment procedure. The depression subitem of the neuropsychiatric inventory (NPId) and Montgomery and Åsberg depression rating scale (MADRS) were used to estimate depression. Cut-off scores for any depression were 0/1 (NPId) and 6/7 (MADRS), and for clinically significant depression 3/4 and 14/15, respectively.

RESULTS

Two hundered and twenty-three subjects with dementia participated, of whom 59 and 50% showed symptoms of depression assessed by NPI or MADRS, respectively, and 25 and 16% had clinically significant depression as measured by NPI and MADRS, respectively. Depression was more frequent in dementia with Lewy bodies (DLB) than in Alzheimer's disease (AD; p < 0.05). APOE genotype was available in 153 patients, and in AD, but not in DLB, a general linear model showed that the presence of APOEε4 allele was significantly associated with depression (F = 4.14; p = 0.045).

CONCLUSION

Depression is common even in mild dementia, and more common and severe in DLB compared to AD. Future studies should explore the longitudinal course of depression in DLB, and the neural underpinnings of depression in DLB.

Occurrence of depression and its correlates in early onset dementia patients

OBJECTIVE

We wanted to investigate the occurrence of depression in early onset dementia (EOD) patients and which characteristics were associated with depressive symptoms.

METHODS

We included 221 patients who were diagnosed with dementia before the age of 65. Depression in these patients was measured by the Montgomery Asberg depression scale (MADRS). Measurements of cognition, behavioural and psychological symptoms and activities of daily life were along with hypothyroidism, diabetes and stroke included in the analysis. History of depression, current psychiatric co-morbidity and usage of antidepressants were recorded.

RESULTS

Mean age of patients was 58.6 years (SD = 5.2); 50.6% were women. Of them 123 patients (55.6%) had a mild degree of depression (MADRS total score 7-19), 21 patients (9.5%) had a moderate degree of depression (MADRS total score 20-34) and only 1 patient had a severe degree of depression (MADRS total score >or=35). A factor analysis produced two factors; the first factor described dysphoria: lack of concentration, pessimistic thoughts, inner tension, suicidal thoughts lassitude and lack of sleep. The second factor denoted sadness: observed sadness, reported sadness, lack of appetite and inability to feel. In an adjusted linear regression analysis history of depression was the only significantly variable associated with the MADRS total score and both factors 1 and 2.

CONCLUSION

We found a high occurrence of depressive symptoms in EOD patients; 65.7% of all our patients had some degree of depression. A history of depression was the most important correlate of depression in these patients.

Relation between neuritic plaques and depressive state in Alzheimer's disease

Meynen G, Van Stralen H, Smit JH, Kamphorst W, Swaab DF, Hoogendijk WJG. Relation between neuritic plaques and depressive state in Alzheimer's disease.

BACKGROUND

To investigate for the first time in a prospective study the relationship between depressive state and the neuropathological hallmarks of Alzheimer's disease, using a scale for depressive symptoms in dementia, while controlling for clinical severity of dementia.

METHOD

Within the framework of a prospective longitudinal study of depression in Alzheimer's disease, patients with dementia underwent a clinical evaluation every six months during the last years of their lives, using the Cornell scale for depression in dementia to assess depressive symptoms and using the Functional Assessment Staging scale to control for clinical severity of dementia. The brains of 43 Alzheimer patients were obtained. The last clinical evaluations prior to death together with post-mortem neuropathology measures were analysed.

RESULTS

We found a correlation between the Cornell scores and the sum score for the density of neuritic plaques in the entire cortex (p = 0.027), and even stronger in the temporal cortex (p = 0.012). The observed correlations were independent of sex, age of death, clinical dementia severity and duration of Alzheimer's disease.

CONCLUSIONS

This study shows a positive relationship between depressive state at time of death and the presence of neuritic plaques in Alzheimer's disease, which is independent of the clinical severity of dementia.

Apathy and depressive mood in nursing home patients with early-onset dementia

The study explored whether apathy and depressive mood symptoms (DMS) are related to cognitive and functional features of dementia in 63 nursing home (NH) residents with early-onset dementia (EOD). All EOD residents from one NH (n = 41) and a random sample from another NH were assessed for depressive symptoms (Montgomery Asberg Depression Rating Scale [MADRS]), apathy (Neuropsychiatric Inventory [NPI]), global cognitive functions (Mini-Mental State Examination [MMSE]), activities of daily living (ADL, Minimum Data Set-Resident Assessment Instrument [MDS-RAI]), and overall dementia severity (Global Deterioration Scale [GDS]). DMS were not associated with apathy and dementia severity. Regression analyses adjusted for age, gender, the type of dementia, and DMS revealed that dementia severity measures accounted, respectively, for 14% (ADL), 13% (GDS), and 9% (MMSE) of the variance in apathy. In line with previous research in older patients, the higher apathy scores were associated with more cognitive and functional problems in EOD.