Zahra S Goodarzi1,2, Bria S Mele3, Derek J Roberts1,4,5, Jayna Holroyd-Leduc1,2. 1. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. 2. Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada. 3. Quest University Canada, Squamish, British Columbia, Canada. 4. Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada. 5. Department of Surgery, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.
Abstract
OBJECTIVES: To compare the diagnostic accuracy of depression case finding tools with a criterion standard in the outpatient setting among adults with dementia. DESIGN: Systematic review and meta-analysis. SETTING: Studies of older outpatients with dementia. PARTICIPANTS: Elderly outpatients (clinic and long-term care) with dementia (N = 3,035). MEASUREMENTS: Prevalence of major depression and diagnostic accuracy measures including sensitivity, specificity, and likelihood ratios. RESULTS: From the 11,539 citations, 20 studies were included for qualitative synthesis and 15 for a meta-analysis. Tools included were the Montgomery Åsberg Depression Rating Scale, Cornell Scale for Depression in Dementia (CSDD), Geriatric Depression Scale (GDS), Center for Epidemiologic Studies Depression Scale (CES-D), Hamilton Depression Rating Scale (HDRS), Single Question, Nijmegen Observer-Rated Depression Scale, and Even Briefer Assessment Scale-Depression. The pooled prevalence of depression in individuals with dementia was 30.3% (95% CI = 22.1-38.5). The average age was 75.2 (95% CI = 71.7-78.7), and mean Mini-Mental State Examination scores ranged from 11.2 to 24. The diagnostic accuracy of the individual tools was pooled for the best-reported cutoffs and for each cutoff, if available. The CSDD had a sensitivity of 0.84 (95% CI = 0.73-0.91) and a specificity of 0.80 (95% CI = 0.65-0.90), the 30-item GDS (GDS-30) had a sensitivity of 0.62 (95% CI = 0.45-0.76) and a specificity 0.81 (95% CI = 0.75-0.85), and the HDRS had a sensitivity of 0.86 (95% CI = 0.63-0.96) and a specificity of 0.84 (95% CI = 0.76-0.90). Summary statistics for all tools across best-reported cutoffs had significant heterogeneity. CONCLUSION: There are many validated tools for the detection of depression in individuals with dementia. Tools that incorporate a physician interview with patient and collateral histories, the CSDD and HDRS, have higher sensitivities, which would ensure fewer false-negatives.
OBJECTIVES: To compare the diagnostic accuracy of depression case finding tools with a criterion standard in the outpatient setting among adults with dementia. DESIGN: Systematic review and meta-analysis. SETTING: Studies of older outpatients with dementia. PARTICIPANTS: Elderly outpatients (clinic and long-term care) with dementia (N = 3,035). MEASUREMENTS: Prevalence of major depression and diagnostic accuracy measures including sensitivity, specificity, and likelihood ratios. RESULTS: From the 11,539 citations, 20 studies were included for qualitative synthesis and 15 for a meta-analysis. Tools included were the Montgomery Åsberg Depression Rating Scale, Cornell Scale for Depression in Dementia (CSDD), Geriatric Depression Scale (GDS), Center for Epidemiologic Studies Depression Scale (CES-D), Hamilton Depression Rating Scale (HDRS), Single Question, Nijmegen Observer-Rated Depression Scale, and Even Briefer Assessment Scale-Depression. The pooled prevalence of depression in individuals with dementia was 30.3% (95% CI = 22.1-38.5). The average age was 75.2 (95% CI = 71.7-78.7), and mean Mini-Mental State Examination scores ranged from 11.2 to 24. The diagnostic accuracy of the individual tools was pooled for the best-reported cutoffs and for each cutoff, if available. The CSDD had a sensitivity of 0.84 (95% CI = 0.73-0.91) and a specificity of 0.80 (95% CI = 0.65-0.90), the 30-item GDS (GDS-30) had a sensitivity of 0.62 (95% CI = 0.45-0.76) and a specificity 0.81 (95% CI = 0.75-0.85), and the HDRS had a sensitivity of 0.86 (95% CI = 0.63-0.96) and a specificity of 0.84 (95% CI = 0.76-0.90). Summary statistics for all tools across best-reported cutoffs had significant heterogeneity. CONCLUSION: There are many validated tools for the detection of depression in individuals with dementia. Tools that incorporate a physician interview with patient and collateral histories, the CSDD and HDRS, have higher sensitivities, which would ensure fewer false-negatives.
Authors: Maiya R Geddes; Megan E O'Connell; John D Fisk; Serge Gauthier; Richard Camicioli; Zahinoor Ismail Journal: Alzheimers Dement (Amst) Date: 2020-09-22
Authors: Jennifer A Watt; Zahra Goodarzi; Areti Angeliki Veroniki; Vera Nincic; Paul A Khan; Marco Ghassemi; Yonda Lai; Victoria Treister; Yuan Thompson; Raphael Schneider; Andrea C Tricco; Sharon E Straus Journal: BMJ Date: 2021-03-24
Authors: Carlota M Grossi; Kathryn Richardson; George M Savva; Chris Fox; Antony Arthur; Yoon K Loke; Nicholas Steel; Carol Brayne; Fiona E Matthews; Louise Robinson; Phyo K Myint; Ian D Maidment Journal: BMC Geriatr Date: 2020-07-31 Impact factor: 3.921