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Am J Geriatr Psychiatry. 2008 Jun;16(6):469-77. doi: 10.1097/JGP.0b013e318165dbae.

Diagnosing depression in Alzheimer disease with the national institute of mental health provisional criteria.

Author information

  • 1Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073, USA. eteng@ucla.edu

Abstract

OBJECTIVE:

To compare the rates of depression in Alzheimer Disease (AD) determined using National Institute of Mental Health (NIMH) provisional criteria for depression in AD (NIMH-dAD) to those determined using other established depression assessment tools.

DESIGN:

Descriptive longitudinal cohort study.

SETTING:

The Alzheimer's Disease Research Centers of California.

PARTICIPANTS:

A cohort of 101 patients meeting NINDS-ADRDA criteria for possible/probable AD, intentionally selected to increase the frequency of depression at baseline.

MEASUREMENTS:

Depression was diagnosed at baseline and after 3 months using NIMH-dAD criteria and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I Disorders. Depressive symptoms also were assessed with the Cornell Scale for Depression in Dementia (CSDD), the Geriatric Depression Scale (GDS), and the Neuropsychiatric Inventory Questionnaire.

RESULTS:

The baseline frequency of depression using NIMH-dAD criteria (44%) was higher than that obtained using DSM-IV criteria for major depression (14%; Z = -5.50, df = 101, p <0.001) and major or minor depression (36%; Z = -2.86, df = 101, p = 0.021) or using established cut-offs for the CSDD (30%; Z = -2.86, df = 101, p = 0.004) or GDS (33%; Z = -2.04, df = 101, p = 0.041). The NIMH-dAD criteria correctly identified all patients meeting DSM-IV criteria for major depression, and correlated well with DSM-IV criteria for major or minor depression (kappa = 0.753, p <0.001), exhibiting 94% sensitivity and 85% specificity. The higher rates of depression found with NIMH-dAD criteria derived primarily from its less stringent requirements for the frequency and duration of symptoms. Remission rates at 3 months were similar across instruments.

CONCLUSIONS:

The NIMH-dAD criteria identify a greater proportion of AD patients as depressed than several other established tools.

PMID:
18515691
[PubMed - indexed for MEDLINE]
PMCID:
PMC2989660
Free PMC Article
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