title: The clinical utility of the Cornell Scale for Depression in Dementia as a routine assessment in nursing homes.
abstract: OBJECTIVE
  To examine the clinical utility of the Cornell Scale for Depression in Dementia (CSDD) in nursing homes.
  
  
  METHODS
  14 nursing homes in Sydney and Brisbane, Australia.
  
  
  METHODS
  92 residents with a mean age of 85 years.
  
  
  METHODS
  Consenting residents were assessed by care staff for depression using the CSDD as part of their routine assessment. Specialist clinicians conducted assessment of depression using the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders for residents without dementia or the Provisional Diagnostic Criteria for Depression in Alzheimer Disease for residents with dementia to establish expert clinical diagnoses of depression. The diagnostic performance of the staff completed CSDD was analyzed against expert diagnosis using receiver operating characteristic (ROC) curves.
  
  
  RESULTS
  The CSDD showed low diagnostic accuracy, with areas under the ROC curve being 0.69, 0.68 and 0.70 for the total sample, residents with dementia and residents without dementia, respectively. At the standard CSDD cutoff score, the sensitivity and specificity were 71% and 59% for the total sample, 69% and 57% for residents with dementia, and 75% and 61% for residents without dementia. The Youden index (for optimizing cut-points) suggested different depression cutoff scores for residents with and without dementia.
  
  
  CONCLUSIONS
  When administered by nursing home staff the clinical utility of the CSDD is highly questionable in identifying depression. The complexity of the scale, the time required for collecting relevant information, and staff skills and knowledge of assessing depression in older people must be considered when using the CSDD in nursing homes.
authors.affiliation: Sydney Nursing School, the University of Sydney, Sydney, Australia. Electronic address: yun-hee.jeon@sydney.edu.au.
authors.forename: Yun-Hee
authors.initials: YH
authors.lastname: Jeon
authors.affiliation: Sydney Nursing School, the University of Sydney, Sydney, Australia.
authors.forename: Zhicheng
authors.initials: Z
authors.lastname: Li
authors.affiliation: Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia.
authors.forename: Lee-Fay
authors.initials: LF
authors.lastname: Low
authors.affiliation: Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia; Faculty of Health, University of Technology Sydney, Sydney, Australia.
authors.forename: Lynn
authors.initials: L
authors.lastname: Chenoweth
authors.affiliation: Southern Clinical School, Monash University, Clayton, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: O'Connor
authors.affiliation: Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Beattie
authors.affiliation: Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia.
authors.forename: Zhixin
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia.
authors.forename: Henry
authors.initials: H
authors.lastname: Brodaty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003704:Dementia / Q000175:diagnosis*; D003863:Depression / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009735:Nursing Homes; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D012680:Sensitivity and Specificity
keywords: Cornell Scale for Depression in Dementia; Depression; assessment; dementia; nursing homes