Depression Case Finding in Individuals with Dementia: A Systematic Review and Meta-Analysis.
OBJECTIVE
To compare the diagnostic accuracy of depression case finding tools with a criterion standard in the outpatient setting among adults with dementia.


METHODS
Systematic review and meta-analysis.


METHODS
Studies of older outpatients with dementia.


METHODS
Elderly outpatients (clinic and long-term care) with dementia (N = 3,035).


METHODS
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.


CONCLUSIONS
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.
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.|Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.
Zahra S
ZS
Goodarzi
Quest University Canada, Squamish, British Columbia, Canada.
Bria S
BS
Mele
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.|Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.|Department of Surgery, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.
Derek J
DJ
Roberts
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.|Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.
Jayna
J
Holroyd-Leduc
D000368:Aged; D003704:Dementia / Q000523:psychology*; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D008134:Long-Term Care; D010045:Outpatients; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity
dementia; depression; detection; diagnostic test accuracy