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Meta-Analysis
. 2017 May;65(5):937-948.
doi: 10.1111/jgs.14713. Epub 2017 Feb 2.

Depression Case Finding in Individuals with Dementia: A Systematic Review and Meta-Analysis

Zahra S Goodarzi  1   2 , Bria S Mele  3 , Derek J Roberts  1   4   5 , Jayna Holroyd-Leduc  1   2
Affiliations
Meta-Analysis

Depression Case Finding in Individuals with Dementia: A Systematic Review and Meta-Analysis

Zahra S Goodarzi et al. J Am Geriatr Soc. 2017 May.

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] J Am Geriatr Soc. 2018 Jul;66(7):1441. doi: 10.1111/jgs.15407. J Am Geriatr Soc. 2018. PMID: 30117570 No abstract available.

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.

Keywords: dementia; depression; detection; diagnostic test accuracy.

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