1. The Clinical Utility of the Cornell Scale for Depression in Dementia as a Routine Assessment in Nursing Homes
- Author
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Zhixin Liu, Lee-Fay Low, Henry Brodaty, Yun-Hee Jeon, Lynn Chenoweth, Daniel William O'Connor, Zhicheng Li, and Elizabeth Beattie
- Subjects
Male ,medicine.medical_specialty ,Youden's J statistic ,Sensitivity and Specificity ,medicine ,Homes for the Aged ,Humans ,Dementia ,Medical diagnosis ,Psychiatry ,Geriatric Assessment ,Depression (differential diagnoses) ,Aged ,Aged, 80 and over ,Psychiatric Status Rating Scales ,Receiver operating characteristic ,Depression ,business.industry ,Australia ,medicine.disease ,Nursing Homes ,Diagnostic and Statistical Manual of Mental Disorders ,Psychiatry and Mental health ,ROC Curve ,Family medicine ,Scale (social sciences) ,Female ,Geriatrics and Gerontology ,Alzheimer's disease ,business ,Nursing homes - Abstract
Objective To examine the clinical utility of the Cornell Scale for Depression in Dementia (CSDD) in nursing homes. Setting 14 nursing homes in Sydney and Brisbane, Australia. Participants 92 residents with a mean age of 85 years. Measurements 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. Conclusion 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.
- Published
- 2015