Chapter 1 - Measures of depression in Alzheimer’s disease

Abstract

Untreated depression in dementia is associated with increased mortality, accelerated cognitive decline, earlier nursing home placement, and decreased quality of life. Thus it is important to accurately measure and treat depression in dementia. This chapter summarizes, discusses, and compares the several existing scales that measure depression in Alzheimer’s disease (AD). Accordingly, this chapter will assess the efficiency of the following scales in accurately measuring depression in AD patients: the Cornell Scale for Depression in Dementia, the Montgomery-Asberg Depression Rating Scale, The Geriatric Depression Scale, The Hospital Anxiety and Depression Scale, Hamilton Depression Rating Scale, the Dementia Mood Assessment Scale, the Nurses Observation Scale for Geriatric Patients, National Institute of Mental Health-depression in AD measure, the Cambridge Examination for Mental Disorder of the Elderly Depression Scale, the Provisional Diagnostic Criteria for Depression in Alzheimer’s Disease, the Even Briefer Assessment Scale for Depression. Further, our review shows that depression in dementia is a complex construct that involves hopelessness, feelings of guilt, feeling worthless, thoughts of self-harm, significant change in weight or appetite, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, difficulties concentrating, and recurrent thoughts of death or suicide. These vary across patients with dementia, although the most common feature is negative mood. Importantly, our review shows that (1) some of these depression scales do not correlate, suggesting that they assess different aspects of depression; (2) reports of depression in dementia vary based on depression in dementia scale used; and (3) severe memory impairment may impact the ability to assess depression in the patients using self-reports.