Diagnosing Depression in Alzheimer Disease With the National Institute of Mental Health Provisional Criteria

Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073, USA.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry (Impact Factor: 4.24). 06/2008; 16(6):469-77. DOI: 10.1097/JGP.0b013e318165dbae
Source: PubMed


To compare the rates of depression in Alzheimer Disease (AD) determined using National Institute of Mental Health (NIMH) provisional criteria for depression in AD (NIMH-dAD) to those determined using other established depression assessment tools.
Descriptive longitudinal cohort study.
The Alzheimer's Disease Research Centers of California.
A cohort of 101 patients meeting NINDS-ADRDA criteria for possible/probable AD, intentionally selected to increase the frequency of depression at baseline.
Depression was diagnosed at baseline and after 3 months using NIMH-dAD criteria and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I Disorders. Depressive symptoms also were assessed with the Cornell Scale for Depression in Dementia (CSDD), the Geriatric Depression Scale (GDS), and the Neuropsychiatric Inventory Questionnaire.
The baseline frequency of depression using NIMH-dAD criteria (44%) was higher than that obtained using DSM-IV criteria for major depression (14%; Z = -5.50, df = 101, p <0.001) and major or minor depression (36%; Z = -2.86, df = 101, p = 0.021) or using established cut-offs for the CSDD (30%; Z = -2.86, df = 101, p = 0.004) or GDS (33%; Z = -2.04, df = 101, p = 0.041). The NIMH-dAD criteria correctly identified all patients meeting DSM-IV criteria for major depression, and correlated well with DSM-IV criteria for major or minor depression (kappa = 0.753, p <0.001), exhibiting 94% sensitivity and 85% specificity. The higher rates of depression found with NIMH-dAD criteria derived primarily from its less stringent requirements for the frequency and duration of symptoms. Remission rates at 3 months were similar across instruments.
The NIMH-dAD criteria identify a greater proportion of AD patients as depressed than several other established tools.

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    • "In addition, the NIMH workgroup criteria require only three symptoms for the diagnosis of depression, as opposed to the five required by the DSM-IV criteria and do not require that the symptoms occur nearly every day. Although the validity of the NIMH criteria was supported in a study of 101 AD patients, the debate over the diagnostic accuracy of DSM-IV criteria for depression in AD continues (Teng et al., 2008). A recent study of 971 AD patients found that all nine DSM-IV criteria for major depression were significantly associated with the cluster of patients diagnosed with major depression, whereas the criterion of irritability was not (Starkstein, Dragovic, Jorge, Brockman, & Robinson, 2011). "
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    • "In recognition of the unique presentation and possible prognostic significance of major depressive disorder within AD, the National Institute of Mental Health developed a modified provisional set of criteria for depression in AD, distinct from the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria for major depressive disorder [73,74]. Work with these criteria has indicated that the prevalence of major depressive disorder is significantly under-estimated in this population relative to DSM-IV-based prevalence estimates [74,75]. "
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