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Comparison of Different Clinical Diagnostic Criteria for Depression in Alzheimer Disease

https://doi.org/10.1097/01.JGP.0000209396.15788.9dGet rights and content

Objective

Data in the literature show different estimates of the prevalence of depression in patients with Alzheimer disease (AD) when different classification systems are used. This study describes the prevalence and clinical features of depression in AD based on five different depression classification systems.

Methods

This was a cross-sectional, observational study of 491 patients with probable AD. Depression was diagnosed using five classification systems (International Classification of Diseases, 10th Revision [ICD-10], Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM–IV], Cambridge Examination for Mental Disorder of the Elderly [CAMDEX], Provisional Diagnostic Criteria for depression in AD [PDC-dAD], Neuropsychiatric Inventory [NPI]).

Results

The prevalence of depression was 4.9% (95% confidence interval [CI]: 3.2–7.1) according to ICD-10 criteria; 9.8% (95% CI: 7.3–12.6) according to CAMDEX; 13.4% (95% CI: 10.6–16.6) according to DSM–IV; 27.4% (95% CI: 23.6–31.5) according to PDC-dAD criteria; and 43.7% (95% CI: 39.4–48.2) when using the screening questions from the NPI depression subscale. The level of agreement between the classification systems was low to moderate (χ <0.52). The characteristics associated with the most diagnostic disagreement were loss of confidence or self-esteem and irritability.

Conclusions

This study shows that there is a high variability in the prevalence rates of depression in AD depending on the diagnostic criteria used and that there is a low rate of agreement among the diagnostic criteria analyzed. The results suggest that the use of generic diagnostic criteria such as the ICD-10, the CAMDEX, or DSM–IV provides low prevalence rates of depression in patients with AD compared with specific diagnostic criteria such as the PDC-dAD.

Section snippets

Subjects

The sample included subjects referred from the primary care centers to the UVaMiD memory clinic as a result of progressive cognitive decline. Clinical diagnosis of AD was made according to the standard UVaMiD memory clinic protocol, which includes the medical history through an interview with the patient and with the caregiver; a general medical, psychiatric, and neurologic examination; and a set of complementary tests: basic hematologic and biochemical analysis and brain computed axial

RESULTS

The sample consisted of 491 patients, of whom 70.9% were women and 40.1% were <75 years (mean age: 75.2 years, standard deviation [SD]: 6.6, range: 52–89 years). The mean number of years of education was 5.9 (SD: 3.7, range: 0–21 years). A total of 27.7% of the patients scored between 30 and 20 points on the MMSE, 66.6% between 19 and 11 points, and 5.3% scored 10 or less, and the mean score was 17.1 points (SD: 4.1, range: 6–27). The mean score on the CAMCOG was 55.6 points (SD: 13.4, range:

DISCUSSION

This study examined the prevalence rate of depression according to five different conceptualizations in a large clinical sample of patients with AD. The objective was to obtain estimations of prevalence based on five conceptualizations of depression in an increasing order of diagnostic rigidity. The prevalence rates for the four clinical diagnostic criteria ranged from 4.9% for the ICD-10 to 27.4% for the PDC-dAD. The prevalence rate according the screening question of the NPI depression

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