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UBC Theses and Dissertations

National Institute of Mental Health Depression of Alzheimer Disease : assessment and diagnostic validity studies using depression scales developed for older adults Sepehry, Amir Ali


The Lancet published a large multicenter randomized controlled clinical trial of noradrenergic and specific serotonergic antidepressant (NSSA) and selective serotonin re-uptake inhibitors (SSRI) for depression in Alzheimer’s disease (AD) suggesting that these compounds have no clinical benefit [Banerjee et al 2011]. We felt that it might be premature to suggest that the use of all antidepressant treatments is ineffective [Sepehry et al 2012]. In response, we ran a meta-analysis examining the evidence for the use of SSRIs for treatment of depression co-occurring with AD [Sepehry et al 2012, see Appendix N]. This study suggested that treatment effects are potentially assessment dependent, and provided the motivation for the current examination of depression diagnostic criteria and assessment/screening scales for AD. A literature search showed that Provisional Diagnostic Criteria for depression of AD (PDC-dAD) was proposed to diagnose depression in AD. Their validity has not been established, yet they have been used in epidemiological studies and clinical trials. Likewise, no study examined short and easy to use screening measures with comparable collateral version’s validity and utility for use with the PDC-dAD. Hence, I set these as my goals : to examine the validity-evidence of the PDC-dAD followed by simultaneous examination of the reliability (internal consistency), utility, and validity (content, construct, and concurrent) of screening measures already validated for use with older adults, for use with the PDC-dAD. Thus, the literature around depression in older adults and in AD was reviewed to improve understanding of the importance of investigating depression and its diagnostic/assessment approaches. Briefly, the result of the validity studies showed that, first, the PDC-dAD are the best that exist to date for diagnosing depression in AD; however it needs optimization. Second, screening measures developed for depression in older adults, including the collateral version, are psychometrically acceptable (valid and reliable) allowing for adequate screening of mild to mildly-moderate AD for dAD; however, the collateral version was the most valid given its psychometric properties, particularly, positive predictive value, specificity, and clinical accuracy for use with the PDC. Hence, recommendations are made for the use of the screening scales with the PDC and for future research.

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