Depression Case Finding in Individuals with Dementia: A Systematic Review and Meta‐Analysis

Goodarzi, Zahra; Mele, Bria; Roberts, Derek J.; Holroyd‐Leduc, Jayna

doi:10.1111/jgs.14713

Cited by 53 publications

(38 citation statements)

References 44 publications

(190 reference statements)

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“…Commonly recommended tools were the CSDD and GDS, with preference towards the CSDD due to better accuracy [39, 42, 45, 47, 48]. This was confirmed by a 2015 systematic review of depression tools for dementia, finding that the CSDD had a area under the curve of 0.89 [58]. …”

Section: Discussionmentioning

confidence: 97%

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Guidelines for dementia or Parkinson’s disease with depression or anxiety: a systematic review

et al. 2016

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BackgroundDepression and anxiety remain under-diagnosed and under-treated in those with neurologic diseases such as dementia or Parkinson’s Disease (PD). Our objectives were to first, to provide a synthesis of high quality guidelines available for the identification and management of depression or anxiety in those with dementia or PD. Second, to identify areas for improvement for future guidelines.MethodsWe searched MEDLINE, PsycINFO, and EMBASE (2009 to July 24, 2015), grey literature (83 sources; July 24-Sept 6, 2015), and bibliographies of included studies. Included studies were evaluated for quality by four independent reviewers the AGREE II tool. Guideline characteristics, statements and recommendations relevant to depression or anxiety for dementia and PD were then extracted. (PROSPERO CRD: 42016014584)Results8121 citations were reviewed with 31 full text articles included for assessment with the AGREE II tool. 17 were of sufficient quality for inclusion. Mean overall quality scores were between 4.25 to 6.5. Domain scores were lowest in the areas of stakeholder involvement, applicability, and editorial independence.Recommendations for the screening and diagnosis of depression were found for PD and dementia. There was little evidence to guide diagnosis or management of anxiety. Non-pharmacologic therapies were recommended for dementia patients. Most advocated pharmacologic treatment for depression, for both PD and dementia, but did not specify an agent due to lack of evidence.ConclusionsThe available recent high quality guidelines outline several recommendations for the management of comorbid depression or anxiety in PD or dementia. However there remain significant gaps in the evidence.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-016-0754-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 97%

“…ZG, BM, SG, HH, SS, TP, NJ and JHL provided input and reviewed the proposal, protocol, analysis and manuscript. ZG registered the protocol with PROSPERO [58]. All authors had access to the data, reviewed and approved the final manuscript.…”

Section: Acknowledgementsmentioning

confidence: 99%

Guidelines for dementia or Parkinson’s disease with depression or anxiety: a systematic review

et al. 2016

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“…To avoid false negatives at this point, we excluded patients who scored below the cut-off for greatest sensitivity on the CSDD scale (CSDD score ≥ 6). The screening cut-off value of ≥ 8 and the re-assessment threshold for persistent depression of ≥ 6 on the CSDD scale correspond to the optimal cut-off points for specificity and sensitivity, respectively, as summarised in a recent meta-analysis [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

“…Depressive symptoms were assessed using the CSDD scale, which has been validated and used in clinical studies including people with and without dementia [ 24 ]. Each of the 19 items is rated from zero (no symptoms) to two (severe symptoms), and yields a sum score of between zero (no depression) and 38 (most severe depression).…”

Section: Methodsmentioning

confidence: 99%

Efficacy and Safety of Analgesic Treatment for Depression in People with Advanced Dementia: Randomised, Multicentre, Double-Blind, Placebo-Controlled Trial (DEP.PAIN.DEM)

et al. 2018

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BackgroundChronic pain and depression often co-occur, and pain may exacerbate depression in people with dementia.ObjectiveThe objective of this study was to assess the efficacy and safety of analgesic treatment for depression in nursing home patients with advanced dementia and clinically significant depressive symptoms.MethodsWe conducted a multicentre, parallel-group, double-blind, placebo-controlled trial in 47 nursing homes, including 162 nursing home patients aged ≥ 60 years with dementia (Mini-Mental State Examination ≤ 20) and depression (Cornell Scale for Depression in Dementia ≥ 8). Patients were randomised to receive active analgesic treatment (paracetamol or buprenorphine transdermal system) or identical placebo for 13 weeks. The main outcome measure was the change in depression (Cornell Scale for Depression in Dementia) from baseline to 13 weeks, assessed using linear mixed models with fixed effects for time, intervention and their interaction in the models. Secondary outcomes were to assess whether any change in depression was secondary to change in pain (Mobilisation-Observation-Behaviour-Intensity-Dementia-2 Pain Scale) and adverse events.ResultsThe mean depression change was − 0.66 (95% confidence interval − 2.27 to 0.94) in the active group (n = 80) and − 3.30 (− 4.68 to −1.92) in the placebo group (n = 82). The estimated treatment effect was 2.64 (0.55–4.72, p = 0.013), indicating that analgesic treatment had no effect on depressive symptoms from baseline to 13 weeks while placebo appeared to ameliorate depressive symptoms. There was no significant reduction in pain in the active treatment group (paracetamol and buprenorphine combined) vs. placebo; however, a subgroup analysis demonstrated a significant reduction in pain for paracetamol vs. placebo [by − 1.11 (− 2.16 to − 0.06, p = 0.037)] from week 6 to 13 without a change in depression. Buprenorphine did not have significant effects on depression [3.04 (− 0.11 to 6.19), p = 0.059] or pain [0.47 (− 0.77 to 1.71), p = 0.456] from 0 to 13 weeks. Thirty-five patients were withdrawn from the study because of adverse reactions, deterioration or death: 25 (31.3%) during active treatment [23 (52.3%) who received buprenorphine], and ten (12.2%) in the placebo group. The most frequently occurring adverse events were psychiatric (17 adverse reactions) and neurological (14 adverse reactions).ConclusionAnalgesic treatment did not reduce depression while placebo appeared to improve depressive symptoms significantly by comparison, possibly owing to the adverse effects of active buprenorphine. The risk of adverse events warrants caution when prescribing buprenorphine for people with advanced dementia.Trial registrationClinicalTrials.gov NCT02267057 (registered 7 July, 2014) and Norwegian Medicines Agency EudraCT 2013-002226-23.Electronic supplementary materialThe online version of this article (10.1007/s40266-018-0546-2) contains supplementary material, which is available to authorized users.

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“…Approximately 79.1% older adults with dementia living in nursing homes have exhibited agitated behaviours at least once (Testad, Aasland, & Aarsland, 2007). The prevalence of depression in older adults with dementia has been reported as 30% (Goodarzi, Mele, Roberts, & Holroyd-Leduc, 2017).…”

Section: Introductionmentioning

confidence: 99%

Modelling factors of urinary incontinence in institutional older adults with dementia

Chen

Hsu

2019

Journal of Clinical Nursing

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Aims and Objectives This study applied structural equation modelling to explore the relationships among agitated behaviours, depression, cognitive function and activities of daily living, as well as associations between these factors and urinary incontinence). Background A high prevalence of urinary incontinence is found among institutional older adults with dementia. People with urinary incontinence suffer from increased financial burden and social isolation and experience reduced quality of life. Design Cross‐sectional correlational research. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Methods In total, 226 older adults with dementia were recruited through convenience sampling at 15 long‐term care facilities in southern Taiwan. The urinary incontinence frequency, agitated behaviours, depression, cognitive function and activities of daily living were evaluated using bladder records, the Cohen‐Mansfield Agitation Inventory, the Cornell Scale for Depression in Dementia, the Mini‐Mental State Examination and the Barthel Index, respectively. Results Activities of daily living performance was found to be significantly associated with urinary incontinence; however, age, cognitive function, depression and agitated behaviours were not significantly related to urinary incontinence. Age did not have effects on any of the variables tested in this model, whereas activities of daily living performance was significantly associated with cognitive function and depression. Results further showed that cognitive function and depression were mediators between activities of daily living and agitated behaviours. Conclusion Enhanced activities of daily living independency directly reduced urinary incontinence, improved cognitive function, decreased degrees of depression and indirectly reduced agitated behaviours. Relevance to clinical practice The findings could serve as a valuable reference for long‐term care facilities in providing effective urinary incontinence care and prevention to older adults with dementia.

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Depression Case Finding in Individuals with Dementia: A Systematic Review and Meta‐Analysis

Abstract: There are many validated tools for the detection of depression in individuals with dementia. Tools that incorporate a physician interview with patient and collateral histories, the CSDD and HDRS, have higher sensitivities, which would ensure fewer false-negatives.

Cited by 53 publications

References 44 publications

Guidelines for dementia or Parkinson’s disease with depression or anxiety: a systematic review

Guidelines for dementia or Parkinson’s disease with depression or anxiety: a systematic review

Efficacy and Safety of Analgesic Treatment for Depression in People with Advanced Dementia: Randomised, Multicentre, Double-Blind, Placebo-Controlled Trial (DEP.PAIN.DEM)

Modelling factors of urinary incontinence in institutional older adults with dementia

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