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

From the Departments of Neurology (ET, JMR, GB, JLC) and Psychiatry and Biobehavioral Sciences (JLC), David Geffen School of Medicine at UCLA, Los Angeles, CA; Institute for Health and Aging, UCSF School of Nursing, San Francisco (LKR); Program in Nursing Science (RAM) and Institute for Brain Aging and Dementia (MBD), UC Irvine, Irvine, CA; Department of Psychiatry, Stanford University, Stanford, CA (HDD); Department of Neurosciences, UC San Diego and VA Medical Center, San Diego, CA (DG); Alzheimer’s & Memory Center, UCSF-Fresno, Fresno, CA (LH); Department of Neurology, UC Davis, Davis, CA (DM); Alzheimer’s Disease Center, UC Davis, Martinez, CA (BRR); Departments of Psychiatry, Neurology, and Gerontology, Keck School of Medicine, USC, Los Angeles (LSS); Rancho Los Amigos National Rehabilitation Center, Keck School of Medicine, USC, Downey, CA (FS-G); Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics, UCSF, San Francisco (KY).

Objective: 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.

Design: Descriptive longitudinal cohort study.

Setting: The Alzheimer’s Disease Research Centers of California.

Participants: A cohort of 101 patients meeting NINDS-ADRDA criteria for possible/probable AD, intentionally selected to increase the frequency of depression at baseline.

Measurements: 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.

Results: 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 ( = 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.

Conclusions: The NIMH-dAD criteria identify a greater proportion of AD patients as depressed than several other established tools.