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Validation of Montgomery-Åsberg Rating Scale and Cornell Scale for Depression in Dementia in Brazilian elderly patients

  • Maria da Glória Portugal (a1), Evandro Silva Freire Coutinho (a2), Cloyra Almeida (a1), Maria Lage Barca (a1) (a3), Anne-Brita Knapskog (a3), Knut Engedal (a3) and Jerson Laks (a1)...


Background: There are few studies on validation of depression scales in the elderly in Latin America. This study aimed to assess the validity of Montgomery-Åsberg. Depression Rating Scale (MADRS) and Cornell Scale for Depression in Dementia (CSDD) in Brazilian elderly outpatients.

Methods: A convenience sample of 95 outpatients was diagnosed for dementia and depression according to DSM-IV-TR, ICD-10, and PDC-dAD criteria. Receiver Operating Curves (ROC) were used to calculate the area under the curve (AUC) and to assess MADRS and CSDD cut-offs for each diagnostic criterion.

Results: Dementia was diagnosed in 71 of 95 patients. Depression was diagnosed in 35, 30, and 51 patients by ICD-10, DSM-IV, and PDC-dAD, respectively. MADRS cut-off score of 10 correctly diagnosed 67.4% and 66.3% patients as depressed according to DSM-IV and ICD-10. A cut-off of 9 correctly identified 74.7% by PDC-dAD criteria; a CSDD cut-off score of 13 best recognized depression according to DSM-IV and ICD-10. A score of 11 diagnosed depression according to PDC-dAD, while MADRS = 9 recognized depression in dementia. CSDD was more efficient in showing depression in mild than in moderate/severe dementia according to DSM-IV/ICD-10. PDC-dAD behaved nicely for any severity stage.

Conclusion: MADRS and CSDD cut-offs of 10 and 13 were the optimal ones to diagnose depression in elderly, respectively. CSDD cut-offs are higher than those found in other countries. Other Latin American studies are needed to compare results with our study.


Corresponding author

Correspondence should be addressed to: Maria da Glória Portugal, Center for Alzheimer's Disease, Institute of Psychiatry, Federal University of Rio de Janeiro, Av. Nossa Senhora de Copacabana, 680/314, Bairro Copacabana, 22050-001, Rio de Janeiro- RJ, Brazil. Phone: +55 21 2255 3454; Fax: +55 21 2235 6320. Email:


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Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988). Cornell Scale for Depression in Dementia. Biological Psychiatry, 23, 271284.
APA (American Psychiatric Association) (1994). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.
Barca, M. L., Engedal, K. and Selbaek, G. (2010). A reliability and validity study of the Cornell scale among elderly inpatients, using various clinical criteria. Dementia and Geriatric Cognitive Disorders, 29, 438447. doi: 10.1159/000313533.
Barca, M. L., Selbaek, G., Laks, J. and Engedal, K. (2008). The pattern of depressive symptoms and factor analysis of the Cornell scale among patients in Norwegian nursing homes. International Journal of Geriatric Psychiatry, 23, 10581065. doi: 10.1002/gps.2033.
Bertolucci, P. H., Brucki, S. M., Campacci, S. R. and Juliano, Y. (1994). O mini-exame do estado mental em uma população geral: impacto da escolaridade. Arquivos de Neuro-psiquiatria, 52, 17.
Camozzato, A. L. et al. (2008). Reliability of the Brazilian Portuguese version of the Neuropsychiatric Inventory (NPI) for patients with Alzheimer's disease and their caregivers. International Psychogeriatrics, 20, 383393. doi:10.1017/S1041610207006254.
Carthery-Goulart, M. T. et al. (2007). Brazilian version of the Cornell Depression Scale in Dementia. Arquivos de Neuro-psiquiatria, 65, 912915. doi: 10.1590/S0004-282X2007000500037.
Chaves, M. L. et al. (2007). Validity of the Clinical Dementia Rating scale for the detection and staging of dementia in Brazilian patients. Alzheimer Disease and Associated Disorders, 21, 210217.
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 23082314.
Debruyne, H. et al. (2009). Is the Geriatric Depression Scale a reliable screening tool for depressive symptoms in elderly patients with cognitive impairment? International Journal of Geriatric Psychiatry, 24, 556562. doi: 10.1002/gps.2154.
Dratcu, L., da Costa Ribeiro, L. and Calil, H. M. (1987). Depression assessment in Brazil: the first application of the Montgomery-Åsberg depression rating scale. British Journal of Psychiatry, 150, 797800.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566572.
Inouye, K., Pedrazzani, E. S., Pavarini, S. C. I. and Toyoda, C. Y. (2010). Quality of life of elderly with Alzheimer's disease: a comparative study between the patient's and the caregiver's report. Revista Latino-Americana de Enfermagem, 18, 2632. doi: 10.1590/S0104-11692010000100005.
Judd, L. L. and Akiskal, H. (2002). The clinical and public health relevance of current research on subthreshold depressive symptoms to elderly patients. American Journal of Geriatric Psychiatry, 10, 233238.
Krause, N. and Goldenhar, L. M. (1992). Acculturation and psychological distress in three groups of elderly Hispanics. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 47, S279S288.
Laks, J. and Engelhardt, E. (2010). Peculiarities of geriatric psychiatry: a focus on aging and depression. CNS Neuroscience & Therapeutics, 16, 374379.
Lam, C. K., Lim, P. P. J., Low, B. L., Ng, L. L., Chiam, P. C. and Sahadevan, S. (2004). Depression in dementia: a comparative and validation study of four brief scales in the elderly Chinese. International Journal of Geriatric Psychiatry, 19, 422428. doi: 10.1002/gps.1098.
Leentjens, A. F. G., Verhey, F. R. J., Lousberg, R., Spitsbergen, H. and Wilmink, F. W. (2000). The validity of the Hamilton and Montgomery-Åsberg depression rating scales as screening and diagnostic tools for depression in Parkinson's disease. International Journal of Geriatric Psychiatry, 15, 644649.
Leontjevas, R., van Hooren, S. and Mulders, A. (2009). The Montgomery-Åsberg depression rating scale and the Cornell scale for depression in dementia: a validation study with patients exhibiting early-onset dementia. American Journal of Geriatric Psychiatry, 17, 5664. doi: 10.1097/JGP.0b013e31818b4111.
Logsdon, R. G., Gibbons, L. E., McCurry, S. M. and Teri, L. (2002). Assessing quality of life in older adults with cognitive impairment. Psychosomatic Medicine, 64, 510519.
Montgomery, A. S. and Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382389.
Müller-Thomsen, T., Arlt, S., Mann, U., Mass, R. and Ganzer, S. (2005). Detecting depression in Alzheimer's disease: evaluation of four different scales. Archives of Clinical Neuropsychology, 20, 271276.
Olin, J. T., Katz, I. R., Meyers, B. S., Schneider, L. S. and Lebowitz, B. D. (2002). Provisional diagnostic criteria for depression of Alzheimer disease: rationale and background. American Journal of Geriatric Psychiatry, 10, 129141.
Porta-Etessam, J., Tobaruela-González, J. L. and Rabes-Berendes, C. (in press). Depression in patients with moderate Alzheimer disease: a prospective observational cohort study. Alzheimer Disease and Associated Disorders.
Pujol, J., De Azpiazu, P., Salamero, M. and Cuevas, R. (2001). Depressive symptoms in dementia – the Cornell scale: validation of the Spanish version. Revista de Neurologia, 33, 397398.
Relkin, N. (2000). Screening and early diagnosis of dementia. American Journal of Managed Care, 6 (Suppl. 22), S1111S1118; discussion S1119–S1124.
Schreiner, A. S., Hayakawa, H., Morimoto, T. and Kakuma, T. (2003). Screening for late life depression: cut-off scores for the Geriatric Depression Scale and the Cornell Scale for Depression in Dementia among Japanese subjects. International Journal of Geriatric Psychiatry, 18, 498505.
Silberman, C. D., Laks, J., Capitão, C. F., Rodrigues, C. S., Moreira, I. and Engelhardt, E. (2006). Recognizing depression in patients with Parkinson's disease: accuracy and specificity of two depression rating scales. Arquivos de Neuro-psiquiatria, 64, 407411. doi: 10.1590/S0004-282X2006000300011.
Silveira, M. J., Given, C. W., Given, B., Rosland, A. M. and Piette, J. D. (2010). Patient–caregiver concordance in symptom assessment and improvement in outcomes for patients undergoing cancer chemotherapy. Chronic Illness, 6, 4656. doi:10.1177/1742395309359208.
Slawek, J., Derejko, M. and Lass, P. (2003). Depression in patients with Parkinson's disease. Neurologia i Neurochirurgia Polska, 37, 351364.
Spiegel, R. et al. (1991). A new behavioral assessment scale for geriatric out- and in-patients: The NOSGER (Nurses’ Observation Scale for Geriatric Patients). Journal of the American Geriatrics Society, 39, 339347.
Stata Corp (2007). Stata Statistical Software: Release 10. College Station, TX: Stata Corp LP.
Tran, T. V. and Dhooper, S. S. (1997). Poverty, chronic stress, ethnicity and psychological distress among elderly Hispanics. Journal of Gerontological Social Work, 27, 319.
Vida, S., Des Rosiers, R., Carrier, L. and Gauthier, S. (1994). Depression in Alzheimer's disease: receiver operating characteristic analysis of the Cornell Scale for Depression in Dementia and the Hamilton Depression Scale. Journal of Geriatric Psychiatry and Neurology, 7, 159162.
Wagenaar, D. B., Mickus, M. A., Gaumer, K. A. and Colenda, C. C. (2002). Late-life depression and mental health services in primary care. Journal of Geriatric Psychiatry and Neurology, 15, 134140.
Watson, L. C., Lewis, C. L., Moore, C. G. and Jeste, D. V. (2011). Perceptions of depression among dementia caregivers: findings from the CATIE-AD trial. International Journal of Geriatric Psychiatry, 26, 397402. doi: 10.1002/gps.2539.
WHO (World Health Organization) (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva: WHO.


Validation of Montgomery-Åsberg Rating Scale and Cornell Scale for Depression in Dementia in Brazilian elderly patients

  • Maria da Glória Portugal (a1), Evandro Silva Freire Coutinho (a2), Cloyra Almeida (a1), Maria Lage Barca (a1) (a3), Anne-Brita Knapskog (a3), Knut Engedal (a3) and Jerson Laks (a1)...


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