William H. Roccaforte

The Short Form of the Geriatric Depression Scale: A Comparison With the 30-Item Form:

The Geriatric Depression Scale (GDS) exists in both short and long forms. The original 30-item form of the GDS has been shown to be an effective screening test for depression in a variety of settings. However, its utility in patients with demen tia of the Alzheimer type (DAT) is questionable. The short, 15-item version of the GDS was developed primarily for brev ity and, in particular, for use in populations such as the medically ill or those with dementia, where the longer form might be burdensome. How well this short form works in these populations, however, is largely undetermined. In this paper, the sensitivity and specificity of the 15- and 30-item GDS are compared in a group of patients who were either cognitively intact or had mild DAT. The findings suggest that the short version of the GDS, like its longer prede cessor, is an effective screening tool in the cognitively intact. However, in a population of subjects with mild DAT, it does not appear to retain its validity. (J Geriatr Psychiatry Neurol 1991;4:173-178).

Validation of a telephone version of the mini-mental state examination

To assess the construct validity of a telephone‐administered version of the Mini‐Mental State Examination (MMSE).

Use of the Geriatric Depression Scale in dementia of the Alzheimer type.

The Geriatric Depression Scale (GDS) has been shown to be an effective screening test for depression in selected geriatric populations. However, it has not been evaluated as a screening test for depression among elderly adults with dementia of the Alzheimer type. Over a two‐year period 283 patients were seen in a geriatric assessment center and were screened for depression using the Geriatric Depression Scale. They also received a clinical psychiatric diagnosis by one of two geropsychiatrists. Patients with a Clinical Dementia Rating (CDR) of 0 (cognitively intact) (n = 70) and those with mild Alzheimers disease (CDR of 1) (n = 72) were selected for comparison. The data were analyzed using Receiver Operating Characteristic Curves (ROCs) in order to compare the utility of the Geriatric Depression Scale in these two groups. ROC curves, which plot sensitivity against false positives, have come into increasing use as a method of examining the clinical performance of tests. The area lying beneath the curve (AUC) can be estimated and used as a quantitative measure of test performance (equivalent to the Wilcoxon rank sum). In the intact group, the Geriatric Depression Scale produced a ROC curve with an AUC of 0.85 (percent score = 1), which is significant (z = 7.28, P < .0001). In the group composed of those with Alzheimers disease, the Geriatric Depression Scale yielded a ROC curve with an AUC of 0.66, which was not significantly different from chance (z = 1.92, P = NS). This study provides empirical evidence that while the Geriatric Depression Scale is an accurate screening test for depression in cognitively intact geriatric populations, it does not maintain its validity in populations that contain large numbers of patients with dementia of the Alzheimer type.

Reliability and Validity of the Short Portable Mental Status Questionnaire Administered by Telephone

Effective, economical, and reliable means of screening subjects for cognitive impairment when personal contact is not feasible could facilitate epidemiologic studies and longitudinal assessment. The Short Portable Mental Status Questionnaire (SPMSQ) is a 10-item examination that has been found reliable and valid in distinguishing demented subjects from cognitively intact subjects when given face to face. The current study assessed the utility of a telephone version of the SPMSQ in patients evaluated in an outpatient geriatric assessment program. Mean scores for both test versions decreased with dementia severity and correlated significantly. Mean score differences between the two versions were not affected by reports of hearing impairment or the time interval between test administration. Both test versions correlated significantly with the Mini-Mental State Examination. In distinguishing demented “from nondemented subjects, sensitivity and specificity were .74 and .79 for the telephone test and .74 and .91 for the face-to-face test, respectively.

A Prospective Evaluation of the Geriatric Depression Scale in an Outpatient Geriatric Assessment Center

Objective: To prospectively evaluate the Geriatric Depression Scale (GDS) in cognitively intact and impaired patients undergoing outpatient geriatric assessment.

Donepezil Improves Symptoms of Delirium in Dementia: Implications for Future Research:

Delirium is a common complication of dementia and may produce considerable morbidity. In addition to psychotic symptoms such as hallucinations and delusions, delirium may produce considerable agitation, which may be refractory to conventional medications such as antipsychotics and benzodiazepines. The main approach to delirium is to treat any underlying medical problem that could cause the delirium. However, delirium is not always reversible, and there is no specific treatment for persistent delirium. The authors present a case of delirium complicating a preexisting dementia that resolved rapidly following initiation of the cholinesterase inhibitor donepezil, suggesting that cholinergic dysfunction may have played a role in the etiology of this patients delirium. Future research needs to be directed at the issue of cholinergic activity in delirium through monitoring of serum anticholinergic activity and its response to procholinergic therapy.

The Reliability and Validity of the Geriatric Depression Rating Scale Administered by Telephone

OBJECTIVE: To evaluate prospectively the reliability and validity of the Geriatric Depression Scale administered by telephone (T‐GDS) in patients undergoing outpatient comprehensive geriatric assessment.

Disagreement in the Reporting of Depressive Symptoms Between Patients With Dementia of the Alzheimer Type and their Collateral Sources

The authors investigated sources of disagreement on the Geriatric Depression Scale (GDS) between patients and their collateral sources (CSs). There were 198 subjects with possible or probable Alzheimers disease (DAT) and 64 cognitively intact subjects evaluated at an outpatient geriatric assessment center. The 30-item GDS was completed by the patient and the CS version of the GDS by the CS. A sizable discrepancy was found in the reporting of depressive symptoms by the subjects vs. the CSs. Multiple-regression analyses revealed that both level of insight and level of physical illness in the subjects with DAT significantly influenced the discrepancy. An increased sense of burden in the CSs was associated with a larger symptom gap in both DAT and control subjects. CSs consistently perceived more depressive symptoms than subjects, especially subjects with DAT who had no insight into their cognitive impairment.

L‐Deprenyl in the Treatment of Mild Dementia of the Alzheimer Type: Results of a 15–Month Trial

Objective: To examine the cognitive and behavioral effects of L‐deprenyl in persons with mild dementia of the Alzheimer type (DAT) over a 15‐month period.

THE USE OF SELECTIVE SEROTONIN REUPTAKE INHIBITORS FOR DEPRESSION AND PSYCHOSIS COMPLICATING DEMENTIA

This retrospective chart review examines the impact of selective serotonin reuptake inhibitors on 20 patients with both depression and psychosis complicating dementia of the Alzheimer type (DAT) and other dementias. Fifteen of the 20 patients had moderate to marked improvement in depressive and psychotic symptoms. Eleven of 12 patients with DAT had moderate to marked improvement compared to only four of eight patients with dementia from other causes. The drugs were effective in diminishing or eliminating psychotic symptoms in six patients who had previously not responded to a trial of a neuroleptic. The selective serotonin reuptake inhibitors may have an important role to play in patients with DAT who have coexisting depression and psychosis. These drugs are very well tolerated and may have a place as first‐line agents in non‐emergent settings where a clinician might otherwise think of instituting a neuroleptic or as a second‐line agent when a neuroleptic has proven ineffective.