Clinical utility of Patient Health Questionnaire-9 (PHQ-9) in memory clinics

Abstract

Background. Both dementia and depression may produce complaints of memory impairment. Differential diagnosis may be difficult, but has practical implications regarding choice of appropriate treatment. Aim. To assess the clinical utility of the Patient Health Questionnaire-9 (PHQ-9), a validated instrument for measurement of depression severity, in differentiating patients with and without dementia, referred with complaints of memory impairment to dedicated memory clinics. Methods. Pragmatic prospective study of consecutive referrals (n=113) to two dementia clinics, diagnosed using standard clinical diagnostic criteria for dementia (DSM-IV) and also administered the PHQ-9. Results. PHQ-9 proved acceptable to patients, and was quick and easy to use. Using traditional parameters of diagnostic utility (sensitivity, specificity, positive predictive value, likelihood ratios), PHQ-9 performance was modest for the diagnosis of dementia. However, pragmatically PHQ-9 scores proved helpful in deciding which patients, both with and without dementia, required a trial of antidepressant medication. Conclusions. PHQ-9 proved useful as a brief screen for depression in patients attending dementia clinics with a complaint of memory impairment.

Test Your Memory test: diagnostic utility in a memory clinic population

“…Moreover, patient self-administered tests also omit the clinician-patient interaction in testing which may inform clinical judgements over and above any raw tests scores. We recommend that TYM should be used as a screening test, not a stand-alone diagnostic measure, with patients who fall below the designated cutoff being subjected to further investigation to ascertain a cause for their cognitive impairment, since poor performance on such tests may result from a number of variables beside disease state, including anxiety, depression (Hancock and Larner, 2009a), sleep disturbance (Hancock and Larner, 2009c), low premorbid abilities and medication use. Additional studies will be required to examine the TYM further, such as longitudinal follow-up to ensure validity, in other clinical settings such as primary care, and to assess the dependence of test scores on patient age and education level, since these factors are recognised to influence test scores of other screening instruments such as the MMSE.…”

“…Standard clinical diagnostic criteria were used for the diagnosis of dementia (DSM-IV; American Psychiatric Association, 2000) and dementia subtypes (McKhann et al, 1984(McKhann et al, , 2001Román et al, 1993;McKeith et al, 1996McKeith et al, , 1999Neary et al, 1998;Petersen et al, 1999), as in previous collaborative studies between these units (Hancock and Larner, 2007, 2008, 2009a, 2009b, 2009cLarner and Hancock, 2008). As this was a pragmatic study, patients were not selected according to diagnosis but as they presented to the clinics.…”

The Poppelreuter figure visual perceptual function test for dementia diagnosis

“…25 However, like the PHQ-9, the Poppelreuter Poppelreuter figure z Original research figure has pragmatic value: the good negative utility index indicates that it is useful for ruling out a diagnosis of dementia, rather than for ruling it in (poor positive utility index). A possible exception to this rule may be cases of posterior cortical atrophy (visual variant Alzheimer's disease): all the cases in these studies performed below the cutoff ≤ 3/4.…”

Intrafamilial clinical phenotypic heterogeneity with MAPT gene splice site IVS10+16C>T mutation

“…He died at the age of 50 years but without neuropathological examination or neurogenetic testing for MAPT mutations. Using the Patient Health Questionnaire-9, a measure of depression severity [7], there was no evidence of depression (= 0). On the Informant Questionnaire on Cognitive Decline in the Elderly (range 1-5, lower scores better), completed by his ex-wife who still saw him regularly, his score was 4.07, above the cutoff (3.60) for optimal accuracy for diagnosis of dementia in this clinic [8].…”