Ecological Momentary Assessment of Depression in People With Advanced Dementia: Longitudinal Pilot Study

Abstract

Background Barriers to assessing depression in advanced dementia include the presence of informant and patient recall biases. Ecological momentary assessment provides an improved approach for mood assessment by collecting observations in intervals throughout the day, decreasing recall bias, and increasing ecological validity. Objective This study aims to evaluate the feasibility, reliability, and validity of the modified 4-item Cornell Scale for Depression in Dementia for Momentary Assessment (mCSDD4-MA) tool to assess depression in patients with advanced dementia. Methods A intensive longitudinal pilot study design was used. A total of 12 participants with advanced dementia were enrolled from an inpatient psychogeriatric unit. Participants were assessed using clinical depression assessments at admission and discharge. Research staff recorded observations four times a day for 6 weeks on phones with access to the mCSDD4-MA tool. Descriptive data related to feasibility were reported (ie, completion rates). Statistical models were used to examine the interrater reliability and construct and predictive validity of the data. Results Overall, 1923 observations were completed, representing 55.06% (1923/3496) of all rating opportunities with 2 raters and 66.01% (1923/2913) with at least one rater. Moderate interrater reliability was demonstrated for all items, except for lack of interest. Moderate correlations were observed between observers and patient-reported outcomes, where observers reported fewer symptoms relative to participants’ self-reports. Several items were associated with and able to predict depression. Conclusions The mCSDD4-MA tool was feasible to use, and most items in the tool showed moderate reliability and validity for assessing depression in dementia. Repeated and real-time depression assessment in advanced dementia holds promise for the identification of clinical depression and depressive symptoms.

Assessing behavioral and psychological symptoms of dementia: a comprehensive review of current options and future perspectives

“…The CAMDEX was also revised [CAMDEX-R (Roth et al, 1998 ; Ball et al, 2004a )] and adapted for persons with Down syndrome [CAMDEX-DS and CAMDEX-DS II (Ball et al, 2004a )]. The MOUSEPAD also exists in a shorter version [mini-MOUSEPAD (Ball et al, 2004b )] and so do the DBDS [DBD13 (Machida, 2012 )], the CERAD/BRSD [with a 17-item version (Fillenbaum et al, 2008 )], and the CSDD [mCSDD4-MA, a four-item scale for advanced dementia (Niculescu et al, 2021 )].…”

Toward Quantification of Agitation in People With Dementia Using Multimodal Sensing

“…Using the ESM to quantify agitation in people with dementia is a novel application of this method. Related research (in neurodegenerative disease) has used this method to quantify a caregiver’s mental state and experiences when involved in the life of a person with dementia ( Knippenberg et al, 2018 ), as well as to assess depression in people with dementia ( Niculescu et al, 2021 ), but not yet agitation. Existing multimodal studies on agitation have labeled the data either through direct observation ( Homdee et al, 2019 ), or through retrospective analysis based on the available video to refine timestamps of prospective annotation ( Spasojevic et al, 2021 ).…”