Effect of age on geriatric depression scale performance in Parkinson's disease

Abstract

The purpose of this study was to compare the validity of the 15-item Geriatric Depression Scale (GDS-15) in nonelderly (<65 years), young-elderly (age, 65-75), and old-elderly (>75 years) patients with Parkinson's disease (PD). 57 nonelderly, 88 young-elderly, and 81 old-elderly PD patients were administered the GDS-15 and the Structured Clinical Interview for DSM-IV depression module. Receiver-operating characteristic (ROC) curves were plotted for GDS-15 scores against a DSM-IV diagnosis of major or minor depression. The discriminant validity of the GDS-15 was high for nonelderly, young-elderly, and oldelderly subjects (ROC area under curve = 0.92, 0.91, and 0.95, respectively), with optimal dichotomization at a cut-off of 4/5 (85% sensitivity and 84% specificity in nonelderly; 89% sensitivity and 82% specificity in young-elderly) and 5/6 (90% sensitivity and 90% specificity in old-elderly). In conclusion, the GDS-15 has comparable validity in younger and older PD patients, suggesting its appropriateness as a depression screening instrument in PD patients of all ages. KeywordsParkinson's disease; depression; age; Geriatric Depression Scale Major or nonmajor depression in Parkinson's disease (dPD) affects up to 40% of patients. 1 Depression in PD contributes to functional disability, 2 diminished quality of life, 3 increased caregiver distress, 4 and more rapid cognitive decline. 5 Despite its frequency and adverse effects, dPD appears to be underrecognized and undertreated, even in specialty care settings. 6,7 Therefore, it is important for clinicians to have simple, valid screening instruments for dPD.Owing to symptom overlap and psychiatric comorbidity, diagnosing dPD can be challenging, and so validating depression rating scales in PD is important. For a scale to be useful as a screening instrument, the proposed cut-off point should maximize the proportion of depressed patients scoring positive for depression (sensitivity) and maximize the proportion of negative test results corresponding to nondepression (negative predictive value [NPV]). To be useful as an instrument to differentiate depressed from nondepressed individuals, it should have high sensitivity and specificity (i.e., discriminant validity), which maximizes the proportion of patients whose test results are accurate. The GDS was constructed with the following thoughts in mind regarding geriatric depression:(1) vegetative symptoms are common in nondepressed elderly persons; (2) thoughts of death and hopelessness about the future have different meanings for those in the later stages of life; (3) medical comorbidity is common in the geriatric population and may be associated with motor retardation or decreased activity levels; (4) comorbid cognitive impairment may affect concentration and cognitive processing.The GDS-15 16 is a widely-used instrument for the screening of depression in the elderly. It is brief, nonsomatically focused, and can be either observer-or self-administered. Scores range from 0 to 15, with higher scores indicating more...

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