The Clinical Utility of the Cornell Scale for Depression in Dementia as a Routine Assessment in Nursing Homes

Jeon, Yun‐Hee; Li, Zhicheng; Low, Lee‐Fay; Chenoweth, Lynette; O'Connor, Daniel William; Beattie, Elizabeth; Liu, Zhixin; Brodaty, Henry

doi:10.1016/j.jagp.2014.08.013

Cited by 24 publications

(13 citation statements)

References 31 publications

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“…The low agreement between actigraphy and proxy-rater measures may simply indicate that the CSDD and the NPI-NH fail to capture sleep difficulties. In light of recent research that indicates that when the CSDD is administered by NH staff, its clinical utility is highly questionable, the discrepancy found in the present study also questions the use of proxy-raters to ascertain symptoms [ 43 ]. However, it is noteworthy that we do not recommend actigraphy as the primary tool for evaluating sleep in the NH setting.…”

Section: Discussionmentioning

confidence: 61%

Clinically significant discrepancies between sleep problems assessed by standard clinical tools and actigraphy

et al. 2017

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BackgroundSleep disturbances are widespread among nursing home (NH) patients and associated with numerous negative consequences. Identifying and treating them should therefore be of high clinical priority. No prior studies have investigated the degree to which sleep disturbances as detected by actigraphy and by the sleep-related items in the Cornell Scale for Depression in Dementia (CSDD) and the Neuropsychiatric Inventory – Nursing Home version (NPI-NH) provide comparable results. Such knowledge is highly needed, since both questionnaires are used in clinical settings and studies use the NPI-NH sleep item to measure sleep disturbances. For this reason, insight into their relative (dis)advantages is valuable.MethodCross-sectional study of 83 NH patients. Sleep was objectively measured with actigraphy for 7 days, and rated by NH staff with the sleep items in the CSDD and the NPI-NH, and results were compared. McNemar's tests were conducted to investigate whether there were significant differences between the pairs of relevant measures. Cohen's Kappa tests were used to investigate the degree of agreement between the pairs of relevant actigraphy, NPI-NH and CSDD measures. Sensitivity and specificity analyses were conducted for each of the pairs, and receiver operating characteristics (ROC) curves were designed as a plot of the true positive rate against the false positive rate for the diagnostic test.ResultsProxy-raters reported sleep disturbances in 20.5% of patients assessed with NPI-NH and 18.1% (difficulty falling asleep), 43.4% (multiple awakenings) and 3.6% (early morning awakenings) of patients had sleep disturbances assessed with CSDD. Our results showed significant differences (p<0.001) between actigraphy measures and proxy-rated sleep by the NPI-NH and CSDD. Sensitivity and specificity analyses supported these results.ConclusionsCompared to actigraphy, proxy-raters clearly underreported NH patients' sleep disturbances as assessed by sleep items in NPI-NH and CSDD. The results suggest that the usefulness of proxy-rater measures of sleep may be questionable and further research is needed into their clinical value. The results highlight the need for NH staff to acquire and act on knowledge about sleep and sleep challenges among NH patients.Trial registrationRegistered at www.clinicaltrials.gov (registration number NCT02238652) on July 7th 2014 (6 months after study initiation).

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Section: Discussionmentioning

confidence: 61%

Clinically significant discrepancies between sleep problems assessed by standard clinical tools and actigraphy

et al. 2017

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“…Ten studies examined the CSDD for major depression detection . When best‐reported estimates were pooled, sensitivity was 0.84 (95% CI = 0.73–0.80, I 2 = 75.18, P < .001), and specificity was 0.80 (95% CI = 0.65–0.90, I 2 = 92.5, P < .001) (Figure ).…”

Section: Resultsmentioning

confidence: 99%

“…14,30,31 Cornell Scale for Depression in Dementia Ten studies examined the CSDD for major depression detection. [1][2][3]8,11,30,[34][35][36][37][38] When best-reported estimates were pooled, sensitivity was 0.84 (95% CI = 0.73-0.80, I 2 = 75.18, P < .001), and specificity was 0.80 (95% CI = 0.65-0.90, I 2 = 92.5, P < .001) (Figure 1). The positive LR (LR+) was 4.21 (95% CI = 2.24-7.88, I 2 = 86.61, P < .001), and the negative LR (LRÀ) was 0.20 (95% CI = 0.12-0.35, I 2 = 77.17, P < .001).…”

Section: Accuracymentioning

confidence: 99%

Depression Case Finding in Individuals with Dementia: A Systematic Review and Meta‐Analysis

Goodarzi

Mele

Roberts

et al. 2017

J American Geriatrics Society

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“…The clinical utility of the CSDD is highly questionable in identifying depression when administered by LTC staff because of the complexity of the scale, the time and skills required for collecting data, and knowledge of assessing depression [86]. Further, the creators of the CSDD recommend standardized training [60], which reduces its utility in a practice setting.…”

Section: Limitationsmentioning

confidence: 99%

Virtual Reality Experience In Long Term Care Resident Older Adults With Dementia: A Case Series

Sultana

Campbell

Jennings

et al. 2020

Preprint

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BACKGROUND: Behavioural and psychological symptoms of dementia (BPSD) worsens as dementia progresses, intensifies caregiver distress and consequent institutionalization. We wanted to evaluate feasibility of Virtual Reality (VR) as non-pharmacologic intervention for BPSD in a Long-Term Care (LTC) home. METHODS: A single site (Henley Place at London, Ontario) case series with a convenience sample (24 older adult residents with moderate to severe dementia). Intervention was 30 minutes of VR experience with Broomx©, five days a week for two weeks. BPSD was measured with Cornell Scale for Depression in Dementia (CSDD), Cohen-Mansfield Agitation Inventory (CMAI) scale, Dementia Observation System (DOS) scale, and proportion of night-time sleep. We validated selected tools with Global Rating of Change (GRC) scale. RESULTS: Implementing VR experience was possible at Henley Place (recruitment rate=40%, the adherence rate=21%, and the attrition=0%) and participants could tolerate it. No emergency transfers or one-to-one staff use were recorded during the intervention period. BPSD measuring instruments also were sensitive to change. CONCLUSION: VR experience can be implemented in a LTC home. TRIAL REGISTRATION: The study was not registered as clinical trial. We obtained ethics approval from ADVARRA Canada Ethics Board before recruiting participants for the study.

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The Clinical Utility of the Cornell Scale for Depression in Dementia as a Routine Assessment in Nursing Homes

Cited by 24 publications

References 31 publications

Clinically significant discrepancies between sleep problems assessed by standard clinical tools and actigraphy

Clinically significant discrepancies between sleep problems assessed by standard clinical tools and actigraphy

Depression Case Finding in Individuals with Dementia: A Systematic Review and Meta‐Analysis

Virtual Reality Experience In Long Term Care Resident Older Adults With Dementia: A Case Series

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