Depression detection in dementia: A diagnostic accuracy systematic review and meta analysis update
Bibliographic record
Abstract
Abstract Background Depression is common in persons with dementia and is often under‐detected and under‐treated. It is critical to understand which available tools accurately detect depression in the context of dementia. Methods We updated our systematic review completed in 2015. The search strategy of our original review was replicated in Medline, Embase, and PsycINFO. Studies describing the use of a tool to identify depression in persons with dementia, compared to a criterion standard, and reporting diagnostic accuracy outcomes were included in the review update. Pooled prevalence estimates of major depression and pooled estimates of diagnostic accuracy outcomes (i.e., sensitivity [SN], specificity [SP]) for tools were calculated. Results Three studies were included of the 8980 returned from the database search and were added to the prior 20 articles from the 2015 review. The Cornell Scale for Depression in Dementia (CSDD), Geriatric Depression Scale (GDS)−15 item, Neuropsychiatric Inventory‐Depression items (NPI‐D), and Depression in Old Age Scale (DIA‐S) were evaluated in the three studies. Two new studies were added to the existing pooled prevalence estimate of major depression (29%, 95% confidence interval [CI] = 21.6%–36.5%, n = 17) and pooled diagnostic accuracy estimate for the CSDD at the best cut‐off (SN = 0.83, 95% CI = 0.74–0.90; SP = 0.81, 95% CI = 0.69–0.89). New pooled diagnostic accuracy estimates were completed for the CSDD (cut‐off ≥12) (SN = 0.61, 95% CI = 0.42–0.77; SP = 0.83, 95% CI = 0.76–0.88), GDS‐15 (best cut‐off) (SN = 0.65, 95% CI = 0.40–0.83; SP = 0.72, 95% CI = 0.55–0.85), and Montgomery Asberg Depression Rating Scale (MADRS) (best cut‐off) (SN = 0.77, 95% CI = 0.67–0.85; SP = 0.68, 95% CI = 0.60‐0.75). Conclusions The CSDD continues to have the most evidence for depression case finding in persons living with dementia. The CSDD and Hamilton Depression Rating Scale have the highest sensitivities and may be recommended for use over other common tools like the GDS‐15 and MADRS. Newly identified tools like the NPI‐D and DIA‐S require further study before they can be recommended for use in practice.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.050 | 0.135 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.018 | 0.032 |
| Bibliometrics | 0.012 | 0.011 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".