The Cornell Scale for Depression in Dementia: Content and Accuracy

Woman with Dementia and Depression
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What Is It?

The Cornell Scale for Depression in Dementia (CSDD) is a way to screen for symptoms of depression in someone who has dementia. Unlike other scales and screens for depression, the CSDD takes into account additional signs of depression that might not be clearly verbalized by a person. For example, if your loved one or patient has Alzheimer's disease, vascular dementia or another kind of cognitive impairment, he might not consistently be able to accurately express his feelings.

The Cornell Scale measures observations and physical signs that could indicate depression.

When Was the Test Developed?

The CSDD was first published in 1988 by George S.Alexopoulos, Robert C. Abrams, Robert C. Young and Charles A. Shamoian. These researchers worked for the Cornell Institute of Geriatric Psychiatry at Cornell University.

How Is the Test Administered?

The questions are asked of a close friend, family member or caregiver (called an informant) who knows the individual well. The questions are also separately asked of the person who is being assessed. If the answers given by the person being assessed and the informant do not match, the test administrator reviews the information provided and makes a determination based on her clinical impression.

It's important to note that the test-giver should not count symptoms that are directly tied to a physical disability or illness. For example, if a person has Parkinson's disease and dementia, his slow movements and speech are not counted as signs of depression and are given a score of zero, or absent.

What Kind of Questions Does the CSDD Include?

The Cornell Scale includes questions in five different areas:

  • Mood-Related Signs: Anxiety, sadness, lack of reaction to pleasant events and irritability
  • Behavioral Disturbances: Agitation, retardation (slow movements) and speech, multiple physical complaints (not including gastrointestinal symptoms only), and loss of interest in usual activities
  • Physical Signs: Appetite loss, weight loss, easily fatigued
  • Cyclic Functions: Increase in symptoms in evening, difficult time falling asleep, awakening multiple times during sleep, awakening earlier than usual in the morning
  • Ideational Disturbance: Suicidal, poor self-esteem, pessimism, delusions of poverty, illness or loss. (Cornell Screen for Depression in Dementia)

How Is the CSDD Scored?

For each question, the following answers equate to the number of points identified:

  • Absent (meaning there are no symptoms or observations for that behavior): 0 points
  • Mild to Intermittent (the behavior or symptom is present occasionally): 1 point
  • Severe (the behavior or symptom is present frequently): 2 points

Following the administration of the scale, the test administrator determines which frequency is most accurate and adds up the score, allocating the number of points specified above. A score above 10 signifies a probable major depression, and a score above 18 indicates a definite major depression.

How Long Does the Test Take to Administer?

The Cornell Scale takes approximately 30 minutes to complete, making it one of the more time-intensive depression scales.

This is because interviews of both the patient and an informant are conducted.

How Accurate is the CSDD?

The Cornell Scale has been demonstrated to be very effective in identifying people who are experiencing depression. Interestingly, even though the instrument was designed for use in people with dementia, it can also be used effectively to test for depression in those who do not have dementia.

Research has also been conducted to evaluate its effectiveness across cultures. For example, a study conducted in 2012 demonstrated good reliability and validity when a Korean version of the Cornell Scale was used to test for the presence of depression in Korean ethnic people.

What to Do If You're Noticing Symptoms of Depression

Depression can be very effectively treated. If you or your loved one is experiencing feelings of depression, it's important to get an evaluation and treatment by a professional.

Sources:

Alexopoulos, G.S. Cornell Institute of Geriatric Psychiatry. The Cornell Scale for Depression in Dementia: Administration & Scoring Guidelines.

Biological Psychiatry 1988;23(3):271-284. Cornell Scale for Depression in Dementia. http://www.biologicalpsychiatryjournal.com/article/0006-3223%2888%2990038-8/abstract

Department of Health. Victoria State Government. Tool and Resource Evaluation Template. Accessed February 25, 2013. http://www.health.vic.gov.au/older/toolkit/06Cognition/03Depression/docs/Cornell%20Scale%20for%20Depression%20in%20Dementia%20%28CSDD%29.pdf

Nordic Journal of Psychiatry. 2006;60(5):360-4. The Geriatric Depression Scale and the Cornell Scale for Depression in Dementia. A validity study. http://www.ncbi.nlm.nih.gov/pubmed/17050293

Psychiatry Investigation. 2012;9:332-338. Reliability and Valididty of the Korean Version of the Cornell Scale for Depression in Dementia.

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