ALZHEIMER TERAPÉUTICA II

The 2002 NIMH Provisional Diagnostic Criteria for Depression

of Alzheimer’s Disease (PDC-dAD): Gauging their Validity
over a Decade Later
Article type: Research Article
Authors: Sepehry, Amir A.a; b; c; * | Lee, Philip E.b; c; d | Hsiung, Ging-Yuek R.a; b; c | Beattie, B.
Lynnc; d | Feldman, Howard H.b; c; e | Jacova, Claudiaa; b; c; *
Affiliations: [a] University of British Columbia (UBC), College for Interdisciplinary Studies,
Graduate program in Neuroscience, Vancouver, Canada | [b] Department of Medicine, UBC
Division of Neurology, Vancouver, Canada | [c] Clinic for Alzheimer Disease and Related
Disorders, UBC Hospital, Vancouver, Canada | [d] Department of Medicine, UBC Division of
Geriatric Medicine, Vancouver, Canada | [e] Djavad Mowafaghian Centre for Brain Health,
Vancouver, Canada
Correspondence: [*] Correspondence to: Claudia Jacova, PhD and Amir A. Sepehry, MSc,
PhD, School of Graduate Psychology, Pacific University, Hillsboro, OR, USA. Tel.: +1 503 352
3613; E-mails: cjacova@pacificu.edu (C. Jacova), sepehryaa@alumni.ubc.ca (A.A. Sepehry).
Abstract: Presented herein is evidence for criterion, content, and convergent/discriminant
validity of the NIMH-Provisional Diagnostic Criteria for depression of Alzheimer’s Disease
(PDC-dAD) that were formulated to address depression in Alzheimer’s disease (AD). Using
meta-analytic and systematic review methods, we examined criterion validity evidence in
epidemiological and clinical studies comparing the PDC-dAD to Diagnostic and Statistical
Manual of Mental Disorders fourth edition (DSM-IV), and International Classification of Disease
(ICD 9) depression diagnostic criteria. We estimated prevalence of depression by PDC, DSM,
and ICD with an omnibus event rate effect-size. We also examined diagnostic agreement
between PDC and DSM. To gauge content validity, we reviewed rates of symptom
endorsement for each diagnostic approach. Finally, we examined the PDC’s relationship with
assessment scales (global cognition, neuropsychiatric, and depression definition) for
convergent validity evidence. The aggregate evidence supports the validity of the PDC-dAD.
Our findings suggest that depression in AD differs from other depressive disorders including
Major Depressive Disorder (MDD) in that dAD is more prevalent, with generally a milder
presentation and with unique features not captured by the DSM. Although the PDC are the
current standard for diagnosis of depression in AD, we identified the need for their further
optimization based on predictive validity evidence.
Keywords: Alzheimer’s disease, depression, diagnosis, DSM, epidemiology, meta-analysis,
NIMH Provisional Diagnostic Criteria, validity

Prevalence of depression in
Alzheimer's disease and validity of
Research Diagnostic Criteria
 S Vida 1, P Des Rosiers, L Carrier, S Gauthier
Affiliations expand

 PMID: 7826494

 DOI: 10.1177/089198879400700409

Abstract
This study was undertaken to estimate the point-prevalence of Research Diagnostic
Criteria (RDC) depressive syndromes in Alzheimer's disease (AD) and to evaluate
the validity of existing and potential alternative diagnostic criteria for major
depression in the presence of probable AD. Twenty-six subjects with probable AD
of mild to moderate severity and their caregivers were interviewed to estimate the
prevalence of RDC depressive syndromes. For the evaluation of the validity of RDC
for major depression, an additional 8 probable-AD subjects with suspected
depression were added to the sample. Sensitivity, specificity, and correlation with
diagnosis of RDC major depression were calculated for each diagnostic criterion,
and existing major depressive criteria were compared to potential alternative
criteria currently used for RDC minor depression. Of the subjects in our prevalence
sample, 15.4% were found to have major depression; 23.1%, minor depression; and
11.5%, intermittent depression. In our validation sample, two criteria for major
depression, self-reproach/guilt and thinking/concentration difficulty, were weakly
associated with the final diagnosis of major depression because of poor sensitivity
or specificity. In contrast, three possible alternative criteria were significantly
associated with the diagnosis of major depression and showed high sensitivity and
specificity. These included nonverbal manifestations of depression,
irritability/complaining, and demandingness/dependency. We conclude that RDC
depressive syndromes are common in probable AD of mild to moderate severity. In
the presence of AD, the validity of some existing major depressive criteria may be
limited in comparison to several potential alternative criteria because of relatively
poor sensitivity and/or specificity.