Goodarzi Zahra S, Mele Bria S, Roberts Derek J, Holroyd-Leduc Jayna
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.
J Am Geriatr Soc. 2017 May;65(5):937-948. doi: 10.1111/jgs.14713. Epub 2017 Feb 2.
To compare the diagnostic accuracy of depression case finding tools with a criterion standard in the outpatient setting among adults with dementia.
Systematic review and meta-analysis.
Studies of older outpatients with dementia.
Elderly outpatients (clinic and long-term care) with dementia (N = 3,035).
Prevalence of major depression and diagnostic accuracy measures including sensitivity, specificity, and likelihood ratios.
From the 11,539 citations, 20 studies were included for qualitative synthesis and 15 for a meta-analysis. Tools included were the Montgomery Åsberg Depression Rating Scale, Cornell Scale for Depression in Dementia (CSDD), Geriatric Depression Scale (GDS), Center for Epidemiologic Studies Depression Scale (CES-D), Hamilton Depression Rating Scale (HDRS), Single Question, Nijmegen Observer-Rated Depression Scale, and Even Briefer Assessment Scale-Depression. The pooled prevalence of depression in individuals with dementia was 30.3% (95% CI = 22.1-38.5). The average age was 75.2 (95% CI = 71.7-78.7), and mean Mini-Mental State Examination scores ranged from 11.2 to 24. The diagnostic accuracy of the individual tools was pooled for the best-reported cutoffs and for each cutoff, if available. The CSDD had a sensitivity of 0.84 (95% CI = 0.73-0.91) and a specificity of 0.80 (95% CI = 0.65-0.90), the 30-item GDS (GDS-30) had a sensitivity of 0.62 (95% CI = 0.45-0.76) and a specificity 0.81 (95% CI = 0.75-0.85), and the HDRS had a sensitivity of 0.86 (95% CI = 0.63-0.96) and a specificity of 0.84 (95% CI = 0.76-0.90). Summary statistics for all tools across best-reported cutoffs had significant heterogeneity.
There are many validated tools for the detection of depression in individuals with dementia. Tools that incorporate a physician interview with patient and collateral histories, the CSDD and HDRS, have higher sensitivities, which would ensure fewer false-negatives.
比较在门诊环境中，针对患有痴呆症的成年人，抑郁症病例筛查工具与标准诊断方法的诊断准确性。
系统评价和荟萃分析。
针对老年痴呆症门诊患者的研究。
患有痴呆症的老年门诊患者（诊所和长期护理机构）（N = 3,035）。
重度抑郁症的患病率以及包括敏感性、特异性和似然比在内的诊断准确性指标。
从11,539篇文献中，纳入了20项研究进行定性综合分析，15项进行荟萃分析。所使用的工具包括蒙哥马利-艾森伯格抑郁评定量表、康奈尔痴呆抑郁量表（CSDD）、老年抑郁量表（GDS）、流行病学研究中心抑郁量表（CES-D）、汉密尔顿抑郁评定量表（HDRS）、单问题量表、奈梅亨观察者评定抑郁量表和简易评估量表-抑郁。患有痴呆症个体的抑郁症合并患病率为30.3%（95%置信区间=22.1-38.5）。平均年龄为75.2岁（95%置信区间=71.7-78.7），简易精神状态检查表平均得分在11.2至24分之间。针对各个工具，汇总了报告最佳的临界值以及（若有）每个临界值的诊断准确性。CSDD的敏感性为0.84（95%置信区间=0.73-0.91），特异性为0.80（95%置信区间=0.65-0.90）；30项GDS（GDS-30）的敏感性为0.62（95%置信区间=0.45-0.76），特异性为0.81（95%置信区间=0.75-0.85）；HDRS的敏感性为0.86（95%置信区间=0.63-0.96），特异性为0.84（95%置信区间=0.76-0.90）。所有工具在报告最佳临界值时的汇总统计数据存在显著异质性。
有许多经过验证的工具可用于检测痴呆症患者的抑郁症。纳入医生对患者及其旁证病史访谈的工具，即CSDD和HDRS，具有更高的敏感性，这将确保更少的假阴性结果。
