JMIR Publications

ABSTRACT

Background:

Barriers to assessing depression in advanced dementia include the presence of informant and patient recall biases. Ecological Momentary Assessment (EMA) provides an improved approach for mood assessment by collecting observations in intervals throughout the day, decreasing recall bias and increasing ecological validity.

Objective:

The study objectives were to evaluate the reliability and validity of a modified Four-Item Cornell Scale for Depression in Dementia for Momentary Assessment (mCSDD4-MA) tool to assess depression in advanced dementia.

Methods:

A pilot intensive longitudinal study design was used. Twelve participants with advanced dementia were enrolled from an inpatient psychogeriatric unit. Participants were assessed using clinical depression assessments at admission and discharge. Research staff recorded observations four times a day for six weeks on phones with access to the mCSDD4-MA tool. Statistical models were used to examine variance partitioning, inter-rater reliability, construct and predictive validity of the data.

Results:

Overall, 1,923 observations were completed. The total variability in item score was largely explained by variance related to changes in participants’ symptoms. Moderate inter-rater reliability was demonstrated for all items except lack of interest. There were moderate correlations between observers and patient-reported outcomes, where observers reported fewer symptoms relative to participants’ self-reports. Several items were associated with and able to predict depression.

Conclusions:

Most items in the tool showed moderate reliability and validity for assessing depression in dementia. Repeated and real-time depression assessment in advanced dementia holds promise to identify clinical depression and depressive symptoms.