Grant: Knowledge Synthesis Grant

A Systematic Review and Meta-Analysis of the Accuracy of Depression Rating Scales to Diagnose Depression in Older Adults with Alzheimer's Disease and Other Dementias

<html> <body> <strong>Importance:</strong>&nbsp;There are increasing numbers of older adults with Alzheimer's disease and related forms of dementia in Canada and other parts of the world. Major depressive disorder in is common among individuals with dementia with up to 30% of all individuals with dementia being affected by depression.&nbsp;Depression in dementia (DpD) is both underdiagnosed and overdiagnosed in clinical settings. The diagnosis of DpD can be challenging as individuals with dementia may not be able to report their own symptoms due to memory or communication problems. Also, some symptoms of depression in populations without dementia can be observed in non-depressed individuals with dementia. Depression in dementia&nbsp;is important to accurately diagnose as it has an important impact on quality of life for the person, their families and caregivers and when misdiagnosed can contribute to inappropriate treatments.There are several depression rating scales which may be used&nbsp;to diagnose&nbsp;DpD including generic depression rating scales and scales developed specifically for use in DpD. However, little is known about the accuracy of these&nbsp;scales and which depression rating scales are optimal for diagnosing DpD in different populations and settings. To date, there has been no syntheses assessing the accuracy of the various&nbsp;scales which may be used to diagnose DpD. <br> <strong>Objectives:</strong> Using an integrated knowledge translation approach, our team of researchers and knowledge users will: 1.) Complete a systematic review and meta-analysis of the accuracy of depression ratings scales for the diagnosis of depression in dementia (DpD); 2.) Examine factors that may impact on the accuracy of depression rating scales that are used to diagnose depression; and, 3.) Create knowledge tools to assist clinicians with diagnosing DpD in routine clinical settings.<strong> <br> </strong><strong>Methods</strong>: Our knowledge synthesis is a systematic review and meta-analysis of the&nbsp;diagnostic test accuracy&nbsp;of depression rating scales for diagnosing DpD. We will search electronic databases to identify research articles comparing the&nbsp;accuracy of depression ratings scales&nbsp;to a reference standard of DpD determined through clinical evaluation by&nbsp;mental health&nbsp;specialists. The&nbsp;characteristics of included studies including sensitivity, specificity, positive and negative predictive values and likelihood ratios will be determined. The quality of&nbsp;studies will be assessed using the QUADAS-2 criteria. We plan to use meta-analysis techniques for test accuracy studies&nbsp;to arrive at pooled estimates of the sensitivity and specificity of depression rating scales and to compare the&nbsp;accuracy of different tools and cut-points for diagnosing DpD where sufficient data is available. Meta-analysis will also be used to compare the&nbsp;accuracy of different depression rating scales where data comparing different instruments are available. Variables related to test characteristics and participants will be explored in subgroup and sensitivity analyses.<br> <strong>Knowledge Translation Plan:</strong> Using an integrated knowledge translation plan involving researchers and stakeholders&nbsp;we will create&nbsp;peer-reviewed manuscripts and an open-access report summarizing the findings of this review. A website with information on appropriate depression screening tools and a DpD probability calculator will be created to provide clinicians with a tool to identify individuals that may be at high risk of depression based on depression rating scale scores and other clinical factors.</body> </html>