Running head: PSYCHOLOGICAL MEASURES

Psychological Measures Name PSY475 - Psychological Tests and Measurements Date Instructor

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Psychological Measures In psychology, there are many measures for depression. Specifically, they range from scales designed for children, adolescents, young adults, adults, and the elderly. Within those different demographics, there are measures for specific circumstances. Depression is a common disorder among the elderly and even more common in patients with dementia. The Cornell Scale for Depression in Dementia (CSDD) is a measure used to diagnose those patients. The following will compare and contrast two articles regarding the CSDD their findings. It will also discuss the appropriate uses for the scale and the populations in which it is valid and invalid. Cornell Scale for Depression in Dementia
Two publications were chosen to aid this examination of the CSDD. The first is the Cornell Scale for Depression in Dementia Administration and Scoring Guidelines. This is the official guidelines for administering this test and describes in detail how to conduct both interviews with the patient and the informant (Alexopoulos, 2006). It further describes in detail what criteria would qualify an individual as an informant for this test. Although this publication does not rate the CSDD for validity or reliability, it does provide a better general understanding this test and how it can be effective. The CSDD is described being specifically designed to assess depression in one with dementia and states that the final rating in this test is based upon the raters clinical impression, not the responses of the patient and informant (Alexopoulos, 2006). It also provides rating guidelines to the rater to aid in the elimination of other extraneous variables like side effects of medication and how to rate some more specific or complicated categories (Alexopoulos, 2006). By allowing a trained, and more likely unbiased perspective, to score the categories based on patient and informant responses and specified guidelines, this test seems to eliminate a large amount of error that could enter into other tests. This is something that is testing in the second article chosen for this examination.

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The Geriatric Depression Scale and the Cornell Scale for Depression in Dementia: A validity study is a study conducted that tests for validity and compares two tests that are meant to identify depression in elderly patients. The Geriatric Depression Scale (GDS) is described in this study as a test that was originally intended to detect symptoms of depression in elderly but non-demented patients. Both tests were administered in this study to a group of 145 patients, all over the age of 65, along with other tests meant to acquire a baseline for both depression and dementia. The study discovered that, while both the GDS and CSDD are valid tests for depression in both demented and non-demented elderly patients, the CSDD is a better scale for both demented and non-demented patients. The GDS lost some validity when administered to patients with dementia, while the CSDD maintained its high level of validity and specificity with all patients regardless of whether or not dementia was present. One weakness of the CSDD that was assessed, however, was that an informant would be necessary in order for it to be administered, something that is not always available (Krner, Lauritzen, Abelskov, Gulmann, Brodersen, Wedervang-Jensen, Kjeldgaard, 2006). The study shows that the methods of relying on the rater, not just the patient, and gaining additional input from an informant, permit the CSDD to have increased accuracy and validity when compared to other tests for depression.

Appropriate Use of Cornell Scale for Depression in Dementia The Cornell Scale for Depression in Dementia, also known as the CSDD, is a test that was created in order to assess signs and symptoms of major depression in patients with dementia (Alexopoulos, 2002, para. 1). Because many patients who suffer from dementia tend to give information thought to be unreliable, the CSDD relies upon the use of a comprehensive interviewing approach that derives information from the patient and the informant (Alexopoulos, 2002, para. 1). After conduction an interview with both the individual supplying the information and the patient, the individual who is gathering information can begin scoring the CSDD by assigning a preliminary score to each item of the scale on the basis of the

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informants report in the informant column (Alexopoulos, 2002, para. 1). After a score has been assigned, the patient is interviewed. During the interview the main focus is on symptoms and signs of depression. The whole process takes approximately 20 minutes with symptoms being rated on a scale of zero to two with zero meaning absent, one meaning mild, and two meaning severe. All scores totaled with scores more than 10 meaning that there is an indication of a possible major problem with depression, more than 18 meaning that there is a definite problem with major depression, and scores below six meaning that there is no sign of any major problems of depression. To be considered as a possible informant, it is recommended that an individual be someone that has frequent contact with the patient (Alexopoulos, 2002, para. 1). Possible informants may be a nurse who has cared for the patient either in a hospital setting or a nursing home setting or a loved one of a patient. It is best for individuals conducting the interviews to be specialized in psychiatry and to be trained in psycho-geriatricians and for the interviews to take place in a clinic where the patients are thought of as outpatients. Populations for which CSDD is Valid In regard to the Cornell Scale for Depression in Dementia (CSDD) it is essential to differentiate between a valid and invalid population sample. The article written by Dr. George S. Alexopoulos and the validity study written by Alex Korner and associates are in agreement in regard to the characteristics of both the valid and invalid population sample for the CSDD measure. However, they disagree in that the validity study allows for patients without dementia to participate in the CSDD and found that the measure served well in analyzing patients for depression with and without dementia.

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The necessary characteristics of an individual or population sample to be considered valid or acceptable as a participant in the CSDD measure is as follows: the participant must be elderly; 65 years and older, depressed, have dementia, and have a caregiver or someone who has frequent contact with the individual be willing to participate and comply with the interview process (Alexopoulos, 2006). In regard to the requirement of dementia the patient may have degrees of dementia ranging from mild to severe as long as he or she is capable of engaging in the test. As mentioned earlier the validity study differs that a patient does not need to meet the dementia requirement (Krner, et, al., 2006). An individual or population sample is considered invalid if he or she does not meet the above requirements and if he or she suffers from a major psychiatric illness, or aphasic disorder. Conclusion In the two articles selected for this examination, the CSDD was found to be a reliable and valid way to diagnose depression in demented and non-demented elderly patients. Both articles stressed the importance of an informant when dealing with demented patients and how reliable the informant must be to obtain accurate responses to questions. The CSDD is most appropriately used in a clinical setting. The interviewer should be someone unbiased, who has specialized in psychiatry, and can score the test appropriately. According to the articles, there are certain requirements that must be met to qualify for this test. Only then are the results valid and reliable. A person undergoing the CSDD must be at least 65, depressed, at any phase of dementia, and have a caregiver that also can attend the testing. It is also been noted that the test is also valid for those without dementia. Currently, the CSDD is the most comprehensive and reliable way for clinicians to diagnose depression in their elderly patients suffering from dementia.

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References

Alexopoulos, M.D, G. S. (2002). The Cornell Scale for Depression in Dementia. Cornell University. Retrieved from http://www.scalesandmeasures.net/files/files/The%20Cornell%20Scale%20for%20Depre ssion%20in%20Dementia.pdf

Alexopoulos, G. S. (2006). SC cooperative for healthy aging in minority populations resource centers for minority aging research. RCMAR. Retrieved from http://www.musc.edu/dfm/RCMAR/Cornell.html

Krner, A., Lauritzen, L., Abelskov, K., Gulmann, N., Marie Brodersen, A., Wedervang-Jensen, T., & Marie Kjeldgaard, K. (2006). The Geriatric Depression Scale and the Cornell Scale for Depression in Dementia. A validity study. Nordic Journal of Psychiatry, 60(5), 360-364.