If you’re a caregiver for a senior citizen, it’s important to be aware of the signs and symptoms of depression. Older people are at a higher risk for developing depression, and it can often go unnoticed or undiagnosed.
One useful tool that can help to assess elderly patients with cognitive decline for depression is the Cornell Scale for Depression in Dementia.
The Cornell Scale for Depression in Dementia is a screening tool, in the form of interview questions and observation. This scale includes items such as loss of appetite, sleep disturbance, and feelings of depression, such as sadness or hopelessness.
A clinician, usually in an outpatient clinic) asks the person questions and then scores the answers. Although not an outright diagnosis, the Cornell Scale is valuable in determining whether your senior should see a mental health professional.
If you want to learn about the Cornell Scale, this is the article for you. Ahead, we’ll talk more about what the test is, how it works, how to make sense of the results, and whether the Cornell Scale is accurate, so keep reading!
What Is The Cornell Scale For Depression In Dementia Used For?
It must be noted that assessing emotional well-being in dementia patients requires an individualized approach that considers their physical, psychological, social, and spiritual needs.
The assessment should be conducted in a manner that shows respect for the patient’s dignity and autonomy. It is important to use language they can understand and avoid intrusive or overly complex questions.
The Cornell Scale for Depression in Dementia or CSDD is a recommended depression screening tool for individuals with cognitive impairment who may be suffering from depression as well.
Created by Charles A. Shamoian, Robert C. Young, Robert C. Abrams, and George S. Alexopoulos in 1988, the test is called the Cornell Scale due to the researchers’ time at Cornell University’s Cornell Institute of Geriatric Psychiatry.
We must be clear that the Cornell Scale is a tool meant for screening for depression in individuals with dementia only. It’s not a diagnostic test.
Even if a senior’s CSDD scores are high (we’ll talk more about Cornell Scale scoring later in this article), that doesn’t positively mean they’re depressed.
Rather, the Cornell Score can indicate that a dementia patient may be depressed.
As you may imagine, measuring the severity of depression in dementia patients is more difficult than in the general population. It often requires a thorough assessment of both cognitive and psychological functioning, as well as an evaluation of medical history.
The presence of dementia can often obscure or mask underlying depression, making it more difficult to diagnose and treat.
As we touched on in the intro, the CSDD test is administered through clinician interviews with the senior. Since the senior’s responses are directly their own, their answers can be a rare glimpse into their mental state.
Based on the total score derived from the answers that the senior dementia patient gives, you and your fellow siblings or other members of your family may decide to meet and discuss the next steps for the senior’s mental health care.
It may be determined that your older parent or loved one needs to see a therapist, counselor, or another mental health professional.
Read about tests for dementia, including the clock test and the SLUMS test.
Is There A Link Between Depression And Dementia?
Are seniors with dementia even that likely to become depressed?
Absolutely. Seniors in general usually combat higher rates of depression, with the National Institutes of Health or NIH stating that “depression is a common problem among older adults.”
Of course, getting older does not mean that one has to be depressed. As the NIH says, “clinical depression is not a normal part of aging.”
But in this case, you’re adding cognitive impairment / dementia to the mix on top of depression.
The relationship between dementia and depression is an interesting one, although it’s one that medical experts and researchers are still learning more about all the time.
According to a HealthDay News report from 2014, “older people with depression are more likely to develop dementia.”
It may go even deeper than that. In a 2012 publication of the journal Natures Review Neurology, the researchers reviewed a collection of literature on depression and dementia.
Here’s what they found: “The literature suggests an association between depression and dementia, and growing evidence implies that timing of depression may be important to defining the nature of the association.“
The researchers noted that, “In particular, early-life depression or depressive symptoms have been shown to be associated with a 2-fold or greater increase in the risk of dementia.”
That same study also agrees that depression later in one’s life could contribute to dementia, just as the HealthDay News article said.
What Are Some Identifying Signs Of Depression In Dementia Individuals?
The signs of depression in someone with dementia are essentially the same as with any other person suffering from depression. Although, someone with dementia may demonstrate more physical symptoms such as weight loss, fatigue, etc.
The signs to look out for can include:
- Feelings of isolation and loneliness
- Lack of interest in activities they used to enjoy
- Loss of appetite or a sudden change in weight
- Social withdrawal, avoiding friends and family
- Trouble sleeping or oversleeping
- Feeling tired all the time, lacking energy
- Problems concentrating, remembering things or making decisions
- Excessive guilt or feelings of worthlessness
- Fixation on death or suicide
- Unexplained physical aches and pains.
How Do You Use The Cornell Scale?
Now that you understand the link between dementia and depression, you might want to schedule an appointment for your senior parent or loved one to answer the questions according to the Cornell Scale.
The assessment lasts approximately 30 minutes (or it should) and includes 19 items. Not only does the senior answer questions, but the caretaker or adult child is supposed to observe the senior over the past week (the week leading up to the interview) and then share those insights with the clinician.
The senior is scored according to their answers, as you’ll recall. We’ll interpret what a Cornell Scale score means in the next section.
Without further ado, here are the areas the senior will be asked about according to the Cornell Scale.
Mood Related Signs
- Anxiety – worrying, ruminations, anxious expressions
- Sadness – tearfulness, sad voice, sad expressions
- No reaction to pleasant or happy events
- Irritability – short-temperedness, easily annoyed
Behavioral Disturbances
- Agitation – hair pulling, hand wringing, restlessness
- Retardation – slow reactions, slow speech, slow movements
- Physical complaints
- Loss of interest
Physical Signs
- Appetite loss or eating less than normal
- Weight loss
- Lack of energy – unable to keep up with regular activities, easily fatigued
Cyclic Functions
- Diurnal mood variations with worsening symptoms in the morning
- Difficulty falling asleep
- Awakening several times throughout the night
- Early morning awakenings
Ideational Disturbances
- Suicidal ideation – has made suicide attempt, has suicidal wishes, feels like life isn’t worth living
- Low self-esteem – feelings of failure, self-deprecation, self-blame
- Pessimism – anticipating that things will get worse
- Mood-congruent delusions – delusions of loss, illness, or poverty
How Do You Interpret A Cornell Depression Scale?
Cornell Scale for Depression in Dementia scoring system composed of questions that assess a variety of common signs and symptoms such as apathy, loneliness, feelings of helplessness or hopelessness, changes in eating habits, and decreased energy.
For each question there are 5 possible answers that are scored on a 3-point scale. The higher the score, the more severe the symptoms of depression are thought to be.
After taking into account all the answers, a total score is assigned with higher scores indicating more severe signs of depression.
For every area on the Cornell Scale, the clinician can score a senior with dementia in one of three ways.
If they don’t answer a question, they get a zero. If the response is intermittent or mild, then they receive a 1. A score of 2 denotes a severe response.
For example, if a senior with dementia or Alzheimer’s disease reported high levels of anxiety but low levels of sadness, they’d get a 2 in A1 and a 1 in A2.
Some of the parts of the Cornell Scale require higher scores according to certain criteria. If a senior has lost more than five pounds in a month, for instance, they should receive a score of 2. If they’ve lost some weight but it’s not five pounds, they’d get a 1 instead.
After tallying up all the numbers, the senior is given a score.
Scores that are less than 10 mean that the senior is likely having a major depressive episode. A score over 18 means the senior is definitely experiencing a major depressive episode.
How Accurate Is The Cornell Scale?
Before you subject your senior to answering questions per the Cornell Scale, you’ll want to know, how accurate is it? After all, if your senior parent or loved one has dementia, they could be easily confused. You don’t want to cause them undue strife.
In 2006, the Nordic Journal of Psychiatry examined the validity of the CSDD and The Geriatric Depression Scale or GDS.
To do that, the researchers gathered 145 participants who were all at least 65 years old or older. Of the 145, 11 participants were demented, 36 were control group participants, 36 were demented and depressed, and 73 were just depressed.
According to the study, “The criterion validity in the total population showed the CSDD as the better scale with sensitivity and specificity of 93% and 97% with a cut-off value of > or =6.”
In other words, compared to the GDS, the CSDD is more valid, with the researchers concluding this: “The GDS and the CSDD are both valid screening tools for depression in the elderly; however, the CSDD alone seems to be equally valid in populations of demented and non-demented.”
One more time, we must reiterate that the Cornell Scale is a screening tool only. It simply indicates whether a senior with dementia is having a depressive episode but does not diagnose them.
Depressive episodes do not necessarily mean one has depression. Everything from hormonal changes to trauma, the death of a loved one or family member, or other major life changes can cause depressive episodes.
So too can mental health disorders outside of depression such as bipolar disorder.
Keeping all that in mind, our takeaway is this.
If you’re concerned enough about the mental health of your senior parent or loved one that you’re considering having them sit down with a clinician for a Cornell Scale assessment, then you should be ready to follow up with a more thorough mental health evaluation.
During this evaluation, your senior parent or loved one could get diagnosed with depression (or another mental health condition) and be prescribed a treatment, be that medication, therapy, or a combination of both.
Even though the senior in your life has dementia, they don’t deserve a quality of life any lower than a senior without dementia. Use the Cornell Scale assessment as a jumping-off point for prioritizing your senior’s mental health!
Conclusion
The Cornell Scale for Depression in Dementia or CSDD is a screening tool created in the late 1980s to identify potential depression in seniors with dementia. The Cornell Scale assesses a senior’s mood, physical health, behavior, thoughts, and cyclic functions to determine if something is amiss.
Since the Cornell Scale can only screen for depression and not diagnose it, your best course of action as an adult child or caretaker is to take your senior to a mental health professional if you’re concerned about their score.
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