Perceptions of depression among dementia caregivers: findings from the CATIE-AD trial

For patients with Alzheimer's disease complicated by behavioral disturbances, to use single questions about perceived depression and assess patient and caregiver accuracy in recognizing patient depression.

Cross-sectional interviews from the Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer's Disease (CATIE-AD). Patients were asked 'Do you believe you are depressed?' Caregivers were asked 'Do you believe the patient is depressed?' and 'Do you believe you (caregiver) are depressed?' These responses were compared to the patient's score on the Cornell Scale for Depression in Dementia (CSDD), and to the caregiver's score on the Beck Depression Inventory (BDI) using screening test characteristics.

Two hundred fifty-seven total patient/caregiver pairs were evaluated. Patients had a mean age of 78 years, were mainly female, white, and had a mean Mini-Mental State Examination Score of 15. Caregivers were on average 63 years old, and were mostly spouses or children. 37% of patients had depression (CSDD ≥ 12). Patients recognized their own depression with a sensitivity of 0.26 (CI: 0.18, 0.37) and specificity of 0.85 (0.79, 0.90). Caregivers' accuracy in recognizing depression in the patient revealed a sensitivity of 0.65 (C.I.: 0.55, 0.75) and specificity of 0.58 (CI: 0.50, 0.66). Twelve per cent of caregivers were depressed, and caregiver burden was associated with patient depression.

Clinically significant depression was common, and asking a single question to the patient about depression failed to detect most cases. Caregivers identified two-thirds of patient depression when asked this one question. Caregiver depression and perceived burden were associated with patient depression.