International Psychogeriatrics

Research Article

Validation of Montgomery-Åsberg Rating Scale and Cornell Scale for Depression in Dementia in Brazilian elderly patients

Maria da Glória Portugala1 c1, Evandro Silva Freire Coutinhoa2, Cloyra Almeidaa1, Maria Lage Barcaa1a3, Anne-Brita Knapskoga3, Knut Engedala3 and Jerson Laksa1

a1 Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

a2 National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil

a3 Norwegian Centre for Dementia Research, Centre for Ageing and Health, Department of Geriatric Medicine, Ullevaal University Hospital, Faculty of Medicine, University of Oslo, Norway


Background: There are few studies on validation of depression scales in the elderly in Latin America. This study aimed to assess the validity of Montgomery-Åsberg. Depression Rating Scale (MADRS) and Cornell Scale for Depression in Dementia (CSDD) in Brazilian elderly outpatients.

Methods: A convenience sample of 95 outpatients was diagnosed for dementia and depression according to DSM-IV-TR, ICD-10, and PDC-dAD criteria. Receiver Operating Curves (ROC) were used to calculate the area under the curve (AUC) and to assess MADRS and CSDD cut-offs for each diagnostic criterion.

Results: Dementia was diagnosed in 71 of 95 patients. Depression was diagnosed in 35, 30, and 51 patients by ICD-10, DSM-IV, and PDC-dAD, respectively. MADRS cut-off score of 10 correctly diagnosed 67.4% and 66.3% patients as depressed according to DSM-IV and ICD-10. A cut-off of 9 correctly identified 74.7% by PDC-dAD criteria; a CSDD cut-off score of 13 best recognized depression according to DSM-IV and ICD-10. A score of 11 diagnosed depression according to PDC-dAD, while MADRS = 9 recognized depression in dementia. CSDD was more efficient in showing depression in mild than in moderate/severe dementia according to DSM-IV/ICD-10. PDC-dAD behaved nicely for any severity stage.

Conclusion: MADRS and CSDD cut-offs of 10 and 13 were the optimal ones to diagnose depression in elderly, respectively. CSDD cut-offs are higher than those found in other countries. Other Latin American studies are needed to compare results with our study.

(Received June 22 2011)

(Revised August 17 2011)

(Revised September 16 2011)

(Accepted September 28 2011)

(Online publication December 20 2011)


c1 Correspondence should be addressed to: Maria da Glória Portugal, Center for Alzheimer's Disease, Institute of Psychiatry, Federal University of Rio de Janeiro, Av. Nossa Senhora de Copacabana, 680/314, Bairro Copacabana, 22050-001, Rio de Janeiro- RJ, Brazil. Phone: +55 21 2255 3454; Fax: +55 21 2235 6320. Email: