P2‐293: IS DEPRESSION REALLY DEPRESSION IN A MEMORY CLINIC? PREVALENCE, SCREENING AND DIAGNOSTIC ISSUES IN NEUROCOGNITIVE DISORDERS

Depression is common in patients presenting to cognitive clinics, but prevalence estimates are varied. While there are many self-report screening tools for depression, there is no clear consensus on the best instruments for this patient population. Data were prospectively collected as part of a larger cohort called the Neurological Disease and Depression Study (NEEDS). Participants were recruited from the cognitive neurology outpatient clinics at the University of Calgary from March 2014 to June 2017. All patients had to have a confirmed diagnosis of subjective cognitive decline, mild cognitive impairment (MCI), or mild or moderate dementia. Patient reported depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9), Hospital Anxiety and Depression Scale (HADS), and Center for Epidemiologic Studies Depression Scale (CES-D). The reference standard was the Structured Clinical Interview for the DSM-IV (SCID). 202 participants completed both the questionnaire and SCID. The point prevalence of major depression in our cohort using the SCID as the gold standard was 12.4% (n=25). The prevalence of depression according to the PHQ-9, HADS-D, and CES-D was 29.8%, 28.4% and 43.3% respectively at traditional cut-points for the general population. The mean MMSE score was 25.5 (n=192) and 13.0 for the MOCA (n=197). At traditional cut-points, all 3 scales performed well in the ROC analysis with all AUC > 80% (Figure 1). The PHQ-9 and HADS performed better at lower cut-point in this population than at the traditional cut-points. The CES-D maintained 100.0% sensitivity from cut-points 13-21, but the cut-points that maintained the best overall accuracy was 18-21. The optimal cut-point of the CES-D in this population is higher than the recommended cut-point in the general population.