Ecological Momentary Assessment of Depression in People With Advanced Dementia: Longitudinal Pilot Study

Iulia Niculescu; Hannah Quirt; Twinkle Arora; Terry Borsook; Robin Green; Brett Ford; Andrea Iaboni

doi:10.2196/29021

Ecological Momentary Assessment of Depression in People With Advanced Dementia: Longitudinal Pilot Study

JMIR Aging. 2021 Aug 4;4(3):e29021. doi: 10.2196/29021.

Authors

Iulia Niculescu^{1

2}, Hannah Quirt², Twinkle Arora², Terry Borsook², Robin Green^{1

2

3}, Brett Ford⁴, Andrea Iaboni^{1

2

3}

Affiliations

¹ Department of Rehabilitation Sciences, University of Toronto, Toronto, ON, Canada.
² KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
³ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
⁴ Department of Psychology, University of Toronto, Toronto, ON, Canada.

PMID: 34346884
PMCID: PMC8374663
DOI: 10.2196/29021

Abstract

Background: Barriers to assessing depression in advanced dementia include the presence of informant and patient recall biases. Ecological momentary assessment provides an improved approach for mood assessment by collecting observations in intervals throughout the day, decreasing recall bias, and increasing ecological validity.

Objective: This study aims to evaluate the feasibility, reliability, and validity of the modified 4-item Cornell Scale for Depression in Dementia for Momentary Assessment (mCSDD4-MA) tool to assess depression in patients with advanced dementia.

Methods: A intensive longitudinal pilot study design was used. A total of 12 participants with advanced dementia were enrolled from an inpatient psychogeriatric unit. Participants were assessed using clinical depression assessments at admission and discharge. Research staff recorded observations four times a day for 6 weeks on phones with access to the mCSDD4-MA tool. Descriptive data related to feasibility were reported (ie, completion rates). Statistical models were used to examine the interrater reliability and construct and predictive validity of the data.

Results: Overall, 1923 observations were completed, representing 55.06% (1923/3496) of all rating opportunities with 2 raters and 66.01% (1923/2913) with at least one rater. Moderate interrater reliability was demonstrated for all items, except for lack of interest. Moderate correlations were observed between observers and patient-reported outcomes, where observers reported fewer symptoms relative to participants' self-reports. Several items were associated with and able to predict depression.

Conclusions: The mCSDD4-MA tool was feasible to use, and most items in the tool showed moderate reliability and validity for assessing depression in dementia. Repeated and real-time depression assessment in advanced dementia holds promise for the identification of clinical depression and depressive symptoms.

Keywords: dementia; depression; ecological momentary assessment; tool performance.

©Iulia Niculescu, Hannah Quirt, Twinkle Arora, Terry Borsook, Robin Green, Brett Ford, Andrea Iaboni. Originally published in JMIR Aging (https://aging.jmir.org), 04.08.2021.