Cornell Scale for Depression in Dementia: Cut-off Score
The Cornell Scale for Depression in Dementia (CSDD) uses a cut-off score of ≥6 to detect significant depression in geriatric patients with dementia, with scores ranging from 0 to 38. 1, 2
Scoring Structure and Interpretation
The CSDD is a 19-item clinician-administered instrument where each item is rated: 0 = absent; 1 = mild to intermittent; 2 = severe, yielding a total score range of 0 to 38 (none to maximum depressive symptoms). 1
A score of ≥6 demonstrates optimal sensitivity (93%) and specificity (97%) for detecting depression in dementia populations. 2
The scale maintains its validity across the entire severity spectrum of MCI through dementia, making it particularly well-suited for detecting, tracking progression, and monitoring depression in cognitively impaired patients. 1
Administration Method
The CSDD is administered to both the patient and a care partner/informant, and critically, the patient does not need to be able to answer for the scale to be completed—this is a key advantage over self-report measures in dementia populations. 1
The dual-informant approach (patient interview plus caregiver interview) provides superior reliability compared to single-source assessments, with high interrater reliability (kappa = 0.67-0.74) and internal consistency (coefficient alpha = 0.84-0.98). 3, 4
Comparative Validity in Dementia
The CSDD is superior to the Geriatric Depression Scale (GDS) for patients with dementia. While the GDS loses validity as cognitive impairment worsens, the CSDD retains equal validity in both demented and non-demented populations. 5, 2
In Alzheimer's disease patients, the GDS shows only weak correlations with depression (r = 0.273-0.348) and fails to achieve adequate sensitivity/specificity, whereas the CSDD maintains robust psychometric properties. 5
The Alzheimer's Association specifically recommends the CSDD as one of the complementary behavioral assessment tools for comprehensive evaluation in patients with cognitive impairment and behavioral symptoms. 6
Clinical Context and Prevalence
In memory clinic populations, approximately 37.5% of patients score above 7 on the CSDD, and 14.1% score above 12, indicating substantial prevalence of depressive symptoms in dementia assessments. 7
Factors associated with higher CSDD scores include younger age, greater impairment in activities of daily living (ADL), previous depression history, and dementia types other than Alzheimer's disease. 7