Objective: Previous work by ourselves and others indicates that the Delayed Word Recall (DWR) test is highly accurate in distinguishing mild to moderate depression from very mild Alzheimer’s disease (AD), but less so when the severity of depression is moderate to severe (see Coen et al 1998, Psych Med, 28, 495-496). Strong mood congruence effects have been reported in depression, such that depressed individuals tend to better recall more negative words. We modified the DWR test by using negatively valanced words (DWR-neg) instead of neutral words, and investigated the extent to which this increased accuracy in distinguishing depression from Alzheimer’s disease.
Design: Cross-sectional.
Materials and Methods: There were three age-matched groups: depressed (n=18), Alzheimer’s disease (n=18), normal elderly (n=17). Among other tests, these groups were administered the DWR and DWR-neg (order counterbalanced).
Results:
17 item HAM-D: depressed = 18.5±4.25, AD = 3.33±1.85, Control = 3.18±2.55. MMSE: depressed = 27.0±2.61, AD = 22.00±2.93, Control = 27.82±1.85. The DWR test correctly classified all ADs and controls, but misclassified 6/18 depressed cases. The DWR-neg correctly classified all ADs, controls and depressed cases. Conclusion: The DWR-neg was superior to the standard DWR test in discriminating depressed cases from Alzheimer’s disease, and both tests were superior to other widely used tests (Anomalous Sentences repetition Test, Kendrick Tests, Clock Drawing, MMSE). It remains to be seen how well the DWR-neg would perform in cases of severe depression. Clinical acceptability is also an issue as the strong negative valance evokes an oppressive atmosphere which could be counterproductive in assessment.
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