The Montgomery-Asberg Depression Rating Scale (MADRS) is commonly used to assess major depression in Parkinson disease (PD), but studies on its utility are few. This study examines the validity and factor structure of MADRS in population with PD.
Methods:
In 104 patients with idiopathic PD, major depression was diagnosed by Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision; DSM-IV-TR) criteria, and all patients were rated by MADRS.
Results:
The MADRS showed good concurrent validity with DSM-IV-TR criteria. The diagnostic cutoff was established as 16/17 (sensitivity 97.43, specificity 100%, positive predictive value 100%, and negative predictive value 98.48%). Factor analysis identified 3 factors, accounting for 76% of total variance: “sadness-anhedonia” comprising apparent sadness, reported sadness, concentration difficulties, lassitude, inability to feel, pessimistic thoughts, and suicidal ideas; “anxiety” with reduced sleep and inner tension; and “vegetative symptoms” with reduced appetite.
Conclusion:
The MADRS has diagnostic utility in major depression in PD. The 3-factor structure of MADRS may help to understand the different dimensions of major depression and identify distinct symptom subgroups in this population.
CummingsJL. Depression and Parkinson’s disease: a review. Am J Psychiatry. 1992;149(4):443–454.
2.
ShulmanLMTabackRLBeanJWeinerWJ. Comorbidity of the nonmotor symptoms of Parkinson’s disease. Mov Disord. 2001;16(3):507–510.
3.
SchragABaronePBrownRG. Depression rating scales in Parkinson’s disease: critique and recommendations. Mov Disord. 2007;22(8):1077–1092.
4.
ReijndersJSLousbergRLeentjensAF. Assessment of depression in Parkinson’s disease: the contribution of somatic symptoms to the clinimetric performance of the Hamilton and Montgomery-Asberg rating scales. J Psychosom Res. 2010;68(6):561–565.
5.
MontgomerySAAsbergM. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382–389.
6.
BrownRGMacCarthyBGothamAMDerGJMarsdenCD. Depression and disability in Parkinson’s disease: a follow-up of 132 cases. Psychol Med. 1988;18(1):49–55.
7.
GothamAMBrownRGMarsdenCD. Depression in Parkinson’s disease: a quantitative and qualitative analysis. J Neurol Neurosurg Psychiatry. 1986;49(4):381–389.
8.
LeentjensAFVerheyFRLousbergRSpitsbergenHWilminkFW. The validity of the Hamilton and Montgomery-Asberg depression rating scales as screening and diagnostic tools for depression in Parkinson’s disease. Int J Geriatr Psychiatry. 2000;15(7):644–649.
9.
SilbermanCDLaksJCapitaoCFRodriguesCSMoreiraIEngelhardtE. Recognizing depression in patients with Parkinson’s disease: accuracy and specificity of two depression rating scale. Arq Neuropsiquiatr. 2006;64(2B):407–411.
10.
SuzukiAAoshimaTFukasawaT. A three-factor model of the MADRS in major depressive disorder. Depress Anxiety. 2005;21(2):95–97.
11.
ParkerRDFlintEPBosworthHBPieperCFSteffensDC. A three-factor analytic model of the MADRS in geriatric depression. Int J Geriatr Psychiatry. 2003;18(1):73–77.
12.
BuneviciusAStaniuteMBrozaitieneJ. Evaluation of depressive symptoms in patients with coronary artery disease using the Montgomery Asberg Depression Rating Scale. Int Clin Psychopharmacol. 2012;27(5):249–255.
13.
AnderssonSKrogstadJMFinsetA. Apathy and depressed mood in acquired brain damage: relationship to lesion localization and psychophysiological reactivity. Psychol Med. 1999;29(2):447–456.
14.
RosnessTABarcaMLEngedalK. Occurrence of depression and its correlates in early onset dementia patients. Int J Geriatr Psychiatry. 2010;25(7):704–711.
15.
GabryelewiczTStyczynskaMPfefferA. Prevalence of major and minor depression in elderly persons with mild cognitive impairment--MADRS factor analysis. Int J Geriatr Psychiatry. 2004;19(12):1168–1172.
16.
KetharanathanTHanwellaRWeerasunderaRde SilvaVA. Major depressive disorder in Parkinson’s disease: a cross-sectional study from Sri Lanka. BMC Psychiatry. 2014;14(1):278.
17.
DanielSELeesAJ. Parkinson’s Disease Society Brain Bank, London: overview and research. J Neural Transm Suppl. 1993;39:165–172.
18.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Vol text rev. 4 ed. Washington, DC: American Psychiatric Association; 2000.
19.
KhanABrodheadAEKoltsRL. Relative sensitivity of the Montgomery-Asberg depression rating scale, the Hamilton depression rating scale and the Clinical Global Impressions rating scale in antidepressant clinical trials: a replication analysis. Int Clin Psychopharmacol. 2004;19(3):157–160.
20.
WilliamsJRHirschESAndersonK. A comparison of nine scales to detect depression in Parkinson disease: which scale to use?Neurology. 2012;78(13):998–1006.
21.
SnaithRPHarropFMNewbyDATealeC. Grade scores of the Montgomery-Asberg Depression and the Clinical Anxiety Scales. Br J Psychiatry. 1986;148:599–601.
22.
KjaergaardMArfwedson WangCEWaterlooKJordeR. A study of the psychometric properties of the Beck Depression Inventory-II, the Montgomery and Asberg Depression Rating Scale, and the Hospital Anxiety and Depression Scale in a sample from a healthy population. Scand J Psychol. 2014;55(1):83–89.
23.
ZimmermanMChelminskiIPosternakM. A review of studies of the Montgomery-Asberg Depression Rating Scale in controls: implications for the definition of remission in treatment studies of depression. Int Clin Psychopharmacol. 2004;19(1):1–7.
24.
MiyasakiJMShannonKVoonV. Practice Parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006;66(7):996–1002.
25.
McDonaldWMRichardIHDeLongMR. Prevalence, etiology, and treatment of depression in Parkinson’s disease. Biol Psychiatry. 2003;54(3):363–375.
26.
ReijndersJSEhrtUWeberWEAarslandDLeentjensAF. A systematic review of prevalence studies of depression in Parkinson’s disease. Mov Disord. 2008;23(2):183–189.
27.
UherRFarmerAMaierW. Measuring depression: comparison and integration of three scales in the GENDEP study. Psychol Med. 2008;38(2):289–300.
28.
HammondMF. Rating depression severity in the elderly physically ill patient: reliability and factor structure of the Hamilton and the Montgomery-Asberg Depression Rating Scales. Int J Geriatr Psychiatry. 1998;13(4):257–261.
29.
QuiltyLCRobinsonJJRollandJPFruytFDRouillonFBagbyRM. The structure of the Montgomery-Asberg depression rating scale over the course of treatment for depression. Int J Methods Psychiatr Res. 2013;22(3):175–184.
30.
GalinowskiALehertP. Structural validity of MADRS during antidepressant treatment. Int Clin Psychopharmacol. 1995;10(3):157–161.
31.
BrownRGLandauSHindleJV. Depression and anxiety related subtypes in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2011;82(7):803–809.
32.
StarksteinSDragovicMJorgeR. Diagnostic criteria for depression in Parkinson’s disease: a study of symptom patterns using latent class analysis. Mov Disord. 2011;26(12):2239–2245.
33.
CalleoJWilliamsJRAmspokerAB. Application of depression rating scales in patients with Parkinson’s disease with and without co-Occurring anxiety. J Parkinsons Dis. 2013;3(4):603–608.
